Finnish government yielded to TEHY’s demands

Ok, I’m not much of a news freak, I have to shamefully admit that I have hardly been keeping myself up to date about probably the most followed news in Finland the past two months: the nurse’s strike here in Finland. Even though I as a nursing student and a member of the Health worker’s union TEHY…I should be freaking out about this.

Well…out with the news already YAY we are finally getting 24-28% higher salaries, by 2010… only for members of TEHY.

Now if I get my facts straight, let me fill in some more details. Tomorrow, Tuesday the 19 of november (actually…its way past midnight already but whatever) would have marked a terrible event. 1200 Nurses in Finland signed a piece of paper saying that they will QUIT their jobs if the government did not yield to TEHY’s demands for a (some % …can’t remember) pay rise. Now all these nurses were specialized, operating room, anaesthetists, medical nurses, surgical nurses, neonatal nurses, psychiatric nurses, mid-wives, ICU…..It would have been an utter catastrophe. Last week they started moving critical patients to Sweden and Germany.

But something happened last week Thursday night. The topdog decision maker, Finland’s Prime minister Matti Vanhanen was rushed to hospital…I think he was in acute pain or something and had Kidney stones. They let him go home again and he had to go back because of severe pain. Guess which hospital he was treated in? Meilahti hospital, Helsinki university’s key hospital. The very hospital that would probably have had to close tomorrow. Well… I’m sure old Matti got 5 star treatment there, or else our silly government would now be running around like headless chickens because of hospital chaos, and minus a prime minister. Can you, dear reader follow what I have been writing about by now?

Well, I really don’t know why how what happened for sure. I just know that my future now looks 28% brighter. If you would like to know more about this in Finnish check out the Hesari. I don’t know where to find news info about this in English….just google it.

I am very sorry that Matti had to fall ill, it is never nice to be ill. I actually happened to suffer from food poisoning and very high fever (I VERY rarely get a fever) on the exact same day (and had to miss that research and development exam…), what a coincidence. Anyway, I recovered, and I wish a speedy recovery to anyone who might be suffering the consequences of seasonal bugs and etc.

Something that made one of my friends frown was the snotty-nosed attitude of Tehy about its victory: They are very proud and or whatever happy that it will ONLY be members of Tehy that will be benefiting from the pay raise. Well…I mean, they fought for it, so I guess its only fair that they can have their cake, and gobble it down infront of the faces of the rest of Finland’s nurses who backed out of the strike. I’m not going to argue with anyone about this.

And now I go to sleep.

Health tip: Reconsider the very attractive offer of becoming prime minister in a country where the Nurses are unhappy about their pay check and you are to be deciding the fate of their salaries. Its very embarrassing if you end up being at their mercy in the ER.

Edit: Original health tip edited to more tongue and cheek non applicable to real life format.

References for ‘Psychogenic movement disorders’

Hinson V.K. , Haren W.B. (2006) Psychogenic movement disorders. Lancet Neurology, 5: 695-700.

Bauer M. , Boegner F. (1996) Neurological Syndromes in Factitious disorder. The journal of Nervous and Mental Disease, 184(5):281-288.

I would like to add that psychogenic movement disorders are divided into three diagnostic categories: ‘Somatoform disorders encompass conversion disorders (where physical symptoms are brought on by psychological stressors ) and somatization disorders (a multitude of physical, non-organic symptoms). Factitious disorders are associated with symptoms that are intentionally produced with the purpose of achieving some psychological gain, whereas Malingering is intentional symptom production for material (eg. financial) gain … Psychogenic movement disorders are commonly associated with other axis I psychiatric disorders, usually depression and anxiety’ – Quoted from the literature review ‘psychogenic movement disorders’.

I mentioned in my last post that I think it is important for nurses to learn how to understand and recognize these disorders. Now, I am talking of Nurses working and specialised in Medical or Surgical nursing. Nurses working and specialised in Mental Health would obviously be more knowledgeable when confronted with these patients. But The problem is that these patients would not always go straight to the psychiatric hospital, they would most often be admitted to medical wards through the ER. It is there that the medical team have to diagnose the problem and that a psychiatric consultation is made as soon as one of these disorders is suspected so that the patient can be helped as early as possible with intensive psychotherapy and rehabilitation. It is my opinion, based on the evidence in the above articles, that Nurses specialised in Neurology should be well prepared to deal with such particular cases, as there are often close links with neurology and the symptoms presented by these disorders.

