Medical Personnel Training Program

Weekly Report- Week 3

Name Eka Firmansyah Pratama
Nationality Indonesia
Duration Monday To Saturday
Changua Christian Burn Center – 62
Host Hospital Department
Hospital Ward
Program Experience
Monday, 02/12/2018
 Early this morning we were orientated around the burn center room
by one of the room nurse staff.
 In this room there are 6 treatment rooms and 1 operating room and
one room for washing patients.
 The shift in the room is done three times a day, morning, evening
and night. in the morning starting at 08.00-16.00 PM, afternoon 16-
00.24.00 AM and evening 24.00-08.00 AM.
 There is also a drug storage room that contains all equipment for
wound equipment along with medicines and fluids.
 In this room for documenting patients using the same work desk
What did with another room that is all patient data entered into a computer
you do and system making it easier to organize patient data that includes patient
learn this development from day-to-day, treatment / treatment changes or

week? subsequent planning to be given to patients.

 There is one special room for cleaning patients, both bathing and
providing therapy. For bathing or self-cleaning patients in this room
do not use ordinary water but use special sterile water, so as to
minimize the occurrence of contamination with ordinary water
which may contain bacteria that can endanger the patient's wound.
In this room there are 2 beds, the usual bed which is used to bathe
patients and hydrotherapy beds. this room is sterilized twice a day.
 Inside the burn center room there is 1 board in the room specifically
bathing or cleaning the patient, this board is used to write treatment
changes to the wound and the development of the patient's wound,
the nurse usually writes on the board shortly after doing wound care
 to the patient.
 The patient in this room showered using Cussons Baby soap, after
completing the wound bath the patient applied a body lotion
(aloevera) which was used to moisturize the patient's wounds, the
patient's family applied body lotion to the patient on the patient's
back (wound area). and after that the patient's family dried the
patient's hair. The process remains in the monitoring and controlled
by the nurse.
 The nurse takes us to a room that contains all the wound equipment
including fluids, dressing tools, fluids, and storing medicines for
patients.
 The nurse shows one of the tools from the wound care, Mepitel is a
dressing (plastic dressing) that contains anti-bacterial. in its use this
plastic is washed every day and every 3 days is replaced with a new
one, but the price of these dressings is very expensive, so the use
depends on the patient
 In this room in certain patients carried out eschartomy in order to
make blood flow smoothly, the doctor cuts the blood water so that
the blood becomes smoother and prevents the wound from
becoming necrotic and prevents decompression.
 Observation nurses make dressing changes to electronic wound
patients. The index finger and middle finger of the patient's right
hand are amputated and a skin graft is placed on the patient's right
thigh and attached to both amputated fingers. on wound care the
nurse first prepares the tool to be used, then opens the fault, to treat
the wound using NaCl first to clean the wound of the patient, after
cleaning using NaCl, apply betadin and finally apply Silver
Sulfadizine cream to the patient's wound before wrap it with gauze.
 Observation of wound care in patients who have burns all over
their bodies, wound care includes:
- Prepare all the tools needed in wound care
- Greasing gauze with Silver Sulvadizine
- Gradually open the dressing gradually from the
hands, feet, and body.
- Clean the wound using NaCL,
 - While lifting dead tissue.
- Apply betadine only around the drain puncture.
- Apply Silver Sulfadizine cream in the area that has been cleaned.
- Close the wound using gauze that has been brushed with Silver
Sulfadizine.
- Tilt the patient right, then left so that the patient's back is also
cleaned.
- After using the gauze, it closes again using I-M which is useful to
cover the hands, feet and body, then connect using a large pin so
that all the eels are connected and closed.
- After the whole body is finished then open the dressing on the
patient's head clean the wound with the same liquid that is Nacl
- Lifting dead tissue.
- Close the patient's wound.

Tuesday 03/12/2018
 Observation of wound care in patients with facial and right hand
burns due to incidents of gas exposure at work.
 The nurse carries out wound care for the burn patient with the
same stage with the same equipment and preparation as other
patients.
- First opened the wound of the patient who was wrapped in gauze
slowly when opened there was a little bleeding in the patient's
hand
- Shrink the wound of the patient using NaCL,
- Apply Silver Sulfadizine to the patient's wound
- Closing the patient's wound using gauze that has been given
Silver Sulfadizine cream.
- close the wound of the patient who has been wrapped with gauze
using I-M.
- After cleaning the hand, the nurse cleanses the face of the patient
with NaCL and removes the exfoliated dead tissue.
 The patient looked grimace and was very sick, according to the
statement he had received morphine therapy but did not really work,
he still felt very sick during the wound treatment.
  On the wall of each room there is an emergeny button that is useful
for calling nurses or medical personnel in the room so that it can be
easily known by nurses if something happens to the patient.
 The nurse invited us to see the operating room at the Bund Center.
In this room there is one waste of patient beds and various kinds of
expensive surgical instruments.
 The nurse said that in this room to do the nurse's nurse's nurse refers
to the BSA (Body Surface Area) assessment.
 Observation of wound care in burn patients throughout the body
with the same method as before, namely :
- Prepare all the tools needed in wound care
- Greasing gauze with Silver Sulvadizine
- Gradually open the dressing gradually from the hands, feet, and
body.
- Clean the wound using NaCL,
- While lifting dead tissue.
- Apply betadine only around the drain puncture.
- Apply Silver Sulfadizine cream in the area that has
been cleaned.
- Close the wound using gauze that has been brushed with Silver
Sulfadizine.
- Tilt the patient right, then left so that the patient's back is also
cleaned.
- After using the gauze, it closes again using I-M which is useful
to cover the hands, feet and body, then connect using a large pin
so that all the eels are connected and closed.
- After the whole body is finished then open the dressing on the
patient's head clean the wound with the same liquid that is Nacl
- Lifting dead tissue.
- Close the patient's wound.

