My Nursing Thesis Published!

September, 1998 – New England, USA

After I completed my thesis in graduate school, my advisers encouraged me to submit an article summarizing my research findings for publication. The unwieldy title of my thesis was, “Coping Strategies of Successful Caregivers of Nonambulatory Family Members”. Nonambulatory means that the person is unable to walk.

My parents and one of my patients that I had followed as a visiting nurse inspired me to do the research. After my mother had a major stroke which left her paralyzed on one side and with the mind of a ten year old, my dad stepped up to the plate and cheerfully became her full time caregiver. He had to assist her in the shower, dress her, learn to style her hair, do the grocery shopping, cooking, driving, and pay the bills. Prior to her stroke, my mother was an avid artist and gardener. She grieved that she could no longer do these hobbies. The Lord took her home to heaven to be with Him five years after her stroke. I thanked God that she was no longer suffering.

“…Death is swallowed up in victory….But thanks be to God, who giveth us the victory through our Lord Jesus Christ.” I Corinthians 15:54, 57

My parents were my inspiration for my research.

Another patient I visited at home was an elderly lady who was paralyzed from the waist down from a blood clot that went to her spine. Her husband faithfully learned how to provide all her care and purchased a van equipped with a wheel chair lift. He struggled at times with sadness over his wife’s loss of many abilities, but he did all the household tasks and driving. Other patients with similar disabilities ended up being admitted to a nursing home because their caregiver simply couldn’t cope with all the extra responsibilities.

During my research, I interviewed nine caregivers of family members who were unable to walk and then summarized their problems and coping strategies. I repeated similar research that was done with caregivers of home hospice patients to see if they had the same problems and used the same or different coping strategies. Comparison of the two groups showed they only had one problem in common (stress) and three coping strategies (social support, cognitive reformulation, and respite). I developed an educational handout for nurses to give new caregivers of family members who were unable to walk.

I submitted my research article to The Nurse Practitioner journal and was thrilled when they accepted part of it for publication.  They condensed my year of research and 48 page thesis into THREE paragraphs. Such is the world of publishing… They included it under Practice Pointers and named it Lending a hand to caregivers.

If you need to counsel a caregiver of a family member who has recently lost the ability to walk, use these suggestions to ease the load. First, tell him not to try to give care alone, but to ask for and accept help from family, friends, and health care professionals. To relieve stress, suggest that he try exercise, massage, eating out, music, prayer, reading, and napping.

Make sure he asks a physical therapist for assistance in choosing a wheelchair, if his family member can use one. Suggest using cordless and cellular phones, a lifeline necklace, and a pager to communicate with his loved ones when the caregiver is out of the house.

Finally, when traveling, recommend the caregiver pack a travel kit with a list of medications, provider phone numbers, straws, wipes, and other supplies.”

Reflection

I can’t recall the last time I saw a lay person use a pager, and cordless land lines are disappearing rapidly. Cell phones are commonplace now, but they were rare in 1998.

After I entered the full time work world as a nurse practitioner, life seemed to become too busy to continue to do research. However, I have participated in the Nurse’s Health Study 2 since 1989 conducted by the Harvard School of Public Health. Their findings collected from surveys every two years of thousands of nurses have contributed significantly to women’s health. http://nurseshealthstudy.org If you are a nurse and you were born after 1964 and live in the USA, they are looking for participants to join Nurse’s Health Study 3. I hope you will do so and continue this wonderful research that was begun in 1979!

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The Final School Year

September, 1997

I completed my one on one research course this summer with the Director of the Nurse Practitioner program, Dr. K. I learned about the different types of research broken into two broad categories of quantitative and qualitative research. Our small school does not have the staff to support doing quantitative research with labs and statistics, so I have chosen to do qualitative grounded theory research. The topic I chose is “Coping Strategies of Caregivers of Non-Ambulatory Patients”. I know it’s a mouthful!

