INTRODUCTION
For my spring 2012 internship I contacted the volunteer department at UPMC Shadyside so I could expand my knowledge of a large scale Emergency Department, and continue accumulating health care hours. After speaking with the head of the volunteer department and checking their available spots with my schedule, I was able to schedule four hours every Wednesday evening from 5-9pm, starting on January 11th.
With 15 different hospitals spanning across western Pennsylvania, UPMC is one of the largest and well known health care establishments on the east coast. Established in 1972, the Shadyside branch of UPMC has around 1000 primary care physicians and specialists on staff, and is a 520 bed hospital. Aside from the medical care provided, which includes many specialties such as cardiology, oncology, and endocrinology, the hospital is also a sight of continuing education for nursing students, medical school students and residents.
The volunteer department takes on many different responsibilities at the hospital in a wide range of areas. The patient floors, emergency department, reception areas, mail department, and nursing and physical therapy departments all rely on the assistance of volunteers for smooth operation. Volunteers are divided into three age categories; teen, college aged, and adult, and while all ages are able to volunteer in each department, the patient interaction areas are mostly given to those enrolled in a healthcare related field at a university.
Throughout my time in the emergency department I will try and maximize my time there by learning all I can about the process of how the ED is run, how each staff member plays a different roll, witness as many medical procedures as I can, and learn any medical terminology I pick up on.
ED LAYOUT AND RESPONSIBILITIES
My orientation/training day took place on Jan. 4th and consisted of getting my I.D badge, volunteer jacket, and then meeting with one of the nurses for my training. My trainer, Courtney Schlosser (RN BSN), first took me around the perimeter of the ED and showed me the patient entry, as well as the two card access only entrances. The ED in the Shadyside branch is divided into three separate areas, a blue, yellow, and green zone. Aside from being in physically separate areas, they house different categories of patients. The blue zone houses the acute trauma area, the yellow is for general holding and care of patients, and the green is for more stable patients who are being held longer. At the center of each zone is the nurses station which houses many of the computers that the physicians, techs, and nurses utilize. My main areas of involvement would become the two different store rooms that housed various supplies (gloves, surgical masks, cleaning supplies, bandages…)and the linen closets which stored the sheets, blankets, pillows and covers. My main responsibilities as a volunteer would be to make up all the beds in the rooms as well as out in the hallways, check in with patients and ask if there is anything they need, and general restocking (which includes the glove/mask/apron holders in the hallways, the blanket warmers, closets in the rooms, cleaning stations, and kitchen area. After my first couple weeks of getting used to the layout I began taking on more responsibilities. I began collecting the full linen baskets from around the ED and transporting them to the store room, help the nurses take down and clean the rooms after the patients were discharged, and physically transport the patients out to the waiting room or to their cars once discharged.
TERMS AND PROCEDURES
One of the first things I noticed about the ED was the amount of different positions there where.
APCT – Advanced Patient Care Technicians, acted as a nurses aid whose duties include taking vital signs, basic patient care needs, as well as supervised medical interventions.
Nurses – Include nurse practitioners, registered nurses, and the charge nurse. Take on the bulk of patient care, make up the largest portion of the ED staff.
Xray and MRI Tech – Responsible for taking the mobile x-ray units to the patient rooms when needed.
Transport service – takes patients to and from any test that is needed outside of the ED.
Physician Assistant – While not always on the floor, the ED PAs will take on many of the responsibilities of the doctors, and may clean and sew up wounds, make diagnosis, set fractures, and perform other basic procedures.
ED Physician – There is normally two or three physicians on staff going throughout the ED, they are responsible for the primary diagnosis of patients coming in, and any advanced procedures or operations that must be done.
COMMON PROCEDURES OVERSEEN/TERMS HEARD
MI – myocardial infarction, or a heart attack, wasn’t able to view the treatment of this patient, closed door.
Catheterization – Using a tube to insert into the patients bladder (or sometimes vessels) to open the passageway or obtain a specimen. While not being able to be in the room for these, there were several instances of the APCTs performing this procedure.
To start an ‘Infusion’ – This is the process of starting a patient on an IV fluid drip containing 5% dextrose mixed with saline solution. Often performed to patients with blood loss or dropping blood pressure.
Failure to Thrive – A child who came in with a fractured arm was also found to have this condition which describes a state of physiological decline due to underlying nutritional or disease causes.
Oral Intubation – Process in which a breathing tube is inserted into the mouth so as to ensure proper delivery of air. Many of the more serious trauma patients had to be intubated.
NPO – Term used to describe patients that are not to receive any food or liquids by mouth.
Cystorrhexis – Rupture of the urinary bladder.
Hematuria – Blood in the urine, patients with this condition often have a urinary sample taken for lab analysis.
Gastralgia – condition involving stomach pain.
EXPERIENCES
Throughout my time at UPMC Shadyside I have dealt with a wide range of patients and staff members. Most of the patients coming through are not seeking care for life threatening conditions, but rather routine sickness, fractures, and many admittances from neighboring nursing homes for the elderly.
Some interactions have stuck with me more than others, one being the case of an elderly woman who had come in due to repeated dizzy and fainting spells. Due to a heart complication she had been kept for an overnight stay but was not too happy about not being able to go home. While on my rounds at the end of my shift I stopped in to see if there was anything I could get her and ended up talking with her for almost an hour. It occurred to me that many of the patients who are admitted, or come in by their own decision, are simply nervous or lonely people who just want someone to comfort them. Often times the EMT’s drop the patient off, they are quickly seen by the nurse or APCT, sit alone for hours, then are seen by the physician. All this time they are unsure about their condition or current location, especially if they are older. This is where I felt volunteering was most rewarding, being able to come in and just talk with them for a couple minutes seemed to comfort many patients, especially this elderly woman.
Sometimes the most difficult part of the job was not dealing with the patients themselves, but the guests of the patients. One such incidence was when there was an admittance of an elderly woman who was in for recurring pneumonia and other health issues. Her daughter had come in to be with her mother, and had received news that she most likely would not pull through the night. In situations such as this one I just try to offer the visitor whatever I can that would comfort them, in this case it was just a cup of coffee. The woman seemed to be genuinely grateful for the drink and some sympathy, another time when I felt as though these little acts could make a difference for some people.
CLOSING THOUGHTS
My experience at UPMC has been different than any other volunteer position I have held, both on patient floors and in other EDs. This was by far the largest and busiest hospital I have been in, and gave me new appreciation for the work that goes into getting a patient in, diagnosed, treated, discharged, and on their way. Many of the days were hectic, especially when the computer system crashed and all patient info had to be logged by hand, a couple were calm. But each day presented me with something I had not experienced or seen before, be it a medical procedure or the story of a patient, and each day served as a learning experience. While I plan on continuing my volunteering, I will most likely do so in a different area of the hospital so as to learn as much as I can from a different environment and gain a better grasp on how the hospital functions as a whole.