Psychogenic Movement Disorders

Everybody who has watched shows about doctors and hospitals has at least once come across the famous Münchausen syndrome.

A psychiatric disorder where the patient basically fakes his/her symptoms in order to be admitted to hospital, maybe makes this one of the most interesting disorders and therefore no wonder why it is used in medical TV shows (no wonder as to why I am writing about it now).

The first time it actually grabbed my attention was when I happened to watch my first and only episode of Grey’s Anatomy. I can’t remember the exact episode, but there was a female patient who was a neuropharmacology expert thingie (not sure about that term), who took a substance Amytriptyline Hydrochloride (a tricylclic anti-depressant drug) in order to apparently induce an adverse side effect: Ventricular Fibrillation. She was diagnosed with Münchausen syndrome. Now what furthermore aroused my curiosity was that they found proof that the attack was induced when her urine was found to be blue.

Now HOLD it there…

blue urine…tricyclics? Ventricular Fibrillation? Well, obviously, those things do not all add up, as we all know and love TV, the things they show us should be administered with a proper dose of table salt (I prefer NaCl 0,9 % sterile…but it’s a matter of taste in humour).

As it turned out, I searched the beloved Web high and low for more information on that episode, and finally found what I was looking for here, but I am not sure myself how reliable that information is….

Anyway, there are certain substances that turn urine different colours, like some tuberculosis antibiotics, and methylene blue, but not tricyclic anti-depressants. According to my donated BNF 2005, serious side effects of that particular anti depressant can cause sudden cardiac death, in overdoses…but no mention of blue urine (how disappointing).

I then turned to the next item on my ‘research list’ which was Münchausen syndrome. Wikipedia had some rather useful info in layman’s terms, which sufficed for quick orientation. What brought me back to this subject though was this very interesting case that I met at my favourite ward (a neurological ward in the university hospital) when I was filling in an evening shift:

A young patient was exhibiting weird ataxic-seizure like attacks involving only the torso, had paraparesis (could not walk) in the lower extremities and lower back pain. During the evening shift report, the physiotherapist gave her evaluation, which coincided with the nurse’s suspicions: The symptoms were probably being faked.

The reason they believed so was that the attacks could not be linked any organic findings (deep tendon reflexes ok, no signs in MRI scans), and the symptoms were not consistent.

That was when I dug into my brain-pockets to recollect my recently acquired knowledge in Münchausen syndrome.

I suggested to my colleague that the patient’s symptoms and behaviour might be related to the above mentioned syndrome. She agreed and further mentioned that she has seen epileptic patients faking grand mal seizures, which is called somatoform disorder, or conversion disorder, where the mind can induce real symptoms.

We decided to consult Ovid, and I typed in the keywords ‘Neurology’ and ‘Munchausen syndrome’, I combined the searches with ‘AND’, and I think I got something like 10 articles. I managed to print out a few abstracts that included an article ‘is that patient faking it?’, unfortunately I can’t find the full references to those articles anymore, I think I gave the printout to my colleague.

However, I later did the same search in Pubmed, and I found some very interesting articles, that I thought very useful: ‘Psychogenic movement disorders’ and ‘Neurological syndromes in factitious disorder’. The former was actually a literature review, and the latter a quantitative study of the frequency of the occurrence of factitious disorder in one particular hospital’s department of neurology (Freie Universität Berlin). Now, I am no expert (yet) in research articles, so I would not recommend taking every word and every finding I read as the absolute truth, but I think that these articles gave me a clearer understanding of how the disorder works, and how to recognize it. References for these articles and further definitions can be found here.

What I was more concerned with, was how do we, as Nurses, recognize and treat this group of disorders? It is very rare, but when it does show up, causes pure mayhem and because of unnecessary invasive tests and other diagnostic techniques, becomes a costly game.

When I observed this young patient, it occurred to me that there is probably a reason why he/she is doing this; that if I present an attitude of ‘oh stop being a nuisance, you are just faking it’, will only create mistrust and frustration, and will not help anyone. Probably, the attacks are real, and the pain is real, to the patient.

I was wondering, how should I confront the patient, so that I can be supportive yet not encouraging the symptoms, and gain the patients trust, so that I can get to the bottom of this?