I chose this topic largely because of my observation of how wonderfully my Dad took care of my Mom after her massive stroke. She learned to walk again slowly with a quad cane, but her left arm remained paralyzed, so he had to help her with her bath, dressing, and style her hair. I thought it was so sweet of him when he took Mom to the beautician and asked her to teach him how to use a curling iron! I don’t know of too many men who would do that. He also did all the cooking, cleaning, driving, and grocery shopping. My Mom became his full time job which he did the last five years of her life. Thankfully, he was retired and in good health. He also traveled with her by plane and in their trailer home across the country on vacation.

During my years as a visiting nurse, I took care of a dear elderly couple. Ruth had a blood clot that went to her spine and left her paralyzed from the waist down at the age of 70. Her husband, Ray, learned to do everything for her much as my dad did, and bought a van equipped with a wheelchair lift to make it easier to transport her.

Most caregivers at home are women rather than men, so I think Ray and my Dad were the exceptions. Most people would have placed people like Ruth and my Mom in a nursing home because they simply could not provide 24/7 care for them. So I asked myself, how did people cope at home with providing care for a family member who cannot walk? I noticed that when a person can’t walk, their care could become totally overwhelming.

I completed my review of literature and found an oncology nursing study with a similar theme, so I will repeat it to see if I get the same results. At the Master’s level, we are not required to do original research, but only repeat what others have done to see if we get the same results. My proposal was approved by  my two thesis advisors. My goal this semester is to find caregivers to interview and tape record them to gather all my data. Next semester, I will analyze the data and write my thesis. It was so nice to concentrate on nothing but research this summer and not have to work full time! I thank God for my Dad’s financial support to make this possible.

January, 1998

Last semester was very busy, but I really enjoyed it. My clinical assignments were so interesting as I spent two full days a week working in an Internal Medicine office with two physicians. Dr. R. established his private practice about 20 years ago. He grew up in Costa Rica, so he is fluent in Spanish. He moved to the USA when he was 16 years old, but still returns to Costa Rica annually to visit family there. He is a very kind gentleman and an excellent teacher. He just hired an associate, Dr. G., who recently completed his residency. Dr. G. likes to tell me all kinds of interesting stories about patients he saw during his residency. I see the patient first and take the history and do the physical exam. Then I present the patient privately to Dr. R. or Dr. G. and tell them the plan of care that I think would be best. We discuss it and they agree or disagree with me and tell me their reason so I learn how to treat the next patient with a similar problem. It is working out very well!

One day, a lady who was originally from Jamaica, came to see us in near hysteria. She had coughed up a foot long worm that she put in a bottle of water to show us. I immediately recognized it as a round worm which I had learned about when I was in Dominican Republic. She last visited Jamaica two years ago, so it had been growing inside her all that time. Neither Dr. R. or Dr. G. had ever treated worms before, so I told them the medicine to prescribe and calmed the lady after telling her we could easily treat it. She thanked me and said she felt relieved to learn about it. It was fun to teach the teachers that day!

On my third clinical day, I worked several weeks in a clinic seeing adolescents with a Pediatric NP. Rich was also an excellent teacher. The other half of the semester, I shadowed a Neonatal Intensive Care NP. I was too scared to touch the premature babies who looked so tiny and fragile in the incubators on ventilators. I watched her do a lumbar puncture on one of them where she stuck a needle gently in his spine to withdraw cerebral spinal fluid. I also watched her work in a general Pediatrician’s office. I’m just not too comfortable taking care of babies because they can’t tell me what’s wrong!

I found enough caregivers to interview for my research. I tape recorded each session, then took the tapes home and played them back. Whenever the person stated a coping strategy, I stopped the tape and wrote it on an index card. After listening to all the interviews, I took all my cards and separated them into different piles of coping strategies that were repeated. I’m really enjoying doing this type of research!

Graduation, May, 1998!!!

I completed typing my thesis and both my advisors approved the final copy. It was 120 pages long! I am so glad I didn’t have to hire someone to type it, and am thankful for my high school typing teacher. We each made a poster about our research results and presented it a week ago. All my preceptors came to look at it, so I was grateful for their support. I submitted a summary of my research to the Nurse Practitioner Journal, so I will see if it is accepted.

I am amazed that I have had ten job interviews. The job I chose is to work as a Family Nurse Practitioner at a psychiatric hospital. I have never worked in psychiatry before. I will have all weekends and holidays off, and  don’t have to take call at night since a physician stays on grounds each night. The salary is excellent, so maybe I will be able to move to a one story home in the future.

