Nursing practice in Taiwan Aino Ruuttunen, Annika Horkko, Aaro-Pekka Nousiainen
Fu Jen University
Shing Kong Wu Ho-Su Memorial Hospital
Community nursing care & health promotion • The hospital has 35 specialized departments including internal medicine, surgery, medical imaging, health management, obstetrics and gynecology, pediatrics and so on • We stayed Shing Kong Memorial Hospital for 3 weeks • We worked from Monday to Wednesday from 08:30 to 17:00 • The Shing Kong Memorial Hospital is located close to Jiantan metro station and from metro station there is free shuttle bus to the hospital
• We started on monday by presentation of hospital different wards. We get introduction for example, the department of plastic surgery, imaging department, oncology department, the department of education in diabetes treatment, various bed wards and physiotherapy • We were involved in the tuberculosis guidance which was given by nurses • We observed the diabetes care and CKD education ward. At the ward works doctors, nurses and dietitians and they make team work • At diabetes ward we learn about case managment. We were in the doctor's room and doctor discuss with patients about their illness and treatment • Nurses showed us many of the Chinese medical-based pain points and their locations
Acupuncture points and hemodialys
• We observed at the maternity ward and small children's vaccination • We looked at hospital discharge planning service and how to nurse discussed with the patient and how to follow-up treatment or monitoring is carried out • We were introduced at dialysis treatment in women patient's home. The patient showed us how peridoneal dialysis treatment is performed • Also we were introduced hemodialysis ward where it was performed in very sophisticated facilities • We get introduced to home care and we walk along doctor and nurses and visited many of the patient's homes
• Home health care patients condition varied greatly but almost all has had stroke • In home care nurses examine patient's right nutrition by taking measurements and taking a look on their essence. They give instructions for caregivers and caregivers must show for the nurse how she perform different nursing tasks for example feeding, wound care, position treatment etc. • We saw a lot chancing of tracheostomy tube, urinary cathether, nasogastric tube, wound care, fever measurement, blood pressure measurement, lung and abdominal sound listening and taking blood samples
Nursing home
Thoughts • One big difference compared to Finnish hospital is crowd and noisy. Many ward seemed to be quite full of people. • Big difference is also that in Finland there is more privacy for the patient. For example in doctors room there might be another patient waiting for hes/her turn to see a doctor. • Home care patients seemed to be quite often bed patients so they need constant taking care from caregiver. In Finland home care patients usually can do simple tasks by them self. In Finland practical nurse visit home care patients home and assist he/her in shower, clothing, measure blood pressure, measure blood sugar, give medicines etc. • Meal service delivers food and cleaning service cleans. • Caregivers are very rear.
• Nasogastric tube in home care seemed to be here very common. In Finland its rarely with patients in long time home care. More common for patients who can´t eat is PEG-tube. • Homes where patients live are often quite tricky to move. On the other hand, they usually have constant assistant from caregiver. • In Finland aim is to make home care patient's home as smooth and easy move as possible. Thresholds can be removed, railings can be added a kitchen and bathroom can be remodeled and renovated to meet accessibility requirements.
Home care
Home care • Our second practice place was home care service. • We worked there only one week. • Home care service’s office is located to close of Shilin MRT station. Taxi trip from Shilin station to home care office took about 5-10 minutes. • Office located to upstairs of apartment building. • We worked there Monday to Wednesday 8.3017.00.
• There working nurses and social workers. • Nurses and social workers visited at patient’s home and did there assesment about patient’s welfare: they assesment about patient’s function, patient’s residential environment, caregiver’s way of working and if need to make changes to the management plan. • Nurses and social workers didn’t do any nursing treatments, because elderlys have caregiver and most of them was still in good condition. • Nurses and social workers doing assesment visits every three months.
• During those assesment visits social worker or nurse talking with patient, her caregiver or patient’s relative about everyday things. • Caregiver is three times /week, always 2 hours/day with patient. These caregivers aren’t personal caregivers, because they working at home care service’s company. • These caregivers are local because it is very important, that they speak same language with patients. • Workers moving from place to place for scooters or cars.
Thoughts • We visited patients’ home with nurse or social worker. We observed how nurse or social worker did her assesment. • In Finland home care nurses and social workers also doing this kind of assesment visits. • We think that it is good, that workers doing assesment visits so often and observe caregiver’s way of working. This ensures that patients receive good and skilled care. • It’s very good, that patients have caregiver who speaks same languge. It supports patients verbal function especially if eldery has lonely.
Xihu day care center for the elderly
Xihu day care center for the elderly • We worked two weeks at Xihu day care center . • We worked Monday to Wednesday and our practice days were always 8.30-17.00. • Xihu day care center is located to same building than Xihu’s MRT station. • There is working nurses, teachers, social workers and also many volunteers • It was like kindergarten but customers are elderly.