Wednesday 04/12/1018
 Observation of wound care in head injury patients
 This head injury patient was prepared for a CT scan, the nurse
placed the Ambu Bag on the patient's bed as a breathing aid when
 traveling to the CT scan.
 The nurse shows us some way how and what they use to assess the
patient's condition in that room and showing wound images through
a computer
1. Monitor Assassment 6 P Namely :
- Pain
- Preassure
- Parasthesia
- Paralysis
- Pink Color
- Pulse (Doppler)
2. In electronic burn:
- CPK, MB
- ECG monitor, Urine
- Check BB
- urine PH (PH> 6)
3. Trauma and non trauma, intracranial pressure
- Manitol
- Glycerol
- 3% normal saline
- 60% position
- Semi fowler position
- Body temperature
- Co2 decreases (Ventilator)
 In the nurse station there is 1 special computer connected to the
monitor in all patient rooms that is useful to see the state of the
patient's monitor, especially the patient's vital signs so that when
something happens such as a vital sign decreases in one patient, the
alarm will sound and the nurse can immediately find out can
immediately give action.

Thursday 05/12/2018
 On the first day in this room like in the previous room we met the
head nurse on ward 62 first at the nurse station
 In the patient's nurse there is a lot of information about the education
 of the patient's head nurse explaining that this liflet will be given to
the patient when the patient is going home (discharge planning)
 We were taken to the patient's room to see a dressing change in
patients post opp hernia 2 days. tools used are:
- Gauze
- Cotton
- Betadin
- 2% clorhexidine
The nurse cleanses the wound using NaCL and then clorhexidine,
then greases the betadine then closes it again using gauze. Because
this patient is prepared to go home the next day the nurse shows
how to properly treat the patient's wounds and also shows the
patient's leaflet.
 The nurse explained about the consumption of the patient's diet ie
- Eggs
- Meat
- Milk
- High in fiber
- High in protein
After education the patient was asked to sign on the available form
which indicated the patient understood or not what was explained
by the nurse. Jika pasien tidak mengeri akan di jelaskan kembali
sampai pasien mengatakan sudah mengerti.
 In this room, health counseling is conducted every 3 weeks 1 time
conducted by patient-specific nurses.
 Assesment Wound Care (SOP)
 SOP Treatment for wounds
- Check order
- Washing hands
- Wear a mask
- Preparation of tools and materials
- Check the patient
- Check wounds (check for signs of wound infection)
- Teach how to treat wounds, if clean wounds only use NaCL to
clean wounds.
 - Discussion with a doctor if there is a change in wound care
(depending on the condition of the wound)
- Document into nursing records / patient progress
notes.
 Signs of infection
0 - There is no infection
1 - Skin ulcers, wounds in the tendon or deep
2 - Bones
3 - Sepsis
4 - Necrosis
5 - Amputation
 Nurses teach how to do foot soaking in DM patients and clean the
wound :
- Prepare betadin 1ml
- Warm water 500cc-1000cc
- Soak feet for approximately 10 minutes
- Clean the wound if there is necrotic tissue before it is inserted
into the water
- Wipe the patient's feet clean After foot immersion
- 1ml betadin and 20ml NaCl are mixed
- In treating wounds using gauze not too hard because it will affect
wound granulation
- Check pulse
- close the wound depending on the condition of the wound and
the doctor's assessment, can be 4-6 hours or 6-8 hours.
 This room has a manual that is used by all nurses to treat wounds.
 Explained that about the risk consists of level 1 patients can move
on their own, level 2 patients using wheelchairs, and level 3 patients
attached to wheelchairs.
 In providing nutrition to patients in this room always provides the
same therapy, namely Abbott (suplement) as nutrition for all
patients.
 The nurse explains the tools used in surgical wound care, namely:
1. Carbon gauze, usually used for postoperative patients in the
 stomach
2. Hydrogel wound dressing is usually only for laparoscopic
wounds which are useful for absorbing wounds.
3. B floid is usually given to patients 3 days before surgery
(electrolytes)
 In this room there is a tool that is used for respiratory therapy / lung
patients who when turned on the engine can provide a vibration that
serves to clean the airway, the tool is called Vest (airway clearance
system)
 In this room there is a device called Doppler that can hear the
patient's pulse.
 When we asked about the patient's oral medication that was often
used in this room and the nurse explained that the most important
patient's wound healing was only in nutrition and wound care.
therefore by maintaining nutrition (Diet) and proper and routine
wound care carried out it will be more effective and accelerate
wound healing than consuming drugs.
 Nurses said the majority of patients who entered this room were
postoperative patients Hernia, Laparatomi, Brain injury, Cancer,
Dm, Brest cancer and others.
 The nurse explained about an artificial device or blood vessel
performed by a doctor at an operating table called Port A which is
usually used for chemotherapy
 Ice Cold Packing - a place or container containing ice cubes that
serves to prevent swelling. Usually compressed 10-20 minutes and
given in 1 day 4-5 times. Ice cold packing is given after 2 or 3 days
after surgery.