 

1998 Pam MSN

I was so excited to finally receive my Master’s of Science in Nursing and become a Family Nurse Practitioner!

I thank God that my entire family came to my graduation to help me celebrate. I dedicated my thesis to my Dad and read it to them with my theme verses for graduate school:

I can do all things through Christ who strengthens me….But my God shall supply all your needs according to His riches in glory in Christ Jesus! Philippians 4:13, 19.

The school placed a copy of each graduate student’s thesis in the school library for others to read.

Reflection

How I thank God for carrying me through four long years of graduate school. I know I only had the strength to complete it because of Him. I enjoyed working as a Nurse Practitioner in a variety of roles over the next 16 years.

The Nurse Practitioner Journal published a few paragraphs about my research. As I recall, the caregivers that did best were those who used wheels to help transport the patient, took respite from care, and recruited/accepted help from others. My thesis is currently in storage, so the next time I look at it, I will see if my memory is accurate:)

 

 

 

 

Continue Graduate School or Drop Out?

April 19, 1997

Show me Thy ways, O Lord, teach me Thy paths. Psalm 25:4

I am seriously debating whether or not I should continue with graduate school. They are raising the tuition to $380 per semester credit hour, and I have 29 hours to go to complete my Master’s of Science in Nursing, so it will cost me $10,000 to finish. It will take me about three more years to complete and I have already been taking two courses each semester while working full time as a visiting nurse. I am just so weary of it all.

Psalm 25:4 was my prayer which God answered wonderfully!

Psalm 25:4 was my prayer which God answered wonderfully!

Then I read in a nursing journal that they are producing too many Nurse Practitioners (NPs), and that the new graduates are having great difficulty in finding a job. By the year 2000, there will be a glut of 30,000 NPs. I recently spent the afternoon for my clinical rotation with a school NP at the community health center. There was a middle school girl on drugs and so many other kids on antidepressants, etc. At the clinic, there were many pregnant unwed teens who have already had several abortions and sexually transmitted diseases. I don’t think I want to work with that population. A NP came and spoke to our graduate school class this semester, and she is working all kinds of strange hours in the Emergency Department of a local hospital.

After that lecture, my job as a visiting nurse with the elderly seems like an excellent place to work! I work 8 am to 4 pm Monday through Friday, ten weekends, and one holiday each year which isn’t too bad for nursing. The pay isn’t great, but I could pick up some extra Saturdays here and there to make some extra money. The VNA office is only one mile from my house and my territory is so beautiful in rural New England. I am able to come home and finish my charting in the afternoon if we don’t have any meetings at the office. Now that my knee feels better after surgery, maybe I can remain in this old three story house a while longer. I think I’ll make a few more phone calls on Monday after reviewing the job section in the Sunday newspaper. It is so good to rest in the Lord and let Him show me the way!

May 24, 1997

“In the day when I cried, Thou answered me, and strengthened me with strength in my soul.” Psalm 138:3

“For as the heavens are higher than the earth, so are My ways higher than your ways, and My thoughts than your thoughts.” Isaiah 55:9

The Lord has answered prayer in such a marvelous way concerning school since I last wrote on April 19! Last Thursday, my Dad called me and said he wanted to support me financially so I could quit my job and go to school full time and finish my degree. He asked me to send him my monthly budget to cover my expenses. I met with Dr. K., the Dean of the graduate program and she was so excited for me! We worked out my schedule so I can graduate next May. Because I missed the research course last semester, she is teaching me individually this summer for two hours weekly so I can catch up.  I thank my heavenly Father for moving the heart of my unsaved earthly father to help me out in this way, as I never asked my Dad for any financial support. I’m still in shock as to how wonderfully the Lord worked this out, way above what I could ask or think. I thank God for making my path so clear. One of my advisors at school said I definitely should not drop out as she thinks I will make a wonderful Nurse Practitioner, so her encouragement was much appreciated.