• Elderly comes there every morning Monday to Friday and leave to home at afternoon. • Days always start same way: teacher measuring a blood pressure for elderly. • At morning teacher reads the day’s news for elderly and then they sing Taiwanese national song together. • After that they going different groups. Every group has own teacher and teacher leads morning exercise for them.
• Days include always different activities, like art-, musical-, game- or exercise activities. • There is also lots of religious happenings, like elderlys and teachers singing hymns and praying or reading bible. • Those activities support elderly’s physical, verbal and cognitive function. • Elderlys eat lunch together and they set the table and collect the dishes by themselves. • Elderlys can also take a nap after lunch. • Sometimes elderlys and teachers going walk out or doing trip somewhere.
Our practice • During our staying here, we observed activities of Xihu’s day care enter.
• We took a part different activities with elderly. • Second week we had own cases. Every of us had one case who have some disease like Alzheimer’s disease or Parkinson’s disease. We observed our cases and how they performed different activities. • We helped our cases for example to crafty or to play games.
Thoughts • We think that the place was very well designed and the elderly were arranged in a lot of different activities. • We think that this kind of place support also elderlys’ family wellbeing well. • Elderlys have good possibility to maintain their social contacts. Especially for lonely elderlys this is propably very important, because they can see and meet other people for this way. • Day care center's activities support elderlys’ functions well. It is important that elderlys can do things by themselves as long as possible.
• Teachers take account of everyone and they are kind, engaging and supportive for elderly. • We also visited the christian church, which also organizes day care activities for elderly. Activities are similiar like Xihu’s day care center but in addition there organizes differents croups like dancing and cooking groups. • In Finland there is also this kind of day care for elderly, but elderly do not go there every day just for example 1-3 times a week.
Nursing home & Health village at Chan Gung Memorial Hospital
Nursing home & Health village at Chan Gung Memorial Hospital • This was our last practice place and we spent there 2 weeks • we worked there monday to wednesday 08:3017:00 • Hospital and nursing home was far away from Gongguan, we went there by metro and two bus, one way took about 1.5h. • During our practice we visited nursing home, health and culture village and Chan gung memorial hospital, area was large!
Chan Gung Memorial Hospital • Hospital is private and not so crowded (compared- Shin kong hospital). Care is high quality and there is no long waiting periods. • Hospital have wide scale different kind of services, example surgical procedures, aroma therapy, sleep therapy, Chinese medicine, acupuncture etc. Taiwan health insurance does not cover these, the customer must pay for their own -This is the reason why there is no that much patients, not everyone can afford. • We visited that hospital but we worked mostly in nursing home, so hospital enviroment does not become familiar during our practice period.
Nursing home • Nursing home is large, here are seven floors. Floors are divided, example some floor have more active patients and other floor patients are with nasogastric tube, trachea, urinary catheter and they need more help. One floor is for hospice care. • Nursing home have three tempels, one is only for hospice ward • Patients have option to choose a single room, a double or triple room. a single room is clearly costly, but also very spacious and there is space if family wanna stay over night. Here is also possibility to import your own furnitures which makes the room cozy and more like home.
• Many patients in the hospital have a private caregiver who provides 24-hour assistance. • Patients have a lot of activity, that creates comfort and things to do, also makes elderly cheer up. Most popular of these seems to be a karaoke! that is not so common in Finnish nursinghomes. There is also lot of nursing students and volunteers in that nursing home, who have time to create activities. • We saw that the nurse does not participate here as much clinical nursing. She observate the treatment and the patient's condition and interview the patient,she also do lot of paper works.
• We worked with nurse, doctor and pt, ot, st. We visited every floor in nursing home. Most of the time we were with nurse and we saw many pressure wounds and wound care, patients nutrition and taking blood samples. With the doctor we followed acupuncture treatment, that was new for us. In Finland acupuncture treatment is not very common, some private clinics can offer that, and that is expensive. Physiotherapist introduced us rehabilitation room and he showed how the equipment works.
Health and culture village • Village is designed for elderly people. There is about 600 residents. There is a lot of space and easy to move indoors also with wheelchair. Most elderly here are independent and basic healthy. • There are plenty of activities for the elderly example karaoke room, gym, art room, temple, game rooms, canteen, laundry room etc. These activities support elderly funtions well! Also there is own small health center where you can have appointment with nurse.
• Elderly people can easily create new social relationships, what is great thing! It is good that elderly people can live in the same place so they can meet each other everyday and that also avoid loneliness. • There is just a great setting for outdoor activities. There is lot of different types of walking trails, vegetable land, landscape terraces, resting places. The only problem with the place we found was that the health village was a very hilly place and wheelchair users may have problems with independent movement.
• All in all this practice place was rewarding and we saw a lot in a short time!
The End.