Journal #1

Maximo Nivel: Costa Rica

6/01/2015- 1/02/2016 Trip Preparation 10 hours
Nursing Student
The planning for our Costa mission trip began months in advance.
There were fourteen of us that participated in the adventure, and for most of
us the idea began watching students presentations last year. After we all got
together and decided on where exactly we wanted to travel too. We explored
the international HQ website and decided to join the medical campaign
hosted by a multipurpose organization called Maximo Nivel. This organization
has many programs all of which have one goal in mind, the improvement of
Costa Rica as a whole. They host programs that range from turtle
conservation, to education improvement, to a medical campaign and more.
Before we were able to leave for the trip many of us participated in
donation drives and other fundraisers to raise funds for not only our trips but
also for items that we could donate to those in need. While collecting
supplies we attempted to collect things that could be useful for all different
age groups. For the senior living communities, we gathered supplies such as
ibruprophen and pain relievers, adult vitamins, Band-Aids, a multitude of
hygiene products and feminine products. We also collected things for the
children in which would allow us to work on some health based education
with them, these included items such as hand sanitizer, toothbrushes and
tooth paste, sunscreen, and for fun bubbles. These donations ended up being

extremely helpful for the community because of the level of poverty. Many of
the children did not have much and almost none of them owned even a tooth
brush. These donations allowed us to work on educating them about the
importance of hand washing and mouth care in preventing problems further
down the line.
As far as my personal goals, I went to Costa Rica with the hope of
being able to help as many people as possible, with all of the donations we
collected we were able to help over 200 children, and almost 100 older
adults. One of my other goals was being able to improve my communication
skills in order to teach important health care practices, these donations were
very valuable later in our trip in allowing us to demonstrate technique and
worked extremely well as a communication method due to the extreme
language barrier.
During the preparation phase of our trip one of the school of nursing
goals that we met was to relates to the health care environment. What this
goals says is that as nursing students we should be advocating to improve
the health care within many different health care environments. The reason
this goal was reached while in our preparation phase was that it allowed for
us to prepare teaching plans for the community and were meant to improve
health outcomes by using the donations as learning tools. Generalist
Nursing Practice was also something that was accomplished here because
our focus was on identifying a different communities health needs and being
able to organize supplies that could meet those requirements.

Journal #2
Maximo Nivel: Costa Rica
1/02/16- orientation 5 hours
Nursing student
After about eight hours of traveling we finally arrived in San Jose, here
Maximo Nivel met us where we were transported back to their headquarters
for orientation. This was also where we would meet our host mom for the
first time. When we first arrived we went through all of the paperwork about
Maximo Nivel policies and this is where they introduced us to our
assignments and what to expect for the week.
Our orientation was led by a younger woman called Tatiana, luckily for
us her English was very good. She explained to us that for the first two days
of our campaign we would be working in a assisted living facility called
Cartago, that was run by the local nuns. Here we would be expected to
help with meal time feedings, medication administration, and also personal
hygiene and getting them prepared for bed. Then for the last three days we
would be working in a day care that was specifically for the children living in
poverty called Sonrisas. This day care is fun by government funding and is
free to families that cannot afford any other care. Here we would be focusing
more on health promotional teaching, and working with the children to
prevent many diseases they are at an increased risk for. The agency was
very excited and thankful that we were there, they explained to us that

although they do have people who volunteer to go out into the community,
there is not many of them so they do not reach a majority of the population.
While listening to the orientation I realized that my goals of
participating in wound care, and other medical procedures was probably not
going to happen on that trip. However, I had never really thought about
being able to do education with the children and hopefully prevent any
problems instead of treating them. Once I heard what we would be doing my
goal changed. I wanted to be able to communicate as effectively as possible
and explain why hand washing, and dental care, etc. were so important for
them. It had been a few years since I had taken any Spanish so I want a little
rusty. That night after we got back to the host family house, many of us
downloaded an electronic dictionary and were brushing up on our Spanish.
Other things we came up with were ways to demonstrate technique and
because many of them were younger we wanted to try and make it into a fun
game to participate in. We hoped that even if we could not verbally
communicate as effectively as we would normally that these methods would
also be helpful.
During the orientation many of us were extremely tired after a long day
of traveling, and even hungry. During this time, we all showed
professionalism. Before the orientation began we made sure to have all of
our paper work in order and cleaned up into business casual attire. We
introduced ourselves, and explained all of the skills that we were trained in