My final day as a visiting nurse is June 10. It is hard to believe that I have worked there for five years. It is tough to say goodbye to some of my monthly patients who I have known for five years. Some of them are like grandparents to me. I really hate goodbyes!

Reflection

And so the Lord made the way open for me to continue in graduate school and finish in four years rather than six years. In the fall, Dr. K. told the five of us who were full time students that the school had received a grant from the USA government that would cover our entire tuition and books for both semesters! The government says there is a shortage of NPs, so this is their way of graduating NPs more quickly. Because it was a grant, and not a loan, I graduated debt free which was a huge blessing. The tuition for the previous three years of part time courses had been reimbursed to me at the end of each semester by the Visiting Nurse Association. They did not require me to work for them as a NP after receiving my MSN as many organizations do today.

The prediction in the nursing journal of a glut of NPs never materialized as far as I recall. I never had any trouble finding a job as a NP. In fact, I have been inundated with job recruiters my entire career with a multitude of NP openings. In fact, I received a phone call earlier today from a job recruiter even though I told her last month I am not interested in a NP job at this time. Nursing is still a good career for job security in my opinion! There will always be sick people to take care of no matter what the economy is like.

Rejection and Sorrow

April, 1995

My interview for graduate school seemed to go well. I will learn next week whether or not I am accepted, so the waiting which began last September is almost over! I hope the fact that I did well in my first two courses at the State University will help with my admission. But the competition is very strong with hundreds of nurses applying for only 15 positions.

May, 1995

I received my letter today from the State University, and I was not accepted. They invited me to apply again next year, because they just don’t have room. It was quite a blow and a shock, and I feel like a total failure. It’s kind of like preparing for the big game for nine months and then being thrown off the team or having the big game cancelled. I guess I thought that since I will probably never marry, I could at least work on my career, but that door appears closed also. I haven’t had the courage to tell my parents or sister yet. I cried all day yesterday and today. I asked God to comfort me and show me what He wants me to do now.

“Make haste, O God, to deliver me; make haste to help me, O Lord.” Psalm 70:1

July, 1995

I attended a Bible seminar with ladies from church a few days after I received my rejection letter. One lady suggested I search for other MSN programs that offer the Nurse Practitioner tract. I discovered a small private college that is a shorter drive than the State University and is just starting a Family Nurse Practitioner program. I have not had any pediatric experience since I received my BSN other than volunteer camp nursing, but I guess I could learn about it again. I decided to apply and I should learn in August whether or not they accept me. If they do, they will allow me to transfer my two courses I completed at the State University, so those courses would not be wasted. I should be able to complete my Master’s of Science in Nursing degree (MSN) in three years by taking two courses in the evening each semester while continuing to work full-time as a visiting nurse. My employer will continue to reimburse me my tuition for up to two courses a semester as long as I receive an A or B grade. The price per course hour is the same as the State University. Right now, I feel like all the ambition for school has disappeared, so I really don’t care one way or the other.

Dear Lord, Please make my heart right concerning school if You want me to continue to study for my MSN. Amen.

I also finished an intense Spanish course at the local community college with an emphasis in medical Spanish. Some folks at church are fluent in Spanish, so they let me practice talking with them which was helpful.

September 30, 1995

So much has happened since July. I was accepted at the College into the Family Nurse Practitioner program. My brother was married on August 20 which my parents were able to attend. My mother’s cancer spread to her liver last January, but her dying wish was to attend my brother’s wedding. It was sad to see her barely able to sit up in her wheelchair. It was bittersweet to say goodby to her on what is normally a happy occasion. My parents flew back to Florida where she died at home on August 28. I flew to her funeral and then started school as soon as I returned to New England. Some nights I can’t sleep and cry for several hours. These feelings are so strange with the sorrow of missing her and yet joy in knowing that she is home with the Lord, rejoicing in Him, and free of her old broken body. I miss hearing her voice and talking with her on the phone.

I was accepted into the MSN program at a small private college.

I was accepted into the MSN program at a small private college.

