Every cloud

2014-03-24 07.10.58

(a view of the hospital on my way to work in the morning)

It has been a while since my last post but I figured I would wait a while until I had got into the swing of starting placement before I started rambling.

So Is it what expected?

No

When I was choosing which country I wanted to apply to for the Erasmus I choose Norway primarily because it offered acute and emergency placements. This to me says very medically/surgically ill patients and a fast working environment along with pressure and a high demand for the workforce to be on its toes. I like that, and I thrive off of it. So it was natural decision.

The reality…

On OBA (translates as the acute treatment and observation ward) It is safe to say that there is a much slower pace of things over here. However, I do not necessarily put that down to the nurses working at a slower place, there is simply far more of them per patient than there is here. 1-4 in the daytime at most and at night it may increase to around 1-8. The majority of the patients are self caring and I have needed to do very little to no personal care at all. Something I confess to missing. The ratio is great and I have rarely if ever so far seen a nurse pushed for time or attention with their patients. I am simply just not used to it.

The one thing that has surprised me which I did not foresee as being as much of an issue as it has turned out to be initially was that of the language barrier. Don’t get me wrong, a lot of the staff speak English and my mentor is fantastic for translating notes for me and helping to me to understand doctors rounds, however it is the huge barrier with patients that it has thrown up. Looking back I am not really quite sure what I expected, there are some patients who can speak English, if they are under the age of 50 then you have a good chance of being able to have a conversation. But, generally I feel like a bystander in patients care, unable to get fully involved because I cannot explain things to them independently without a translator and if I can see a patient is very distressed or unhappy it is much harder for me to try and alleviate that. It has frustrated me hugely and for me it feels like I am unable to care ‘properly’ for people. An interesting discovery as it made me think what caring for someone actually meant to me and what it entailed. My independence in my eyes as practitioner has also taken a slight nose dive.

This particular discovery has made me look at communication in the way the universities always want to try and get through to you but never quite manage with the endless communication lectures and essays, because until you are in a situation where you cannot verbally communicate, only then do you realise its significance, value and presence in the care of patients. Or so this is my opinion anyway. I had certainly taken for granted how much I relied and invested in this within my own practice.

The communication barrier also through up another interesting discovery for myself. I very quickly learnt that I do not like not being able to understand and interpret my environment. It is the most unnerving experience. Patient notes, posters, signs, doctors rounds, general chit chat and conversion in the staff room, a complete mystery without the aid of someone to translate or google at your disposal. I have no shame in admitting that I found this really hard to deal with. It is incredibly isolating. However, for the first time I was able to feel what it was like for those patients that I have cared for that do not have any understanding of their environment or who cannot communicate, dementia and stroke patients among others came to my mind. It is frightening and I have gained at least some empathy with this that I didnt not foresee arising. With this realisation came a note of sadness as well, as I appreciated the loneliness of the situation. With this knowledge now in hand which I endeavor to take with me when I return to the UK, I hope and intend to improve my own practice care for those patients were communication is a barrier.

That aside, one of the other mot notable things that I experienced so far is the amount of mental health nursing that is required here. Unbeknown to me when I arrived, OBA is actually the designated ward for anyone who has attempted suicide or has simply drunken way to much alcohol and has needed to be hospitalised. And it is unfortunate to say that is is a very frequent occurrence. The amount of people coming through the doors with paracetamol overdoses and other means of attempted life taking is heartbreaking. There is rarely time I walk onto the ward and do not see some one being put in line of sight because they are at risk, and the ward itself is usually at least a quarter full of alcohol intoxication. I myself have had to sit within line of sight of someone on varies occasions. My exposure to mental health within my own practice so far has been very limited as we are not given a specific mental health placement, so I am taking this one as so. I have asked the nursing staff why they think there is such a problem with suicide and alcohol and they have said that generally they feel its down the the pressure from society to make something of yourself and be successful. The high cost of living is an added pressure. Patients will get transferred to OBA as well from the psychiatric ward if it is suspected that there is also something more significant medically wrong with them like a heart condition which needs investigation or monitoring. Patients with personality disorders and bipolar again among others will be brought over and the nursing staff will need to care of them as well. Something in this situation which does make the nursing care easier is that face that nurses are trained generally here. And that means they have specific mental health training in their undergraduate years which equips them far better to be able to cope and care for these patients than if it was the UK (granted that may be a matter of opinion). I have always felt that undergraduate nurse training needs to have more varied scope of placements to include in particular mental health as a mandatory component. I do not see where I would have got the exposure and experience of working within mental health if I had not come here. With its prevalence in our own society, I do not see how it can be excluded. This I have to say is not a generic situation as I believe there are some universities which do give their ‘adult’ nursing students mental health experience.

