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Rachel's Clinical Days 5 & 6: Neurology

Tuesday and Wednesday I was on a neurology unit for patient who have had a stroke or been involved in some other kind of traumatic accident that has caused severe brain damage. On Tuesday I worked with a student named Teresa who has been working on this unit for about a month now. She showed me all around the unit and introduced me to different staff members. We were able to step into one patient’s room and observe the nurse interacting with the patient as she provided a morning bed bath and some basal stimulation for a patient who had recently had a stroke. After the washing him, the nurse provided some olfactory stimulation that was a special sort of head and face massage that would help stimulate the olfactory nerves. Because of the recent stroke, the patient had impaired swallowing and was not able to speak. This stimulation and massage was also intended to help stimulate these muscles and nerves. We also had the chance to sit down with the nurse manager of the unit and discuss many different therapies and nursing concepts that are provided and followed on the unit. I learned about the emphasis placed on kinesthetic movement and therapy. I noticed when the nurse was changing the patient’s position she would really reinforce the surface that the patient was touching, which I learned is important to remind the patient of their surroundings and reality (especially with a partially paralyzed patient). We also talked with the manager about a couple of questionnaire/ assessments that the nursing staff uses when a patient is admitted to the unit. The first questionnaire consists of questions such as where the patient has been living previously, history, any previous jobs, most significant life events, family members, hobbies, are they right versus left handed, what they do to help themselves calm down, stress coping mechanisms, and personal goals for their stay. The second questionnaire oriented to basal stimulation asks about what they like to be called, daily routine, preferences, favorite drink or meals, use of special hygiene products, bedtime routine, what kind of music they like, whether they like to watch TV and what show, and what helps them usually if they are having digestion problems. The nurse then communicates these responses with other members of the healthcare team as an effort to have continuity of care. This is very important on this unit because most patients stay anywhere from 4-10 weeks. During their entire stay they work with the same couple of nurses also so that relationships can develop. Furthermore, all members of the healthcare team meet once per week to discuss all the patients, progress, evaluate, and create new plans for therapy. We also talked with the nurse manager a lot about patient safety on the unit which is especially important considering these patients are often disoriented or have severe impairments in many or all of their senses. After having some very interesting conversations about the unit with the manager, Teresa and I were able to observe pet therapy. Dr. Fischer is a retired psychologist from the clinic who has trained his Norwegian Husky to participate in therapy. The particular session we saw was with a woman who had such a severe brain injury she was barely able to open her eyes and could not respond at all. She was participating in pet therapy for the first time in hopes that there would be some response noted in heart rate or eye movement. Unfortunately, there was no response for this patient but since this was only the first attempt, there will be continued attempts. The goal of pet therapy is to stimulate the body’s largest system, the integument, in hopes of creating a reaction or response in a patient in order to help those patient’s who are “locked in.” I was also able to observe a therapy session with an Occupational Therapist. I have never seen an OT at work so this was a very good experience to be able to see what this necessary component of the healthcare team does with the patient. The OT I observed was working with a man who was paralyzed on the right side of his body recovering from a stroke. She used constraint-induced movement therapy in which she really encouraged and only allowed movements made with the affected limb. She explained how this was very important for the patient to truly realize what they are capable of doing because all day long they realize all the things they cannot do and this is very discouraging. Being motivated to make movements with the affected limb and getting praise for doing things well is very important and therapeutic. Finally, the last thing I saw for the day was a series of warm-up exercises done with a patient who could not move at all on her own. These warm-up exercises were a series of passive range of motion exercises. All in all, it was another very interesting and educational day. I am finding so many differences and similarities between the Austrian and US healthcare system. It was also just such a great opportunity to be on a neurology unit and something so specialized that I have not been able to experience in the U.S.

Today, on Wednesday, I had another great day on the Neurology unit. I worked with another wonderful student named Franzi, who has also been working on this unit for about a month now. We started off our morning jumping right into the mix. We teamed up with a nurse for a couple hours as she went through her morning routine with a couple of her patients. Patients on this unit are 2 to a room and a nurse typically has 3 patients per shift. Franzi and I were able to help the nurse by assisting the patients in eating their breakfasts, bathing, brushing their teeth, combing their hair, and transferring the patients in and out of bed for therapies and meals. I learned a lot of new techniques for transferring patients and helping them with their self-care. Also, because of the language barrier with the patients, I learned to better communicate in nonverbal ways versus verbal. After getting some hands-on experience and really getting a chance to see what nursing care looks like on this unit, I realized I would love to work as a nurse with this type of patient population. Patients on a neurology unit with some sort of brain injury have such a need that must be met to compensate for the many self-care deficits they are now facing. And what astounds me and what would be so difficult about being in their shoes is that they once knew and could do all these things they must now have help with. But at the same time, the human body and brain is so complexly beautiful and has the potential to relearn, regrow, and redevelop. So everyday there is the mindset that today is going to be a better day and things are going to improve. One patient I worked with this morning (who was able to speak some English) told me “it is as if she were a child all over again and that it takes 20,000x of repetition of a task in order for it to become natural and habit.” I was able to see so much encouragement offered by the staff and so much motivation within the patients. Furthermore, I was also able to observe another session of occupation therapy (with a woman who had a stroke during a total hip replacement surgery and loss function of her right side) and a physical therapy session. Another thing that I was able to see and hear more about today was about the patient’s lives before coming to the hospital. And I loved hearing how the nurses or therapists stated things in such a way as “she is a teacher” or “she is a hairdresser” because one day they will be able to practice again and these patients are still those professions at heart. Finally, after a lunch break, Franzi and I did some exploring around the clinic. We were given a tour around the intensive care unit for neurology patients and then finally ended our day observing a brain surgery! This particular surgery was for a patient who had to have part of his skull removed because of an infection in the bone. It was amazing to see the surgeons at work and how they made things fit together just like a puzzle. It was also amazing to think about how the human body is able to bounce back and heal from such an invasive procedure such as this. It was definitely a fascinating experience to round out my time here in Linz! I have really had such a wonderful time and am so excited to see how this experience helps to shape my future in the field.


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