I started school the week after Mom died. I wasn’t sure I could concentrate enough because of my grief, but somehow, God is giving me the strength and concentration. I like it much better than the State University. I am taking graduate level statistics and have a wonderful instructor who makes it very clear. Hopefully, I won’t fall asleep in statistics class this time like I did 22 years ago when I took it for my BSN! We are also having to solve problems on the computer with a 5 inch floppy disc that corresponds to our textbook. I am thankful for my personal computer at home so I don’t have to do all my homework on campus.

January 1, 1996

“That I may know Him, and the power of His resurrection, and the fellowship of His sufferings, being made conformable unto His death…I follow after.” Philippians 3: 10,12. “Man of sorrows, and acquainted with grief.” Isaiah 53:3. “The Lord is near unto those who are of a broken heart….None of them who trust in Him shall be desolate.”  Psalm 34:18, 22

As I reflect on 1995, I believe it was my year to become acquainted with sorrow. It was one year ago yesterday that Mom found out her cancer had spread to her liver. I thank God for the work He has done in my heart this past year through my new friend, Sorrow. It is an acquaintance I would not have chosen voluntarily, but God chose this friend for me to press me closer to His heart and make me more sensitive to others who are sorrowing.

I thank God for helping me complete my two courses in graduate school with good grades. I was amazed that I received one of the highest grades in Statistics, my old foe. That was purely by the grace of God for which I praise Him!

God helped me conquer my old foe, Statistics, in graduate school!

God helped me conquer my old foe, Statistics, in graduate school!

I also met with the Dean and found out it will take me four more years of attending school part-time before I can complete my MSN degree.  I have now completed three semesters. I’m not sure I have the strength and ambition to attend eight more semesters, so I guess I will just take it one semester at a time and trust the Lord. I am claiming God’s promise in Psalm 84:11.

Psalm 84-11

Dear Lord, I commit this New Year to You. Cause me to know You better and follow You. Amen.

Reflection

So ended my year of rejection, acceptance, and sorrow. It was a challenging year, but I have learned since then that God seems to use the most difficult times in my life to cause me to lean harder on Him. I grow in His grace as I experience His loving kindness and strength in a new and deeper way. I pray you may be encouraged to draw near to Him if you are going through such a time as this today.

 

Transcultural Nursing Course – Dominican Republic – Part 4

Transcultural Nursing Course – Dominican Republic – Part 4

January, 1995

Over the next few days, I was assigned to work in the Mennonite clinic which was hosting us in nice motel-like rooms. I watched Dr Nancy examine patients all day long in much the same fashion as USA physicians do. She speaks some English and many of the medical terms are the same in Spanish, so I was able to understand quite a bit. One mother brought her newborn to Cora, NP. We looked at the baby with sadness who was born with a micro tongue, stubs for feet, and a lobster claw for a hand. Cora instructed the mother to pump her breasts and feed the baby girl with a syringe, and referred the baby to the specialty clinic in the capital, Santo Domingo. I also met Dolly, the clinic sheep, that supplies blood for the agar used in the laboratory plates for microbiology cultures.

Dolly, the lab sheep who supplied them blood for their agar plates.

Dolly, the lab sheep who supplied them blood for their agar plates.

At 11 a.m., a group of clinic workers started singing hymns and everything stopped. Then the Pastor preached a gospel message for 15 minutes and one young man prayed and received Christ as his Savior which was exciting! One of the young men who volunteered, Johnny, enjoyed practicing speaking English with me. I also observed the surgeons in the operating room which seemed to be done the same way we do it in the States.

Each student was required to prepare a health topic to teach the patients. I chose to teach them on how to prevent getting worms since it is endemic in tropical countries. I remembered treating it when I was in Honduras. I studied Cora’s tropical medicine book and then taught the patients with the help of Cora’s poster while she translated for me. The main thing I emphasized was hand-washing after using the bathroom and before eating. This is challenging when many of them don’t have access to clean water as I discovered in the village where we stayed and in the city hospital. If one doesn’t have running water, one has to get it from the river, boil it after building a fire, and then let it cool which is a tremendous amout of work.

Teaching the patients on how to prevent getting worms.

Teaching the patients on how to prevent getting worms.

Round worms are widespread in tropical countries.

Round worms and other parasites are widespread in tropical countries.

