Daily Clinical Reflections

“I am very nervous about working in a whole new environment where I am the outsider. I think the language barrier will be the most difficult part. I learned a lot from being an “honorary charge nurse”. It was interesting to see how much work went into it. I also was able to see the interaction between the doctors and nurses which was really neat. The one thing I had any patient interaction was when I was pulled into inserting a straight catheter. It was my first time and it was the most difficult thing I've done”.

“I am nervous about being in a foreign hospital with different language. I really enjoyed working with the staff-I was able to help hold the retractor, cut sutures, and just witness the whole thing (appendectomy). Today was a good day”.

“The biggest challenge today was trying to stand the whole shift (I did not succeed I had to sit down every now and then). I was able to give oral meds and IV push med that you draw up out of ampule. I learned some Tagalog phrases and feeling more comfortable entering patient’s room. Waiting to give meds until family brings them; this was a huge difference to me because at home we will not give meds patients bring from home”.

“I got to assist in the birth of a beautiful baby girl. It was an amazing experience and being able to do something rather than just watch was so great! The cultural experience I got to witness was how private the culture is and just how much privacy is important and providing it no matter what; for example a lot of our patients opted for their families to provide cares rather than the nurses just to allow more privacy. I feel like back home we would rather have a nurse rather than a family member, or maybe that’s just me”.

“I am not getting used to the whole 4:45 am wakeup call, but when I go and see their smiles it makes it all worth it. I got to work on my mechanical BP and vitals which was a good refresher.  I also got a lot of experience with medications and giving NG feedings. I gain more and more of a knowledge base of the Philippines and I am so grateful for it”.

“Working with my student nurse partner and the rest of the staff went really well. They were all very helpful and willing to teach, especially with med administration which turned out to be quite different from how we do it in the States. Although things are done a little bit differently here, they are all done for the same reason”.

“I felt a lot more comfortable today in my skills, especially BP, as I haven’t done manual BPs in a long time. I am grateful for this experience as I have been reminded that we cannot always rely on our electronic/automatic supplies. I was able to ask more questions today, and could communicate well with everyone on the floor. I believed I displayed cultural competence by allowing patients to decide when they wished to have their cares done, encouraged family time, and spent time discussing culture with my patient. She proudly told me where she was from, and asked many questions about where I had been”.

“I learned a lot today on the medicine-annex unit. I did rounds with other students and was able to practice my manual blood pressures. I was also able to practice some of my Tagalog by saying “salamat po” (thank you) when I left and “magandang umaga” (good morning) when I entered the room. It was really fun learning to adapt to another culture. I also spoke with the students and nurses on the unit about how we use the EHR to document and give medications in the US. It was fun to be able to talk and compare the way things are done here versus at home”.

“I think the biggest way I practiced cultural fluency was by asking tons of questions when I didn't understand something and then explaining also what I know. I also tried to interact with the patients as much as possible even though none of them spoke English. Another way I demonstrated cultural fluency was by learning skills from my students nurse partner and not trying to do things the “States way”, but learning and doing stuff their way. It was interesting to use their Math formulas and IV skills!”

“I got to see a lot of different things, and gave my first newborn bath! It was really difficult to understand everyone even when they spoke English. Also even conversing with my MJ student was hard sometimes because we have different names for everything. While giving the baby’s bath, the mother asked to take pictures of me while bathing her baby”.

“It is so interesting to observe the different culture and see how they interact and communicate. They are so buddy-buddy with the doctors and everyone seems so close. Back home I feel like you can feel the tension between a lot of nurses, and the nurses and the doctors. The Filipino people are generally just a warm and welcoming group”.

“I am most nervous about experiencing the cultural differences in our health care systems. I am also nervous about the language differences as well. I definitely experienced culture shock during our first day of clinical. It was very interesting to be placed as the one who needs a translator, but I believe it will be very beneficial for my future as a nurse”.

“One thing I thought I did well in the ER today was volunteering to do anything. I wanted to learn even though things are different here. Some things I got to do were insert an NG tube, clean up vehicle accident wounds and giving IV med”.

“I love how much families are involved in the plan of care. It is hard to get used to the fact that we had to wait 3 hours to give a med because the family had not come today yet and they needed to buy medicine and the sterile water needed for mixing”.

“I was in the ER today and right away we saw a code where a 23 year old man passed away. It was the first time I have actually witnessed someone die. It was hard for me to watch the family mourn without anyone really explaining anything to them”.

“I definitely had a culture/knowledge moment when I thought “Oh no, the baby is so dark and purple” then I remembered not everyone is as pale as we are!”

“The biggest challenge was trying to advocate for a very sick patient. I felt that our suggestions/interventions were ignored or they did not have the resources for it or it was something that the patient had to pay for. It was hard to see the healthcare team react very slowly to the terrible situation which was an emergency! I was very frustrated and it was the first time I felt helpless in a situation as a student nurse. Also, another big challenge was seeing the father of the patient try to round up money for his daughter so she could get a CT scan. After hearing that she could not get a CT scan until they provided money was heart breaking. She needed that CT scan ASAP but could not receive it due to money. I held it together for most of the day until I found out that the father was making phone calls and trying to relocate his daughter to another hospital because Mary Johnston was too expensive. That’s when I started to choke and tear up. I thought about how much the CT scan was (about 5,000 pesos) and the fact that I took out 6,000 pesos for this trip for souvenirs and fun stuff. Today really made me reflect on our healthcare system and how blessed we are to have it and to have insurance. I know it is not a perfect system but it could be a lot worse”.