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:)

 

 

 

 

Advertisements

Transcultural Nursing Course in Dominican Republic – Part 2

January, 1995 – San Juan, Dominican Republic

After awakening, I began reading my English-Spanish Bible in my Pan Dia village home, when Maria, a ten year old girl came in and shyly started reading over my shoulder. I gave her a Spanish gospel tract to read, and she was thrilled.  Before we said goodbye, the cute children gathered around us for a final photo.

The village children loved chatting with us!

The village children loved chatting with us!

After we returned to the clinic, we compared our clinic stays. It sounds like Debbie and Julie stayed in a much wealthier community and even had an indoor bathroom, but I think Paula and I had a truer picture on Dominican life for the majority of people. We all watched Paula analyze the water samples she had collected from the boiled water they had given us, the town pump, and the clinic. Paula is doing an extra project on water quality since her first degree is in biology.

The next day, Paula discovered the water that we drank in Pan Dia was unboiled and the filtered water here at the clinic is almost as bad. The tap water here came out clear of bacteria. She will repeat all the tests to confirm her results.  Thankfully, neither Paula nor I became sick from the unboiled water. Perhaps I’m building up a little immunity since this is my fourth trip to the Caribbean region. But it does make me realize how much I take for granted clean water in the USA. (We later learned that the clinic’s board of directors took steps to improve their water filtration system as the result of Paula’s work.)

Watching Paula analyze village water samples.

Watching Paula analyze village water samples.

The next day, Dr Elaine had me work in the city hospital in the Intensive Care Unit (ICU). There was no running water or electricity that day, so no one was on an EKG monitor, and it was very hot since they could not run fans or air conditioning. The only way I could wash my hands was with wet wipes that I brought with me. The nurse pulled out their only stethoscope which had five foot long tubing on it and no diaphragm on the bell, so she grabbed a piece of paper and placed it over the bell. After she checked a 46 year old woman’s blood pressure who had a blood clot in her lung, I rechecked it with my stethoscope. I was shocked that it was very high at  180/120 and that they only checked her blood pressure every 12 hours. She then gave the woman Procardia under her tongue and pushed Ranitidine intravenously quickly through her IV line. I checked the patient’s blood pressure twice after that and it came down to 150/88. There was a can of pear nectar on the woman’s bedside table, so Dr Elaine and I helped her sit up and she drank it thirstily. There was no water pitcher beside her bed. I pitied her because it was so hot in the ICU.

The doctor then came in and changed the abdominal dressing of a man who had a ruptured appendix using Betadine and sterile gloves. The nurse then had me give him a gentamicin antibiotic injection in his arm. Normally I would have given it by IV drip slowly or given it in his thigh. Then she mixed up 1 gram of ampicillin in 5 ml. of normal saline and gave it rapid IV push through his line. She asked me to give it, but I refused and told her I was used to dripping it slowly through the IV over 30 minutes. She then gave him 100 ml. of Gatorade with brown sugar added for lunch. There was a quart of it, but she said he couldn’t have any more. Then she offered Dr Elaine and me a glass of Gatorade as she drank one, but we politely declined.

The third patient in ICU was a woman who had been stabbed by her husband. She had a tube in her stomach with the drainage bag lying on the floor under her bed. She also had a tube in her bladder, with that bag also lying on the floor. She had on no gown and was exposed from the waist up. She was behind a curtain so no nurse could observe her, and her IV ran dry. When the nurse discovered it, she hung a new IV bag and ran a tube full of air into the patient. Since there was no running water, none of the patients were bathed and the nurses never washed their hands. All the patients appeared dehydrated from lack of fluids in the heat.

The medicine cabinet had 3 more bags of IV fluids, and medicines in bottles with labels. Another nurse came to the door and asked for a pill, so the ICU nurse took one from the bottle and handed it to her. Each patient had a chart with doctor’s orders, operating room record, and nurse’s notes. The nurse’s note was divided into four sections: date, hour, medicine, and observation. Dr Elaine pointed out that the nurse’s note didn’t have much room, but at least they had a chart.

On our way to lunch, we stopped by to see Julie in the pediatric ward.  There was a baby in severe respiratory distress. She watched the nurses try 20 times to start an IV in a baby with the same butterfly needle. One male nurse accidentally stuck himself with the needle, and then continued to stick the baby with it.