On our last evening, I watched a lady weave her baskets and hats. All the children gathered around, and she let them model her hats as I took a photo. I will miss these children. We closed tonight by sharing how this trip has changed us. I said it had increased my observation skills, and that I now realized that maybe we didn’t need nearly as much expensive equipment to get the same patient results. The most positive experience for me was delivering the baby. The most negative experience was dealing with the filthy outhouse in Pan Dia. Cora thanked us for being so culturally sensitive. She is such a sweet godly lady. She has been so sick all week with recurrent typhoid fever. I pray for God’s healing hand upon her.

Cute village children model the hand woven hats!

Cute village children model the hand woven hats!

Santo Domingo

We have returned to the capital city for our final few days. I was greatly blessed in worshiping with the brethren at the city church started by Pastor N and his wife 30 years ago. On Monday, they took us to see their daughter, Dr Marilyn, and the clinic, church, and school which she started. It was very impressive. The people have a much higher standard of living here than they did in the western city of San Juan where we were earlier.

Then we went to a stately old white colonial building which houses the Peace Corps offices for the Dominican Republic. The Chief Nurse gave us a lecture on her role here. There are 7500 Peace Corps workers worldwide. The overall attrition rate is 30%, but only 14% in the D.R. Contracting HIV is a big problem among the volunteers. They are given birth control and condoms, but some of the women still get pregnant. They are counseled  and flown to Washington DC for an abortion. If they have more than two abortions, they are dismissed. Everyone must take anti-malarial medicine weekly and wear a helmet when riding on a motor scooter or they are dismissed.

These facts broke my heart. I thought to myself about how much better it is to follow God’s way of only having sex within the marriage relationship of one man and one woman.

“Marriage is honorable in all, and the bed undefiled, but fornicators and adulterers God will judge.” Hebrews 13:4

Then we toured a city clinic where Mary, a Peace Corps volunteer works. Mary has worked here for 18 months doing health promotion. She started out in San Juan, but was in two bus accidents. In the second accident, the driver and all the people riding toward the front of the bus were killed when the bus rolled over. Mary broke her cheekbone and was flown back to the USA for surgery. She lives here in a poor slum area where the houses are close together on a hill with lots of steps. When we saw a huge rat, a woman ran after it and smashed it with a big rock.

The clinic nurse attended vocational school for six months after she finished the eighth grade. They are taught how to take vital signs, give injections, and a few other basic things. I’m guessing she is equivalent to somewhere between a certified nurse’s aide and a licensed practical nurse in the USA.

Then Dr Elaine gave us a lecture on Culture Shock. She said there are three stages. The first is the Honeymoon stage where everything is exotic and wonderful about your new country. It usually lasts 1-6 weeks. The second stage is the Frustration stage where everything is awful, backward, and makes no sense. The third stage is Stabilization where the person appreciates the new country and learns to be flexible with its flaws. One missionary told me the best way to get through culture shock is to stop comparing the new country with one’s country of origin, but just accept the new country as it is.

On January 6, Three Kings Day, all the stores were closed for this major holiday. This is when the Dominicans exchange gifts rather than on Christmas day. I think they calculate that it took the wise men about 12 days to travel from the east and find the Christ child to present their gifts of gold, frankincense, and myrrh.

On this holiday, we enjoyed touring the 500 year old colonial part of the city and seeing the oldest cathedral in the New World, and the oldest protestant church started in Dominican Republic in 1922. I also had my photo taken next to the statue of Christopher Columbus who discovered the island in 1492.

The oldest protestant church in D.R. built in 1922.

The oldest protestant church in D.R. built in 1922.

Pam and Christopher Columbus who discovered D.R. in 1492.

Pam stands beside Christopher Columbus who discovered D.R. in 1492.

Julie and I had a scary experience as we were leaving D.R. at the international airport. This strange man nearly tackled me, saying he would get us to the front of the long check-in line. We told him “NO” and checked our baggage, but he would not leave us alone ,and said he would get our departure tax for us. We told him “NO” again, but he would not go away. Julie gave him 5 pesos and he gave it back and almost spit, “That is only 5 cents in the USA!” She asked him how much he wanted, and he didn’t answer. He kept badgering us, so I put 4 pesos in his hand and ran for the locked gate and told Julie to run too. I heard him throw the coins on the floor in disgust. I was so thankful he couldn’t follow us through the security gate. I was so glad when the plane took off and then later landed in Miami, back in the good ‘ole USA!!

