Lee Pui Kei

MPI Exchange student to Coimbra Nursing School, Portugal
Internship in the Bachelor of Sciences in Nursing


Summary in 6 weeks at Health Center

Time pass fast, our 6 weeks practice in health center at Coimbra was already finished. I really enjoyed so much the time there. In Macau, I never had my practice in health center. The knowledge of community nursing and the structure of health center only came from the lectures and my experiences when I went to there. After I had the community practice in Coimbra, I firstly realize the big differences of the way of nursing and care between hospital and community. Though, we have already finished different practice in different units (for example: medical-surgical ward, pediatric ward, maternity, mental health department, geriatric ward etc), we had this practices individually. That means we only need to focus in one specific area in one time. However, in community health unit, we meet them all at the same time. It really requires lots of health knowledge and lots of communication skills in order to interact and provide suitable health educational advice to our clients.

There are different unit in the health center to provide different services to the citizens. The unit that I stayed in was the Personalized Health Care Unit. In the following paragraphs, I would like to discuss what I have observed and learnt in these services.

Diabetes outpatient service

Chronic hyperglycemia is associated with an increased risk for cardiovascular disease. Therefore, health professionals should aim to optimize not only glycaemic control but also manage blood pressure, cholesterol and smoking cessation in an attempt to reduce the rate of diabetic macrovascular complications (Martin T, 2011).

Before the patient has the diabetic consultation with the doctor, he must go to the nurse’s office and do some examinations. It includes measuring the height and weight (for checking the body mass index, BMI), the waist and hip (for checking the waist-hip ratio, WHR) and other examinations such as checking the food pulse and the sensation of the foot. All these examinations are for the doctor to evaluate the progress of the disease. Aside from the examinations, the nurse might also give some health education to the patient. It might be the education for the diet, the high blood pressure, the exercise or the wound care etc.

Moreover, I believe The Portuguese Government must put a lot of resources for the diabetic patients. For example, the blood glucose monitoring machine is free to provide for the diabetic patients. I think this is good for the patients who might not afford this machine and the test paper for the blood glucose test. However, it is very important for them to check their blood sugar level before or after taking medications or insulin injections.

Home care

The Health Center of Macau does not provide any home care service, so the home care service in Coimbra is a very good experience for me. Home care service might ask by the client or the client’s family, doctor or nurse will then assess the situation of the client. If the client is lack of the ability to go to the Health Center by himself, he will then receive the home care service from the Health Center. The home care service might be wound care, assess the blood pressure, or even change the urinary catheter for the client.

One of the home care clients that I have encountered was an old lady with the wound on her arm which was burnt by hot water; another client was an old man who was suffering from diabetes and has ulcers on his foot. One interesting thing for this old man was the nurse was trying a new method to care of his wound, that is, to put betadine with sugar on his wound.

There are small part of references suggested that the best way to heal any open wound—including burns, lacerations, scrapes, bedsores, and diabetic ulcers—is to use sugar on wounds for healing. When sugar is packed in a wound, it creates a highly concentrated medium where bacteria cannot survive. Sugar also reduces swelling, encourages the removal of dead tissue, and promotes the formation of connective tissue and new blood vessels. The net result of using sugar on wounds is rapid healing with minimal scarring (Julian W , 2014).

Family planning

Family planning services can help address these and other public health challenges by providing education, counseling, and medical services. Family planning services include the following:

(Loretta G, Susan M, Marion C et al, 2014)

  • providing contraception to help women and men plan and space births, prevent unintended pregnancies, and reduce the number of abortions;
  • offering pregnancy testing and counseling;
  • helping clients who want to conceive;
  • providing basic infertility services;
  • providing preconception health services to improve infant and maternal outcomes and improve women’s and men’s health; and
  • providing sexually transmitted disease (STD) screening and treatment services to prevent tubal infertility and improve the health of women, men, and infants.

At first, I am not so sure the contents of family planning service. Since in Macau, family planning is not so well known according to the cultural background. After doing the research about it, I start to understand what family planning is. During the practice, I have observed the pap smear screening, the contraceptives health education etc. If someone asks me what family planning is in the future, I think I can answer him correctly.

Vaccination

The vaccination schedule is designed to protect young children before they are likely to be exposed to potentially serious diseases and when they are most vulnerable to serious infections. Children continue to get several vaccines up to their second birthday, these vaccines do not overload the immune system. Vaccines contain only a tiny amount of the antigens that your baby encounters every day, even if your child receives several vaccines in one day (Vaccines and Your Child's Immune System, 2014).

The following two pictures show the immunization program in Macau and Portugal. I think most of them is similar. Although HPV vaccine was not shown on the Macau schedule yet, the government has announced that HPV vaccine will be provided to the children who are under 18 years old.


Macau Government information Bureau, 2007

Programa Nacional de Vacinação, 2012

Conclusion

Macau and Portugal has a big Cultural difference. Every day, we encounter lots of client. Unfortunately, I cannot speak Portuguese. I think communication is very important between the nurse and the client. We might sense what they need through a good conversation. Luckily, I had a very friendly Portuguese student, Daniela, and a kindly nurse, Emfermeira Céu, who would try their best to translate the conversation to me. So that I can understand what is going on with the client. Furthermore, they also do all they can to answer my questions about the service in health center. I am so touching to have them in my practice in Portugal. They make me feel so warm there.

Moreover, I also would like to thanks my sweet Professor, Marina, always care the needs of us. Thanks for providing many activities to let us adapt and experience the life in Portugal. Some of the activities are so meaningful, such as the home visit. We have visited the elderly who live alone. We helped them to take blood pressure, ask some questions (scales) to evaluate their situations. We also observed their living environment and suggested some safety facilities to them. We also had a very interesting health education program in Coimbra. We have talked about the healthy food and exercise to the primary 2 children. The children are so cute and active. During the presentation, we have provided some healthy snacks (fruits) and a dancing time with them and they looked enjoyable! I love my practice in Coimbra so much. Time pass fast and it is time to leave. However, all my experiences here will always in my mind. It really expands my worldview and I have learnt a lot!
References:

> Anonym. (2007). Retrieved from Macau Government information Bureau
> Julian W . (2014). Sugar on Wounds for Healing. Retrieved from DrWhitaker.com
> Loretta G, Susan M, Marion C et al. (2014). Providing Quality Family Planning Services. USA: Morbidity and Mortality Weekly Report (MMWR)
> Martin T. (2011). Chairside assessment of peripheral arterial disease in diabetes patients. British Journal of Community Nursing, 24-33.
> Programa Nacional de Vacinação. (2012).
> Vaccines and Your Child's Immune System. (2014). Retrieved from Centers for Disease Control and Prevention.