Weeks are going so fast here. We have now six weeks left, six weeks behind. I really don’t know where the time has gone. I’m wondering if time goes faster here than in Finland. Is there already November?!
So, after Pediatrics we moved to the Renal Unit in Mater Dei to do our medical practice for three weeks. Our mentor is really good and all the stuff has been very nice and made our stay there very comfortable all the time. And believe it or not, we found one nurse who has done her Erasmus exchange in Kuopio five years ago. We have done lots of fun about Finnish words and her experiences. She found her staying in Finland one of the greatest time she has ever had. So go Finland! Let’s be proud of our country, knowledge, school system and nature! 🙂
The Renal Unit is one of the biggest units in Mater Dei hospital. There work tens of nurses in two different duties. As in Pediatrics, duties are 12 hours long here in Renal Unit as well. There are two different sides; haemodialysis and peritoneal dialysis. We have been now just in haemodialysis because our mentor is working there all the time. We are going to visit peritoneal side as well during this last week at the Renal Unit. We are probably going to see one fistula or graft operation in theaters as well. Luckily the staff and especially our mentor is really motivated and want to arrange us to see as many sides as possible during our visit there. People are gold here, I think. Or we are lucky. Or both. 🙂
The side of haemodialysis is quite big at the moment and it’s getting bigger and bigger all the time. As we said earlier, the amount of diabetic patients is quite big here which affects of course to the amount of kidney failures as well. One session takes four hours and they are doing three sessions during one day. In one session almost the whole ward is full. There’s about 30 beds they use at one moment for haemodialysis so in one day there visit about 90 patients. One nurse takes care of about three patients. The thing which was a real shock for us is that there’s no doctor working in that unit. Yes, not at all. If there is some case, they call some medical doctor to come and it can take quite a long time to get one there. And when they finally come it’s not so clear if he/she is specialiced to kidney functions and is really able to solve the problem and help the Renal Unit staff and patients. Our mentor said that they have asked and worked a long time to get one doctor for only their ward and needs.
First of all, dialysis is a procedure to remove waste products and extra fluid from the body when the kidneys are not working or are not working properly. Now we concentrate on hemodialysis:
In one hemodialysis session they connect patient to the dialysis machine, set up the blood flow speed and the target which means how much fluids they are going to remove from the patient. First they take the patient’s weight and then they count how much there’s fluids to remove by comparing the weight to patient’s dry weight. Every patient has their own set ups; how much heparin they have to use in one session to prevent clotting etc. After the dialysis has begun, nurses are observing the patient’s blood pressure, arterial pressure, venous pressure, fluids taken out, patient’s feelings and so on. Basically the set ups are following the blood test results which are taken every two weeks. Diet has a big role in patients life. Some patients are following the staff’s guides how to treat theirselves and some are not. I think that might be one issue which tells us if the patient has accepted his/her disease or not.
Kidney failure is a big thing in patient’s life. Dialysis sessions takes their place in patient’s life approximately three times a week. It’s not so easy to handle, we think. We have had good discussions with the patients about their history with dialysis, life, experiences, career and of course they are interested in to hear how is the life in Finland. Patients have four hours time there just to lay down in bed and wait the session to end. It can be boring if You don’t have anything to do. I think we have managed to make some patient’s time there a little bit more comfortable and nice by talking them and spending time with them without hurry and pressure.
Another thing which makes us to look each other with weird faces was the moment when we heard that there’s no head nurses in that ward who could support the nurses and stand behind their backs. There are some kind of debuties who has more responsibilities than other nurses but it seems to us that the nurses don’t feel they are really supporting them in the way they really need. The Renal Unit is a big unit and there are lots of nurses working there so we think there really should be some system which supports the nurses’ work and wellbeing. Duties are long and the work includes quite a lot of responsibility (especially when You compare to other wards and because there’s no doctor working at the ward). The staff is happy, love the patients from the bottom of their hearts but they really need a good backup to handle all the pressure they have.
All in all, these are some points we have seen here in last two weeks. Next week we start in Operating Theaters but before that we have couple of duties to do at Renal Unit with sweet patients and staff.
PS: Here You can see the description of the Renal Unit from the Mater Dei Hospital’s web page: https://health.gov.mt/en/MDH/Pages/MDH-Renal-Unit.aspx