Reflection

And so ended my two weeks in Dominican Republic. I thank God for all I learned about other cultures during this journey which has helped me in my encounters with patients from other countries over the years. It is fun when I can tell patients from the D.R. about my two weeks in their country!

Transcultural Nursing Course – Dominican Republic – Part 3

Transcultural Nursing Course – Dominican Republic – Part 3

January 3, 1995

It seems hard to believe that our trip is half over. Today, we returned to the city hospital to work as a group so Tammy could translate for us. We made rounds in the pediatric ward and watched a skilled nurse easily start several IV’s in babies, unlike yesterday. She wore a cap with a blue velvet band, so she has a Bachelor’s degree in nursing.

Then we went to the Labor and Delivery unit. When the nurses learned I had experience in labor and delivery, they assigned us to a 28 year old woman having her fourth baby who had just been admitted. The doctor examined her and said she was half way dilated and broke her water. We went on rounds and I checked her before lunch. No change. We felt her contractions and I tried to listen to the baby’s heart beat with my new stethoscope, but couldn’t hear anything. There is no fetal monitoring available here.  She looked very comfortable, so we had a leisurely lunch. When we returned at 2 p.m., she was writhing in bed in pain and looked like she was in the transition stage. I asked for a sterile glove, checked her, and she was totally dilated. I asked her to push and the baby’s head crowned, so I told her to blow so she wouldn’t have the baby in bed.  The Dominican nurse said it was time for her to go to the delivery room. We watched in amazement as the mother stood up, and walked in her sandals to the room, laid on the table, and put her feet in the stirrups.

The nurse then told me that they do all the normal deliveries rather than the physician, and motioned me to deliver the baby! It has been 13 years since I worked in labor and delivery, so I silently prayed, Dear Lord, help me! Bring this new baby into the world safely. Amen. The mother gave two pushes and the baby came out with a cord around his neck once which the Dominican nurse quickly removed so he wouldn’t strangle. The baby boy then let out a loud scream, and we all breathed a sigh of relief. It was so exciting! Then the nurse put two clamps on his cord, cut it, and motioned me to carry him to the bassinette. I rubbed him down and gave him an Apgar score of 8 at 1 minute, and 9 at 5 minutes which is totally normal. Thank you, Lord.

The nurse gave me a sterile string and motioned me to tie the cord closer to his abdomen, so I tied my best Girl Scout square knot, and asked if I did it right? She said, “Si!” (yes). Then Julie cut the cord again between the clamp and the string. They removed the 2 clamps so they could sterilize them and reuse them. We examined the cord, and it had three vessels which was normal. Julie and Paula then delivered the placenta. I handed the baby to Mom and she began to breastfeed him. After the nurse cleaned Mom, she stood up and walked to the wheelchair, and was wheeled down the hall to the postpartum area. Mom never screamed the whole time, but only grimaced. She made childbirth look so incredibly easy.

After we settled Mom in bed, she thanked us profusely, while hugging and kissing each of us.  It was so gratifying. The other students had never participated in a delivery before, so we were all thrilled. The miracle of birth never ceases to amaze me. God is so magnificent!

Lo, children are an heritage from the Lord; and the fruit of the womb is His reward. Psalm 127:3

Holding the new baby after I delivered it!

Holding the new baby after I delivered it!

Mom brought two disposable diapers with her. I saw a price tag of 3 pesos on one which equals 25 cents in the US. This is lots of money for her.  Each patient is only given one bed sheet their entire stay.

We then made rounds on the rest of the hospital. The men’s ward had 20 beds with quite a few men in traction from femur fractures from motor scooter accidents. We then went back to the ICU. The three patients we saw yesterday are about the same. The lady with high blood pressure actually had a stroke rather than a blood clot in her lung. Her right pupil was enlarged and non reactive to light. Her left arm was limp, but she could move her left leg. I checked her blood pressure, and it was back up to 196/110 and her heart rate was only 56. There was a new lady who was there with an asthma attack and was on oxygen. They had the head of her bed propped up with a chair since there is still no electricity today.

