NURSING CARE
Nursing care which is the pride of our nurses at home in Europe is not a priority of the nurses here. By culture and tradition the nursing care is done by the relatives. All patients need to have at least one relative admitted with them to take care and look after them during the hospital admission. Our nurses do all the technical parts as giving injections, setting up intravenous infusions, changing dressings and administrating medications etc. To look after the well being of the patients however is not considered to be their business. Washing and feeding the patient, giving bedpans and emptying drain and urine bags are done by the relatives.
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When making my rounds in the morning I have learned to relay on the relatives for crucial information as the occurrence of vomiting, passing urine, stool or gas etc. Sometimes it can be confusing when the patient and the relatives denies any vomiting, but the other patients and their attendants interfere loudly “Oh yes – she vomited three times!” No privacy there! The relatives are also responsible for mobilizing the patients and giving the microscopically seeds of a very basic physiotherapy.
The relatives being farmers without any education or medical knowledge their nursing is not exactly what we dream of, and many times strange things do occur. How many times have I not found the patient at the morning round in a bed socked with urine because the catheter was disconnected from the tubing.
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According to the culture the passive role as patient is taken very seriously, meaning that the patient has to stay in bed until complete recovery or death. Even feeding by hand is most often done by the relatives. Many patients come with completely preventable bed sores and/or contractures after lying in bed at home with simple diseases as measles or pneumonia.
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It took me almost 5 years to reduce the number of days as inpatient (bed rest) after hernia repair from one week to zero as today. It looked impossible to implement the surgery as daycare without being admitted, but we succeeded. Now more than 50% of all surgical procedures are done as outpatients.
I happen to have the first edition of Orthopedic Surgery written in my native language. It was published the same year as I was born, 1947. In that book it is stated firmly that after surgery for “hammer toe” (a very minor surgical procedure) the patients should rest in bed for one week. Today it is being done in local anesthesia as day care surgery. So times have changed back home too.