Not very easy at all.

I have not had any shifts since, at that ward, so I don’t know what happened. But it left me wondering what I could have done more, or said, to help the patient and the doctors to get closer to the answer.

I will do more digging in Ovid, and hopefully I will find some articles or information that deals with the nursing side.

For now…I should really start reading for my research and development exam next week. And then surgical nursing, and then medical equipment, and then neurology, and then drug and pain management, and then anaesthesiology, and then geriatrics…and then I fly to South Africa!

Health tip: Drinking large amounts of caffeine after sleeping only a few hours the night before does not increase concentration levels during exam writing.

Update: I found out a few months later that the patient was diagnosed with a Psychosomatoform syndrome.

An ode to Toenails

An ode to Toenails

Hidden between the damp darkness of the unsuspecting sock and the solemn habitat of the cuticle, thrives the Toenail.
Hated, misunderstood and persecuted, the Toenail has to suffer much throughout its lifetime. Cruelly it is severed as soon as it reaches the length of maturity.

No, says the toenail.

Must thrive. Must grow.

With eagerness, the cells begin to divide anew. The battle is not over yet!
‘Divide, divide, divide…’they call. They will not be beaten. Forward they push with great effort and slowly there emerges a front of fresh keratin. Triumphantly the Toenail shouts to the world ‘I EXIST!!’.

Its newly arrived presence does not go unnoticed.

Little does the freshly weaned Toenail know, the enemy is waiting. Gleaming and keenly sharpened, the clippers grin in their case with their sinister purpose.
The time has come. The turn of fortune lies against the protruding nail.
With glee the clippers cry

‘Cut we can! Cut we must! Cut we will!’

And with one foul swoop the clippers are taken up, their course set straight for south.
The toenail, though it has had its season, knows it cannot withstand its fate.
Paralysed with horror, subjects itself to its sentence.

Cut!

Quickly and neatly, the toenail is reduced to its pink borders. The grey remnants of a masterful effort fly forth with one last stroke of resistance.
Haphazardly their remains that litter the plains,
are scooped up and thrown away.

_______________________________________________________________________________________

Based on a challenge ‘Toenails’ for a free writing exercise during the course ‘verbal, written and web based communications’.

I decided to take it a bit further when I happened to find some spare time at home, and thus could not rest until I had photographed my toes and written the above prose.

Photography, photoshop editing (partly, I had some help with that) and writing by me.

Now who said there is no fun in Nursing?

Health Tip: Avoid cutting toenails too far (or cutting the edges round), as the toenail can grow into the flesh (ingrown toenails).

This can also be found on my art web-page: YoungLass

tragedy

A quick note:

Yesterday, Wednesday the 7th of November, 18 year old Pekka-Erik Auvinen opened fire in his school in Jokela, Tuusula (50 km north of Helsinki), killing eight people, before shooting himself in the head. The victims included the school’s principle, the school’s nurse and several students.

There are plenty of news feeds everywhere, just click on bbc, cnn and read for yourself. I am deeply shocked, and my sympathies and prayers go out to the entire nation, especially the friends and relatives of the victims.

The Helsinki newspaper Helsingin Sanomat has the most up to date news on the matter: http://www.hs.fi/

Everybody has been pointing fingers at America, whilst right under our own noses we have foul intentions brooding. This is the first incidence of its kind in Finland. And I really hope that it is the last.

Peace in Christ.

Siunausta.

Anja.

Update: according to wikipedia.org, there has been a shooting incident in Finland in the past: ”in 1989 at the Raumanmeri school, in Rauma, when a 14-year-old fatally shot two fellow students. ” sheesh…I’m speechless…

What is the Anamnesis?

Pronunciation: an-am-n-ss
Function: noun
Inflected Form(s): plural -ne·ses /-sz/
1 : a recalling to mind
2 : a preliminary case history of a medical or psychiatric patient

- Medline medical dictionary.

Alright. This is my very first Blog entry. I shall do myself the honour and pat my shoulder and say, good job: I have officially given the Internet my little finger.