So despite this so far not being what I had anticipated or expected, and feeling somewhat a few hundred miles outside of my own comfort zone, every cloud has a silver lining and I am readjusting my outlook. This Erasmus is bringing me a lot more personal challenges that I had predicted.

A nurse educational structure breakdown & and In other news I miss the price of bananas in the UK


DSC00075

(I Found these outside a toy shop, couldn’t help but find them entertaining)

Despite the expense, slight location isolation (still missing my four wheels) and that people just don’t seem to smile around here (going for  run, you nod acknowledge say good morning, etc…nothing, blank stare through..) this place is beautiful and I have never experienced cars stopping so far in advance for you to cross the road. We are talking you just have to be near a crossing or even look at it and they will stop. That never happens in the UK.

The week just gone did allow me to have a meeting with our academic link here at the University of Stavanger (UiS) and I was able to gain some enlightenment on the structure and general situation for nursing here in Stavanger.

Student nurses here at UiS (which I have discovered is a common thing in Norway generally) train as general nurses. They do not specialise unless they take on a masters. There are no specific adult, child, mental health or learning disability nurses training at an undergraduate level.

Their placement and theory time like ours is split 50/50 and they have placements in throughout their three years. They have one placement in there first year in which all students go to a nursing home. Students do not enter a hospital environment until there second year, where, continuing into there third year, they undertake placements in medical, surgical, community and mental health settings. Unlike our system they do not have anything that resembles a management placement. The end of their third year consists of them carrying out their thesis (dissertation) and then going on a six week elective. This I found a very interesting deviation, as up until this point we share many similarities in the structure of our training to Norway. This has brought me to think thus far, that, in this instance, student nurses in the UK are prepared and exposed to a far greater amount of leadership and management training and experience than our Norwegien counterparts. What will be very interesting to see is if this has any reflection in practice. I also hope to find out when I have a greater exposure in practice, to understand why that is.

I mentioned that we are similar in our training structure. This is the case, however one other element which does deviate slightly is that their theory and practice assessments are given the same weight as each other. In the UK, and in Nottingham I can only directly relate this, our placement grading makes up a far smaller proportion of our final grade. This also only came in in the year I started my training (2012), as until then, your performance in practice held no direct influence over your final grading. Personally, I prefer this over the current system we have. I feel that your ability and performance in practice should count for a far greater amount in your degree than it currently does. To give an example, each semester at UiS you get 20 ETC (European Transfer Credits though it goes up to 30 in the third year), and a practice block is weighted at 10 ECTs the same as a theory block.

The students here at UiS have a similar work load when it comes to assessment, however, what is most obvious from the offset is that exams are used more frequently. I tend to feel that we have death by written assignment, and that a more balanced way of assessing students would not go amiss.

Nurse education here in Norway is potentially undergoing a radical change. At present there is a national curriculum set, a bit like the NMC sets in the UK, which every institution has to follow. There is a greater North and South divide in Norway, with Northern areas and districts (those outside of a main city) not having the full range of services on offer. With Norway being a much larger and longer country than the UK, things here are very spread out and the current thinking is that the curriculum is to strict, and instead, to hand over control of the curriculum to individual universities and colleges. There would still be a minimum standard set, but it would be far more flexible. I can see the benefits of doing this, however, I can see that this might produce a much greater variance in the experiences and abilities of nurses on qualifying. How do you govern and ensure that patient care is going to be of a high standard from nurses no matter where they have trained, if the educational standards and training are not on an equal footing?

I could go into a list of the clinical skills students get taught/are expected to be able to perform, but I am currently still wading through the pack which details them. Trying to decipher the differences and understand the system may be something I get a greater understanding off in practice. Plus I would really like to get mentors and qualified nurses opinions here about where they think about the the diversity, amount and importance of those clinical skills taught. 

I will leave you with a nice little statistic which has become one of the most obvious things I have noticed since I have been here. People generally are of of a slim disposition. Despite the rates for men and women regarding being overweight or obese on the rise, they currently only sit at about 21% for women and 33% for men (Statistics Norway, 2013). Compare this to the UK where 57% of women and 67% of men are overweight or obese (Public Health England, 2o14). Now that is quite a contrast. To be honest, you can rarely go out anywhere without seeing people out walking/running/or pavement skiing (no I am not joking, think wheels on the bottom of skis and then just push yourself along). It will be interesting to see the rates of diabetes and cardiovascular conditions here compared to that of the UK. I really cannot wait to start in practice. I have a feeling there are going to be some massive contrasts (I have already been tipped off about the lack of paper work compared to the UK, this excites me).