Smiles went a long way at St. Jozef’s Nursing Home in Antwerp. I volunteered there for two weeks from 8am to 2pm. With three months of post IGCSE holiday ahead to decided to give a little something back to the community. As a volunteer I helped with the meals, bath giving, at nap times and with the wheelchair. Apart from making perfect sandwiches it was a chance to practice my Dutch and get some work experience. Navigating my way through a flurry of ‘goedemorgens’, I sought the person who would start me on my epic adventure that would hopefully end with me becoming a doctor.
On the first day of work I met the Head Nurse. She told me that she is normally removed form the practical aspect of nursing and instead focuses on the paperwork side of things such as record keeping and quality control. She introduced me to Wendy one of the four nurses who work on a permanent basis at the Home.
Wendy pays a visit to one of the residents with me tagging along. She informs me that this particular lady had fallen and fractured her hip. Wendy administers a fraxiparine injection on the lady’s abdomen. It is a blood thinning injection. The fall had scared the woman so much that she refused to leave her bed post-surgery. This inactivity could lead to hypercoagulation. Excessive clotting of blood or ‘thick blood’ can lead to strokes and cardiac arrest that’s why blood thinning injection was so important. Additionally, lady’s immobile state had resulted in her developing respiratory problems due to the settling of mucus (in the lungs) and the build up of dirt and disease.
I also helped Wendy dress a bed sore also known as a pressure sore or decubitus ulcer. The ulcer develops due to an interference with blood circulation at a particular place. Cells die aren’t replaced due to the lack of nutrients from the blood. They normally occur where there is a bony prominence for example the elbow, shoulder, heel, hip or lower back (sacrum). They are a common problem at hospitals where people are bed ridden or confined to wheelchairs and many parts of their body constantly feel pressure. Also patients are forcibly dressed and their sheets pulled from under them, this friction force further irritates the skin. Bedsores are incredibly painful and if not attended to the ulcer could reach the bone. Fortunately, this affliction is quite rare at St.Jozef. This particular lady had developed a sore on her heel, she is unable to move independently and relies entirely on healthcare worker pushing her wheelchair. Wendy begins by fixing a thick silican foam pad on the heel. There is opening/hole in middle where the sore lies. By raising the area around the wound, pressure and therefore pain is relieved. Gel is then applied to a swab and the swab is placed on the wound. Her foot was then wrapped with a cloth bandage to keep everything secure.
A bladder rinse or irrigation is something else that I witnessed. The procedure is needed to prevent things such as urinary tract infections which could lead to other problems like sepsis. Infections are quite common in elderly people as they become less able to excrete waste efficiently, in fact women are more susceptible to them than men and accordingly It was a woman who needed the bladder rinse. Although warned, her fluid intake remained low. A catheter was placed up the urethra and water was drained into the bladder. The procedure is sometimes carried out using saline, aminoacetic acid, or antiseptic solution instead. Urine and other waste were flushed out. After the catheter was removed an antibiotic injection was administered to her lower back. The lady has a bladder rinse twice a week.
Other, less, treatable conditions that some of the inhabitants of the Nursing Home had included Parkinson‘s and Alzheimer’s Disease. I’ve learnt that Parkinson Disease is the second most common neurodegenerative disorder and greatly affects an individual’s motor skills. Stiffness is symptom of the disorder and those worst affected at the Home were almost paralysed. Mechanical lifts were used to get ladies out of bed and into wheelchairs and vice-versa. Additionally bathtubs were fixed with mechanical seats that were adjustable. But the technology didn’t take all the pain away, even as a healthcare worker extended a lady’s arm she groaned with the pain. Alzheimer’s is another neurological disease that affects the brain. Ladies were affected by Alzheimer’s at different scales. Some would lose their train of though and forget what they were talking about or where they were going. After spending a half hour looking for a nonexistent inhaler, I found this fact difficult to manage. I didn’t want to ignore the ladies’ mutterings in case something pertinent did come up. Luckily, I had more experienced workers with me who knew exactly who needed what and I soon learnt. The chronic Dementia sufferers were quieter, they didn’t speak much, some couldn’t. There were however occasional bursts of laughter, some smiles as well as some tears. These ladies slept in secured sleeping bags to ensure they wouldn’t hurt themselves by rolling into the bed rails.
Both Parkinson’s and Alzheimer’s have no current cure. With an aging population, increasing numbers of people are diagnosed with the diseases, making the fact even more painful. Thankfully, some medication is available. These however only alleviate the symptoms. At St.Jozef a large part of the nurses job include sorting out pills; the right amount for the right people at the right time. There were a lot of pills for blood pressure, blood thinning, blood glucose levels and pills with vitamin supplements and calcium. Insulin shots were also given to those with diabetes who needed it. I was taught how check blood glucose levels. First a prick to a thumb or finger, then the blood is taken up by a handheld that gives you a value in mg/dL. Each person needs a different amount of insulin, so I adjusted the pen appropriately and then handed it over to the nurse (you need to be certified to administer it ) who pricked an arm or thigh.
A ‘status report’ for every inhabitant is written every evening by a healthcare worker. These reports are consulted by a General Practitioner who comes to the Nursing home twice a week. I was able to follow the doctor on his rounds. The doctor pays regular visits to the people to have the severe disorders. He carries out a general check up. He listened to their breathing with a stethoscope; he used a pulse oximeter to measure heart rate and oxygen percentage in the blood as well as a sphygmomanometer for blood pressure. After that he asks his patients how they are feeling and if they have any unusual aches or pains. I realised that communication between the doctor and patient was extremely important. However talking loudly and slowly had its limits. Communicating in any way with patients with severe Dementia was near impossible. The doctor had to speak to the nurses and healthcare workers and consult the now vital ‘reports’ to make sure his patient was eating, drinking and generally behaving normally. It hit me here, just how essential teamwork is to healthcare in general, whether it be patient-doctor or doctor-nurse co-operation.
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