Well, aside from Internet and phalanges, I should share some more information about the setting of this manuscript: A dark and gloomy afternoon, in a distant and far away mystery city that few within the geographical range of North America have knowledge of. Snow is falling outside slowly to the wet ground and I rather appreciate the warm comfort of the four walls in my student flat. I am in Helsinki, enrolled in my second year at the Helsinki polytechnic in the English degree programme in Nursing. So far, my classmates and I have completed two clinical practices, the first being basics in clinical nursing, and the second in Internal medicine. My medical nursing practice I completed in a Neurological ward in the Helsinki University Central Hospital, Meilahti. My summer was spent at the very same ward, working as a practical nurse. Hence, I have developed a particular fondness for neurology.

Right now we are finishing off courses in Surgical and Perioperative nursing, research and development, Internal medicine and Pharmacology II (neurology), Drug and pain management III (Intra venous medication), Professional English and health promotion. I can’t think of what else there is. Everyone is excited about the oncoming surgical practices that will be happening next January. The surgical placements available to us are in Orthopaedics, Urology, Gastroenterology, Oncology particularly Mastectomy surgical units…and the rest I cannot remember either.

Life as a nursing student at the moment is not very easy, because I and many of my other class mates are working while studying. Most of us who work, do bank nursing in many different hospitals and nursing homes. I personally find it very useful to work as a bank nurse because I find it connects the theory of the class rooms with the practical part of nursing more easily. Our practices are so short and as soon as you feel you know how the ward works, you have to leave.

Then again, in bank nursing it is not any better. I have worked in a different ward every single time, and each shift has begun with the questions: ‘May I please have a report?’ (the nurses who receive me don’t usually have the intelligence to think that I would need to know what is going on before I can change those diapers), followed by ‘What is the rhythm of *that particular shift*?’ (different places serve food at different times) and then inevitably: ‘Where do I find *this or that particular item*?’

For some stupid reason, I decided to be absolutely mad and I did four shifts within five school days. This was because I panicked when I saw my dentist bills and phone bills, and the prognosis of the upcoming nurse’s strike… I did not realise that what I was doing was detrimental to my well being until my last shift on Wednesday. It was not a particularly enjoyable evening shift because of the following events:

I arrived there just in time. It took a while for a member of the staff to react to my introduction and my question as to where I could change. When I was changed and ready to engage my skills, no body knew who I was (or that I was supposed to be there) and they looked at me with confounded expressions. I was taken to the ward manager, who was embarrassed and did not know where I was supposed to work. A few phone calls later (I phoned my recruiting agency), it became evident that I was at the right place, and that I was to replace TWO people who cancelled their shifts. I was to work in two units, hopping to and fro, in a ward that I have never worked in before. When I presented myself to the nurses, no one wanted to give me a report because I missed the general one while the manager was trying to figure out my presence at the ward… Yes, I came home tired and grumpy. And I was tired and grumpy the next day during the early morning lectures.

Then there is the issue of this aforementioned strike. Yes, the nurses in Finland are very disgruntled about their salaries, and after a demonstration and negotiations, almost 12000 Nurses have signed a piece of paper (or rather several pieces of paper) stating that they will resign from their current employment by 19th November, if the government does not yield to their demands. Because I am a member of the Health worker’s union TEHY, I am not allowed to work when the said strike will take place. The ministers are all running around like headless chickens and the nurses are shouting ‘more money! more money!’ while patients are probably going to die, and I will become a poor sod who’s daily diet will consist of oat porridge and have bills piling up. Now that is the pessimistic view of the situation, I have to admit, but I cannot help it because my brain is probably saturated with melatonin. I just blame this whole mess on Scandinavian winter conditions and ignorant politicians (seriously, if you ever aspire to being the most unpopular person in your country, you should really consider politics).

Maybe the way to solve this would be to buy one of those bright lamp thingies that radiate UV light and, maybe, just maybe, we here will be a little less depressed and we can all go back to work, changing diapers and being unpopular.

Actually, I would not mind getting a better pay check after the long and arduous effort of my studies. So, I say ‘yay!’ to TEHY, and ‘yay!’ to Ms Nightingale too, for if it were not for her, there would not be the career of Nursing as we know it. I can hardly say ‘yay!’ to our politicians, for they have really had enough time to think about our salaries.

That was my opinion-riddled Anamnesis of Nursing in Finland today. Thank goodness Normal Saline comes in 1000ml bottles.

Peace!

Health tip: Avoid eating yellow tinted snow.