Through Tammy’s interpretation, I found out more about, Martha, the ICU nurse. She works 9 days out of 14 with two days in a row on each shift, and then she gets two days off. Dr. Elaine said nurses and doctors are not respected in the Dominican culture and the pay is very low. The head nurse makes the equivalent of $120 per month in U.S. dollars.

We then met with a lady in charge of infant feeding who has a doctorate degree from Santo Domingo. She showed us their beautiful classroom with a TV and video player. Mothers complete an 18 hour course of nine two hour classes on infant care. They have posters all over the hospital forbidding baby bottles and other posters showing a beautiful dark haired Mom breastfeeding her baby. This hospital has 190 beds for the whole region, which is not enough. They had 4000 births in 1993, and 6000 births in 1994.

At the end of the day, I rode back to the clinic Dominican style taxi, on the back of a motor scooter, hanging on to the driver for dear life and asking the Lord for safety the whole way. Then I paid him the going rate of 3 pesos – 25 cents. What a day!

Dear Lord, Thank you for the safe delivery. I pray this new baby boy and his Mom will receive you as personal Savior. Thank You for all You have taught me today and for the strength and health You have blessed me with. In Christ’s Name, Amen

 

 

Homework on Thanksgiving Day

October, 1994

I have been enjoying my first semester in graduate school tremendously as I study Nursing Issues. It feels like my brain is coming out of mothballs, and the group discussions are very enlightening. Our professor is excellent and gives interesting lectures. I just went to the hospital library to do some literature searches on my ethical dilemma for my paper. I have chosen to write about Euthanasia. I was surprised to learn that euthanasia (ending a person’s life) is legal in the Netherlands. We need to use the American Psychological Association (APA) format to write all our papers. I have a large textbook with all the writing rules for this format which is a bit overwhelming to learn. I also decided to invest in a personal computer to help me write my papers, so I am trying to learn this also. During my lunch break at work one day, I stopped at the local library and the librarian showed me how to use this pointer called a “mouse” to find my place on the screen. I am not very good at it yet, so I will have to keep practicing.

The "mouse" was difficult for me to use at first!

The “mouse” was difficult for me to use at first!

Thanksgiving Day, November, 1994

I turned in my paper on Euthanasia and my professor handed it back to me without a grade. She said I totally missed the point, so I have to rewrite it before she can grade it. She said I did a report rather than addressing both sides of the ethical dilemma and stating my viewpoint clearly. I am so disappointed and feel very discouraged. I also have to finish writing my final paper on Prescriptive Authority for Nurse Practitioners. This is interesting because the laws are different in each state. Some states allow NPs to prescribe all medications including narcotics independently without a physician on site, while others require a MD co-signature, and still others don’t allow NPs to write for any prescriptions.

No one at church  invited me to Thanksgiving dinner this year, and I live too far away from my family in the Midwest to go home. One of the single fellows in the career group, George, does not have any where to go on Thanksgiving day either. He asked if we could eat together at my house? I said I could take a three hour break from writing my two papers, so he is bringing the turkey and pie, and I am making the side dishes.

We had a pleasant meal together, sharing what the Lord has been teaching us lately.

My 3 hour break from homework for Thanksgiving dinner.

I took a three hour break from homework for Thanksgiving dinner.

I was able to finish both papers by Saturday night after working on them the rest of Thursday, all day Friday, and all day Saturday. Thank You, Lord, for helping me finish on time!

If any of you lack wisdom, let him ask of God that giveth to all men liberally, and upbraideth not (ungrudgingly); and it shall be given him. James 1:5

Reflection

I was so thankful that my professor accepted both my papers and I received an A- for my first course in graduate school. It was quite a stretch for me to get back into the study mode, learn how to write in APA format, and learn how to work a computer while working full time as a visiting nurse.

George and I sometimes laugh about our Thanksgiving dinner together when I gave him three hours of my time! He later married a dear friend of mine from church, and they are both growing faithfully in the Lord.