Friday 06/12/2018
 This last day in the morning we start with observations around the
room to see whether or not there was wound care or the action given
by the nurse.
 Observation the nurse removes sutures in patients who have
postoperative wounds on their left chest. to remove these stitches,
you should pay attention to each space of the stitch whether there is
 or not a liquid in the form of blood or pus, if there is cleaning with
anti-septic. then dressing. treatment is usually done depending on
the wound condition of the patient can be 6-8 hours a day.
 Observation of Vent use in 80-year-old patients.
 Observation of removal of CVP, CVP line contains glucose and fat.
The use of CVP is better and safer than using intravenous which is
more easily infected. For removal of stitches it usually takes 10-14
days.
 In the afternoon we were invited to the 2nd floor nurse, on the 2nd
floor we were in a room with the doctor observing the doctor who
performed the examiner on the patients.
 In the afternoon we were invited to the 2nd floor nurse, on the 2nd
floor we were in a room with the doctor observing the doctor who
performed the examiner on the patients. on the sidelines of the
examination the doctor explained that Gastric Cancer is a disease
that is considered normal in Taiwan, the therapy given to these
patients is oral vitamin B12, Februs-14.9.
Some patients who enter also have Gall Bladder, Laparaskopy,
Cholestectomi, Breast Cancer. But the most entered are patients
with breast cancer. every patient who came they brought a card and
put it in one of the tools on the doctor's desk. The card serves to find
out patient data and information about the patient's development or
disease history.
The doctor said the examination was done to look at cancer by
mammography. This mammography examination can show the
form of cancer which is marked with a white spot and with this
mammography we can see the size of the cancer. This
mammography is preferred in patients aged 45 years and over, but
for 45 years or less it is recommended to use ultrasonography.

Saturday 07/12/2018
 On a very cold morning we went to Lukang Old Street which was
not far from the Dormitory Dapu. The air here is very cold and the
wind blows a little hard. in this place there are so many people
selling food, clothes, bags, shoes, bags, and interesting souvenirs.
 many tourists come here from various countries. we took several
photos together. in this place we bought some souvenirs to bring to
our country, I also bought unique souvenirs and attractive glasses.
in the afternoon we had lunch in one of the parks in Lukang Old
Street. In this place there are 2 temples or places of worship as well
as tourist attractions for tourists, buildings that are high and have a
very beautiful cultural style depict the culture of the community and
have a religious impression for followers of the religion. We took
photos together in front of this temple.
Burn Center is one ward that is not in my country, so I feel very fortunate
to be able to be in this ward having experience being able to see and observe
every action carried out by nurses and be able to see every tool used is very
How to high quality and valuable. and the skills of nurses and other professional
apply your health professionals. all that is equivalent to the salary of nurses who are

learnt on also very different from our country, and technology in our country that is
not as sophisticated as in this hospital, it also makes us interested in
your daily
becoming nurses at this hospital. I really like this hospital because the
work? Or
nurses and medical staff are very good here and I thank you for accepting
anything us to come and to get a lot of knowledge and information, I hope I can visit
you would this hospital later.
share Lukang Old Street is a very interesting place and recommended for tourists.
this place has a building that has a carved cultural pattern that is very good
so it is good for photo taking, and this place also sells lots of food and
souvenirs so it is very interesting to visit.
Treatment of wounds in each of these rooms is very good and uses quality
tools and dressings, also uses technology that is very adequate for every
action. In taking action in taking action it might be a little slow so as not to
surprise the patient, but it is possible because the nurse has many patients
Suggestions who must be done or given an action so that they look firm. But
and/or professionals in each have been very reliable and dexterous in taking action,

Complaints this proves that the skills of each nurse or other health worker cannot be
doubted.
Along the lukang old street, there is very little garbage available, we have
difficulty removing waste / used drink bottles so we have to carry garbage
everywhere, but after a long time we are still walking then we find a trash.