I recently had the incredible opportunity to visit several hospitals and neonatal intensive care units in China. I visited three hospitals in Beijing and two in Guangzhou City. First, one must keep in mind the population of Beijing, which is reportedly 20 million people! I was told there are about 178 hospitals in Beijing and 30 of those have neonatal units.
However, there are not many hospitals or NICUs in areas around Beijing, so even though there are an incredible number of people there, the health care serves a much larger population than that, when they can get to the health care. Most hospitals had both in patient and out patient services and were very, very busy. Doctors did not have offices outside the hospital and are employed by the hospitals or really, the government as they have socialized medicine. So, all those seeking any sort of health care come to the hospital. I did not get to visit a hospital that practiced Chinese medicine although one was pointed out to me. The ones I visited practice “western medicine” although in truth, a combination is practiced. Even in the hospital that practiced Chinese medicine, they do use diagnostic support such as x-ray, CT scan and MRI. They may also refer patients to western medicine practices or doctor. And in the western hospitals, some amount of Chinese medicine is practiced.
The neonatal units I visited varied from 20 beds to 400 beds! The Military Hospital in Beijing had two very large units with 200 beds each! There are no private rooms in any of the hospitals. One was a new hospital and new NICU in Guangzhou City but the rooms were large and what we traditionally call “pods”, open to a larger common hallway with the nursing station across from the patient areas. I visited the “acute” area where some babies were on ventilators, some on CPAP and some on no respiratory support. In this particular unit, the beds were quite old and made in China, although they looked very similar to the old AirShields incubators we had here in the US 20 years ago! The first unit I visited had some of the convertible beds (incubator to open warmer), brand new monitors and a very nice computer system for documentation, x-ray viewing and everything we would use computers for. That was the only unit with such modern equipment.
I learned, over the course of my visit, that the nursing workforce in China is a very young workforce. The average age of nurses is 30 years old. They have a variety of levels of education for nurses, including two levels of what sounds like a diploma program followed by a bachelors and masters program at the university level. It seemed that most nurses were studying while working, either for continuing education or to further their formal education, which would give them a promotion at the hospital, perhaps similar to our clinical ladder programs? They were all very eager to learn how things are done in the US and how they might improve the care they provide. I asked one of the nurses what the weight limit was for resuscitation and was told that most parents would not want the baby resuscitated if they were less than 700 grams, although the healthcare staff felt smaller babies could do well.
The nurses were very aware of infection prevention measures and so I was not able to enter all of the units. If I did enter, in most cases, I was required to wear a hair cover, shoe covers and gown. The nurses changed their shoes upon entering the unit. Lockers were available at the entrance where street shoes were left and the slipper-type shoes were slipped on for wear in the NICU. I did not see any alcohol hand gel, though but hand washing was generally important too. Most nurses wore hair covering throughout their shift, but in some hospitals, the nurses in the NICU wore nursing caps (some of you might remember the nursing hats!). I was informed that the number of stripes on the hat indicated their position i.e. the head nurse had two stripes, nurses who had completed the second level of diploma education had one stripe and those who had only completed the first level did not have any stripes. The nurses worked very hard, although from the information I received, they only work an 8-hour shift. I saw them emptying trash, putting new water bottles up and many other sorts of things, in addition to patient care. At least in some hospitals, the nurses mix the IV fluid, including TPN, in the unit. Overall, nursing practice seemed very independent. Physician orders are not needed to place a PICC, for instance. At least in some hospitals, it also seemed that the nurses mixed the IV fluid according to some standard protocol and orders were not required for each patient.
This was truly an experience I will not forget. Some practices that we have embraced and practiced for many years seemed foreign to the Chinese nurses, and perhaps a little dangerous, such as the use of heparin to keep umbilical and PICC lines patent. We are sometimes reminded here that those practices can be dangerous too! I enjoy seeing and hearing about practices in units across the country, sometimes to learn something new and sometimes to simply compare and consider why we do what we do.
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