Laura's Clinical Days (Day 1 & 2)
Day one and two of my clinical at Wagner-Jauregg took place on the women's acute psychiatric floor. Patients on this floor suffered depression, personality disorders, and displayed suicidal tendencies. There were also women with addictions who were placed on the floor due to overflow from the addiction unit (Suchtmedizine). The ward was split into two parts. You first walk onto the open ward. There was a door on the unit that led to the closed ward. Patients on the open ward were allowed to leave the unit to go to the cafeteria, take a walk or grab a newspaper. Patients on the closed ward were not and had to be supervised if leaving the floor.
However, on day 1, this floor was very quiet. The only sessions we were able to see was morning handoff and daily checks with the patient and psychiatrists. Morning handoff took place in a large staff room that has a kitchen. Nurses and doctors enjoy breakfast and coffee as they go over each patient and get updates. It was an incredibly happy atmosphere and it was enjoyable to see nurses and doctors work so well together and enjoy one another's company. After breakfast, we joined the psychiatrist as they met with 4 patients to review how they were doing and whether they were ready for discharge. All sessions were in German so although I managed to make out some of the conversation, I was able to ask Viola and the psychiatrist after the sessions. So my assigned buddy, Viola, and I went to the mens acute psychiatric floor where we were then told by the head nurse Iyla we should venture around the hospital. I was first taken to the gerontopsychiatrie floor. Patients here have been diagnosed with dementia and stay on the floor. It was a very interesting experience. Patients are provided watches to wear. However these watches are fake and are actually a tracking device that alarms the nurses if a patient tries to the leave the floor. The most interesting part of the unit was a huge black circle at entrance/exit. It was placed there because patients with dementia are too afraid to step over it, thinking it is a black hole and they will fall through. Supposedly it was successful. Some patients are restrained in chairs that look like a high chair. A tray is placed in front of them so they cannot get up from the chair. However, I did not see them being used and majority of the patients were sitting in a nice room watching tv and talking with one another. Patients are continually monitored with cameras 24 hours a day. The most interesting part of my day was the tour of the Intensiv Neurologie Unit. This unit has patients who are comatose, are on ventilators and/or suffering from traumatic brain injuries. I was provided a tour by three neurology nurses. They showed me the set up of their unit. It is a large room with beds, instead of individually separate rooms. They also have a negative pressure room for airborne diseases. They were quite interested on whether American hosptials also had these rooms and how we do contact, droplet and airborne precautions. They showed me a pretty room, painted and decorated in light shades of purple. This room is designed for the family and the patient to say goodbye. For example, they place the patient and family in this room when the patient was declared brain dead, allowing the family some privacy with the patient. I liked how peaceful the room felt. I also learned a bit about organ donations in Austria. In Austria, everyone is declared an organ donor. You only register to say you are not an organ donor. Family cannot say they do not want their loved-ones organs taken. The nurses mentioned it raises some ethical issues, but organs are desperately needed and now they are part of the European Union Organ Transplant Registry. Before this registry was created, patients traveled from different countries to Austria in order to get a transplant.
Day two once again started on the women's acute psychiatrie floor. This time Viola and I joined in on a psychotherapy group session. I also had to participate auf Deutsch! We had to tell the psychotherapist what made us feel empowered and happy. It was nerveracking, but exciting to have to speak German to a psychotherapist. I was scared I would say something wrong! It was interesting to hear how many women stated that walking in nature was incredibly healing. After psychotherapy, Viola and I went to the Intensiv neurologie unit to observe neurosurgeries! The first surgery was on a malignant brain tumor. The surgeon was slowly cutting away the tumor from the brain. It was fascinating to watch. I also observed for similarities and differencies from my surcial experience in America. The room had a circulating nurse who brought the supplies and ensured the surgeon and his surgical nurse were kept sterile. The room was kept dark with the lamp shining on the patient's head. The surgeon used a microscope as he cut away. There was an equivalent to a CRNA watching over the patient's vitals and anesthesia. We were taken from this surgery after about 45 minutes since the surgery itself would take hours. We were then taken to an operating room to watch a surgery from start to finish. The patient had a trepanation (craniotomy) due to a hemotoma in his brain. The surgeon drilled a hole and suctioned out the blood. A drain a placed in the hole. They hoped the hole would close up, however if it does not, they had a spongy material to place in the hole between the lobes. It was an incredible experience. I provided Viola with some information on what was going on during the beginning of the surgery. She has not taken a clinical that provides information on medical-surgical nursing. It was nice to be able to help her with some information since she has been providing me with so much information on psychiatric nursing. Afterwards, Viola and I returned to the mens acute psychiatrie floor. I spoke with nurses on different patients and how and when they use restraints including tranquilizers. At the end of the day, Viola and I went over medical German and terms used in the hospital system. She also showed me the hospital's computer program. Each patient's name has different icons that determine whether they are a fall risk, cannot walk, are a run risk, are in the closed or open ward, and have a special diet.
The first two days were amazing experiences. It was interesting to see just how much mental health is funded in Austria as compared to America. The hospital is clean and bright. Flo Nightingale would have been proud just how conducive to healing the environment was. I was also able to start learning some Austrian dialect. It is quite differenct from the Hochdeutsch I was taught. An Austrian nursing student told me when in Munich, Germany, sometimes Germans talk to her in English because they cannot understand her dialect. I can see why! Sometimes it sounds like a different language from German!