Since the operating room was closed for the holidays, we went with Cora, NP,  as she made home visits to families who have infants on her nutritional program. This very poor village is a number of shacks beside a bean field and the river. We watched them wash their clothes in the river and cook their food over a charcoal fire. One home had two babies because one baby’s mother had died in childbirth. The remaining mother was trying to breastfeed her own baby and the orphan, who appeared to weigh only about three pounds.

Cora spoke with an  18 year old woman about family planning who already has four children. Many women have their first baby before they have their first period. The poor people don’t marry, but just change from one man to another. It is estimated that 25% of the population is HIV positive.

After walking down dirt roads and fording several streams, we arrived at the local midwife’s home. She delivers 100 babies yearly and charges no fee. She was a dear friendly 40 year old grandma who got down on the ground and demonstrated how she delivered her own twins alone! Until last year, when she spent three days training at a local hospital, she had never received any formal instruction. At the end of our visit, she handed us each a chicken egg as a gift. It was difficult for us to accept this gift as we knew we were taking most of her food for the entire week, but Cora said we would have offended her greatly if we would have refused. In turn, we gave her a gift of several boxes of gloves for her home deliveries since she could no longer obtain them. She hugged us all as we left.

Local midwife tells us the amazing story of how she delivered her own twins!

Local midwife tells us the amazing story of how she delivered her own twins!

Reflection

Those days in the city hospital with hardly any supplies and in the homes of people who had very little material goods, once again brought home to me how I have grown up in such relative material wealth in the USA. The poorest people in the USA are wealthy compared to many people in the world. One missionary in Ecuador told me that the people there think that all Americans sleep on mattresses stuffed with money! She offered to let them look at her mattress to prove that there was no money in it:)

I was blessed as I read through some of the many verses in the Bible about poverty and wealth. The only kind of wealth that lasts for all eternity is our relationship with Jesus Christ. The person who has received Christ as Savior is the richest person in the world and the only one who can truly be happy.

“For ye know the grace of our Lord Jesus Christ, that, though He was rich, yet for your sakes He became poor, that ye through His poverty might be rich.” II Corinthians 8:9

“Lay not up for yourselves treasures upon earth, where moth and rust doth corrupt, and where thieves break through and steal, But lay up for yourselves treasures in heaven, where neither moth nor rust doth corrupt, and where thieves do not break through nor steal; For where your treasure is, there will your heart be also.” Matthew 6:19-21

 

Nursing Tour of China – Part 2

Shanghai & Nanjing, China – 1986

June 3 – Shanghai

I was too tired to write last night and am weary again tonight, so I have a feeling this will be a short journal! Yesterday we went to our first hospital tour in Shanghai. We met in a large boardroom first where they told us about the hospital and served us loose-leaf fragrant Jasmine tea in china mugs with a lid to keep it hot. We learned to sip it through our teeth so we didn’t swallow the tea leaves! They told us some health statistics in China compared to the USA.

Nursing in China

Nursing in China

Xin Hua Hospital

Xin Hua Hospital

Entrance to Hospital

Entrance to Hospital

Then we toured the pediatric ward. They have a few pieces of new equipment, but it looks pretty antiquated otherwise – about 1950 era.

Pediatric patient with scalp IV

Pediatric patient with scalp IV

Rubber reusable IV tubing with glass drip chamber and glass bottles.

Rubber reusable IV tubing with glass drip chamber and glass bottles.

Baby under oxygen hood

Baby under oxygen hood

Infant nursery. Note oxygen tank against the wall

Infant nursery. Note oxygen tank against the wall

Nurse's station

Nurse’s station

English lessons for the older children.

English lessons for the older children.

I was excited to talk with Dr. X, a pediatric cardiothoracic surgeon, and give him a gospel of John tucked inside my hospital’s magazine. How I pray he would read the gospel of John and receive Jesus Christ as his personal Savior. He is going to Canada next month to study for a year.

