Three emails sent to Prof Chan in 2010

August, 2010

Dear Sophia,

My name is Samson Lau, a year 2 student studying in BNURS. I got fail in both formative and summative sections of nursing practicum IIB. I just observed some problems happened in my summative practicum. I admitted I did quite poor in the practicum and it is necessary for me to defer in coming academic year. The purpose of this email is to express what I saw and what I heard in those three weeks.

A clinical instructor asked me to observe classmate B’s skill on wound dressing, but his ability in aseptic technique was weakened under the observation by two students including me. I observed that his transfer technique was not proper. Then, the clinical instructor said classmate B always had error under observation. Is it an excuse?

I have not passed the aseptic technique in my last practicum of year two. The clinical instructor asked me to handle a relatively complicated wound. The patient has MRSA infection. I had to wear PPE and middle-size disposable gloves (but my hands are too large to wear) throughout the procedure. As you know, I have to use alcohol hand rub before donning the disposable gloves. Usually, I pressed the alcohol hand rub bottle for two to three times. It took me a relatively long period to dry. The clinical instructor always counted the time I used to irrigate and clean the wound. Therefore, I would wear the gloves before my hands were dry. Because the disposable gloves were not worn properly, contamination occurred due to the unfitted disposable gloves. Then, two clinical instructors (one is second assessor) taught me to press alcohol hand rub only once before wearing the disposable gloves. I think that it is not a proper way to disinfect the hands. All I want to point out is that it is really under pressure when two clinical instructors watching my errors in the whole procedure.

Classmate I’s aseptic technique is very poor. For instance, she put the forceps in the middle of the sterile field at the beginning of wound dressing. Even a year one student knows it is not a proper way to position the equipment. Luckily, she passed the final practicum (after practicing with clinical instructor later?).

In male Foley insertion, two classmates put on the sterile gloves incorrectly. They might be too excited as we do not have many chances to do this procedure. Besides, classmate M held the penis with sterile gauze and then touched other sterile materials using the same hand. I discussed with her mistake after the procedure but she said it's no problem as she thought that she just held the penis with sterile gauze. Also, a balloon should be tested before cleaning penis by Hibitane. That student did not do this step and the clinical instructor did it for him/her.

For AOM, many classmates admitted that they did not complete 3 check 5 right in preparing IVI. Classmate F said she prepared IVI faster than me because I completed the 3 check 5 right procedure.

I forgot to sign after administering medications for two times in the last practicum of year two. However, some of my classmates also had this careless problem but I am the only one to fail AOM.

I also want to write something about professional behavior. Classmate A spoke the full Chinese name of patient in the minibus. Is it a serious incident? Besides, some students watched TV in the ward because they worked so “efficient” in the orthopedic ward and ward staff complaint of their conduct.

Clinical instructor said I could not display good team spirit and cooperate well with colleagues. I was in charge of two to three patients in a particular cubicle. That cubicle had six patients and three students. I cooperated with them well. However, the clinical instructor required me to enter another cubicle and work with others. I just did not want to watch TV with them in another cubicle.

Actually, I have had bipolar disorder (mood disorder) since Form 2 and my left hand has the problem of tremor. I have told my clinical instructor the situation. I told my clinical instructor not to give me any privilege. At the end, she seems to require me to do better than other classmates. I do not want to blame anyone but I observed the problem of double standard. It is unfair to me.

Best regards,
Samson Lau
Year II, BNURS

Second Email sent to Prof Sophia Chan

Dear Sophia,

Firstly, I would like to write about my past experience in participating supervised lab practice. The clinical instructors just wrote "fake" physician's order right before I performed my poor clinical skills. Those lab practice only focused on nursing intervention/implementation. Pre-assessment, patient's general condition, charts (e.g. BP, I&O) and kardex information are not included in lab practice. Therefore, we cannot get the whole picture of the patient. There was only one task for one patient, but it is not the real case we faced in the hospital. Usually, multiple tasks had to be managed at the same time. Then, we had to prioritize those interventions and had to implement them in a step-by-step manner and in a systematic way. And it is the actual requirement of clinical instructors in the clinical setting.

Later, I heard that supervised lab sessions will upgrade to scenario-based supervised lab sessions in the coming academic year. I was glad to know the new strategy at the beginning. However, a clinical instructor told me that year 3 students would have lots of "score-related" clinical assessments. The ratio of clinical instructor to student will probably change from 1:2 to 1:12 (my approximation) just before clinical assessments. All I want to say is my learning will be disturbed heavily under this reform.

Reform without careful consideration will not success. I am sorry that I do not have enough intelligence to give any suggestion. September is coming, I guess everything will turn into a mess if no action taken. We are in the same ship, I do care about the future of HKU school of nursing. Feel free to correct me if I wrote anything wrongly.

Best regards,
Samson Lau


責任之推卸 無理的要求

早前我寫了一封信︰
Date: 11 April 2011
Subject: Problems that cannot be solved by myself only

Dear teachers,

I am a year two student studying year three non-clinical subjects because of fail of Practicum IIB. One clinical instructor said, "You are the most hardworking student in the group, but you really cannot load." That means I am not smart enough.

I have to take lithium sulphate to treat my bipolar disorder. The side effect of this medication is tremor. Dr. Tsoi, a psychiatrist, said lithium sulphate could not be stopped. He prescribed an anti-parkinsonian drug called Benzhexol HCl to reduce the tremor. However, my left hand shakes slightly even not under stress. Tremor does not affect my confidence, but patients may feel scared.

Dr. Cheung, a psychologist at CEDARS, said my illness was probably a physiological problem as my disorder started from Form two. My medications could not be stopped and I have to take these medications for my rest of the life.

Another clinical instructor asked me to be a nurse after handling my illness. Unfortunately, my sickness won't go away before my death.

Besides, I felt disappointed regarding the lab booking system. The reason is that it gives me too many constraints. We could not decide what to practise in the supervised lab. As I observed, not all the clinical instructors used the scenario-based teaching approach. Although I have no experience in OSCA examination, it only trains the working speed of students in my point of view. I have seen a year two classmates practising clinical skill for the OSCA exam. She ran to the white board to do documentation after finishing off-staple. In my opinion, students learn in an OSCA-based way. If the skills are not included in the OSCA exam, they would not practise. It was heard from a year two student. Last year, I could invite clinical instructors to supervise my lab. Now, I don't know if they have time to help me as the workload of clinical instructors is increasing. Two CIs told me their tiredness in their career.

As we all know, HA hospitals do not employ year two student to be TUNS. Therefore, I don't have any chance to improve my skill, knowledge and confidence.

I cannot foresee any hope if support is not given by teachers. I entered HKU by non-JUPAS admission. I failed Chinese Language and Culture in A-level. I studied associate degree for only one year. I even don't have an associate degree. If I fail in the coming practicum, I have to work in the society with the Form 7 qualification because I don't want to be a financial burden for my family. Study has to be postponed. I studied very hard to enter university and I don't want to quit university due to fail of practicum.

Regards,
Samson Lau
BNURS Year II

之後，我跟三個 teaching consultants、一個 assistant professor 會面。安撫之餘，他們要求我交一封醫生信證明本人的 health status is suitable for practicum. 醫生說不知道 placement 的requirement and demand, 不寫 suitable for practicum，只是寫了 suitable for study. 今天，我將醫生信交給相關人士，她卻說醫生信用字不夠specific. 她吩咐我今天致電診所，然後叫我明天以 IIb nursing practicum journal 內的 objectives 向醫生解釋，並請醫生為我再出信。其實，我一開始就不滿 School of Nursing 的做法。為何要一個 psychiatrist 負這樣大的責任？