Chinese English Gospel of John I gave Dr X

Chinese English Gospel of John I gave Dr X

Jesus said unto her, I am the resurrection and the life; he that believes in Me, though he were dead, yet shall he live. And whosoever lives and believes in Me shall never die. Believest thou this? John 11:25-26

Then they served us an elegant lunch at the Seaman’s Club overlooking the harbor. We had the unique experience of eating “1000 year old eggs”! They explained how they hard boil the eggs, remove the shell, and bury them in some type of mud until the egg turns black. It was OK, but one was enough! Then on to the Yu Garden with the zig zag bridge which was very pretty, even though there are no flowers in the garden. (I later learned the Communists think flowers are capitalistic.)

Zig Zag bridge to Yu Garden

Zig Zag bridge to Yu Garden

We then strolled through the fascinating old city before boarding our first class train car to Suzhou, the city of silk.

The train was so interesting with 2 seats facing each other with a small lace-covered table between us with a potted plant in the middle. There was carpet on the floor and overhead ceiling fans which made it very comfortable. We again enjoyed tea served by the stewardess.

First Class Train to Suzhou

First Class Train to Suzhou

Suzhou - City of Silk

Suzhou – City of Silk

Suzhou canals just like Venice!

Suzhou canals just like Venice!

Today in Suzhou we saw the silk spinning factory and embroidery factory and another garden. At the silk factory, they put the silk cocoons in very hot water and the women stand all day taking one thread from each  cocoon and threading it on to a large spool to unwind the cocoon. It was 95 degrees in the factory and the women are required to work 12 hour shifts.

Ladies unwind silk cocoons in 95 degree heat

Ladies unwind silk cocoons in 95 degree heat

In the embroidery factory, teen girls do this incredibly detailed silk embroidery which they copy from oil paintings. They showed us eye exercises they did, but there were no older women there because it caused such eye strain.

Young girls do intricate silk embroidery

Young girls do intricate silk embroidery

Then we took a 4 hour train ride to Nanjing. We had fun visiting on the train and getting to know each other better.There are 20 nurses total with 4 of their husbands who joined us. The new hotel where we are staying is very nice with an excellent dinner.

Chinese traditional instrument band

Chinese traditional instrument band

A Chinese band played traditional instruments. In honor of us Americans, they played Jingle Bells, Oh Susanna, and Elvis’ Love Me Tender. It seemed a little strange to hear Jingle Bells in June! Time for bed- my eyes are drooping.

Nanjing, June 4

It’s a sunny 80 degrees today which I thoroughly enjoyed. I slept well which gave me a little more energy. We started out by climbing up 392 steps to Dr. Sun Yat Sen’s tomb. Whew!  I made it without too much trouble. The view of the rolling green hills was so beautiful.

Dr. Sun Yat Sen's Mausoleum. "George Washington" of China

Dr. Sun Yat Sen’s Mausoleum. “George Washington” of China

nan6

87 year old friendly lady had just climbed 392 steps!

I met a very friendly 87 year-old lady on the way down who held my hand as we had our photo taken together. She had just climbed all those steps also! (I later found out that Dr Sun Yat Sen was a professing Christian who was the first president of China after deposing the last emperor in 1911. He is considered the “George Washington” of China.)

After visiting Ming tombs and drinking plum juice at the former summer home of Madame Chiang Kaishek, we had lunch at the hotel and then toured a second pediatric hospital. It was much like the one in Shanghai except our nurse guides asked us more questions. Their nursing research department was very impressive!nan hosp1 nan hosp8

Our friendly nurse tour guides!

Our friendly nurse tour guides!

Patient laundry hanging out to dry.

Patient laundry hanging out to dry.

We stopped for a few minutes at a tall drum tower where a class of 5 year old children were also touring. They were so cute as they walked hand in hand through the tower!

Children tour the drum tower.

Children tour the drum tower.

Typical Nanjing street corner.

Typical Nanjing street corner with “bendable” city bus in background.

Then we ate dinner and went to a variety show. It was lots of fun with a string quartet, singers, a kungfu demonstration, and a hilarious bird imitator. My eyes are closing fast.

Reflection

I still receive Christmas cards from one of the couples who were on the tour and from the Nanjing nurse guide who later moved to the USA. I have visited her twice in North Carolina. I was thrilled to hear how she went back to college to receive her BSN and is doing very well working at a major university hospital. Her daughter has grown up and has also graduated from college. Two of the nurses on the tour married the following year and I was invited to both their weddings. It was quite amazing how quickly our tour group bonded!