and during the presentation sat respectfully asked questions when

necessary.
Journal #3
Maximo Nivel: Costa Rica
1/3/16- 5 hours Cartago
Nursing student
Our first day was a little bit hectic, we had to figure out public transit
from our host family house. Once we arrived we all piled into a van and
drove for a good half hour into the country side to the assisted living facility
Cartago. There were four dormitory style living quarters, two of which were
female and two male on the other side of the facility. In order to work with all
of the residents the fourteen of us split into four different groups. One of the
things we had to be very aware of while we were here being the religious and
cultural differences. This assisted living facility was run by nuns and was
highly Catholic. One of the things I noticed about the culture was that people
are much more affectionate and in each others space that we are here in the
USA, and took some getting used to. During this first day I worked alongside
the head nun, communication was very difficult because I only knew minimal
Spanish and she did not speak any English. I spent a majority of my day
helping to feed the female residents and keeping up on vitals for the nurses.
Once lunch time was over for those that could either eat themselves or
needed assistance I assisted the nun in getting all of the tube feedings ready
for residents on bed rest. This was very interesting for me to watch, I did not

observe anyone using gloves in the facility at any time and I noticed that
when I wore gloves to help many of them looked at my strangely. However, I
did notice the frequency of hand washing that occurred. Another difference I
noticed was that they used the gravity method for tube feedings because
much of their equipment was dated. On clinical It is rare that I ever see them
use gravity but usually they unlock the jpeg and insert it right in and then
flush. Having us there to help with lunch time feedings and changing was
helpful to the nurses because it allowed them time to catch up on much of
their documentation, and to focus on patients who had more severe
conditions. I talked with one of the girls who spoke more English and she
explained that the doctor only rounds on the facility once a week so much of
the care the nurses are responsible for themselves and increased their
general workload, which I found was very interesting
While I was here I found myself using my assessment skills while
feedings and doing vitals. One of my goals was see what differences in care
occurs, along with the tube feedings I also noticed the sheets and bed
restrains. Here in the USA we have bed alarms to warm us when someone is
getting out of bed, however in Costa Rica they are short staffed with no bed
alarms. The bed sheets they have instead are able to be tied to the bed to
prevent any patients from falling. Even though I understood their rationale
for this practice, it made me feel uneasy.
Some of the nursing school values we exhibited while we were here
were related to collaborative leadership because we were delegated different

care activities with the goal in mind of protecting that patients safety and
providing the best care possible. We did this by keeping the beds in low
position, and thickening liquids for patients who were aspiration risks, and
more. Another value we successfully met was scholarship for practice,
washing in and washing out is a practice that has been linked to lower
infection rates for patients. We were very vigilant about our hand washing
before and after working with patients and even using gloves even though
local staff did not.

Journal #4
Maximo Nivel: Costa Rica
1/4/16- 5 hours Cartago
Nursing student
Our second day we also spend at Cartago, this time we all felt a lot
more comfortable because we knew what to expect. Again we split up, I was
also with the head nun this time also. When I first got there it was time for
medications, each patient had their own container labeled with their names.
All of the medications were already out of their original packaging.
Medications were distributed at the same time that patients were sat down
for lunch. I assisted with medication administration and also feeding. Later
on it came time for doing the tube feedings again, this time alongside the
nun I was able to perform all of the feedings. When I did this I attached the
appropriate tubing, flushed to make sure that the tube was patent, poured
the liquid into the cylinder little by little until it was all gone and then flushed
the tube again. We had one patient that also took her medication through
the tube, because there were no pill crushers we had to dissolve the
medication into water before administering it. While working along side the
nun I found that we were able to communicate with the help of others to
translate for us. She taught me me a lot about their practices and they
benefited from learning our practices. Again it also helped the nurses keep

on top of their workload and allowed them to spend more time with patients
needing extra help.
One of my biggest goals while I was here was learning how the
technique of care differs from a third world country verses the USA.
Medication administration is one of the biggest examples of this, in fact for
me it made me feel very uneasy. There were no wrist bands or any machines
that monitor medication usage, just the pharmacist. The medications come
separated into boxes still in their covers, and the nuns separate them out of
the the individual containers with names on them. I did not think that this
covered the five rights of medication administration, and I talked with the
nun and educated her about our double check processes that we were
taught to practice. Observing these differences were also very good teaching
moments, and also learning for me. Lastly i wanted to perfect my
techniques, by practicing tube feedings it allowed me to get better at a
technique that I dont use very often during clinical practice. The whole
experience was very eye opening.
There were many different values taught throughout the nursing
program that were demonstrated at Cartago. First being scholarship for
practice; medications checks are a big part of patient safety and the quality
of care they receive. I explained the five rights of medication administration
to the nun, right person, right medication, right dose, right route, right time.
We talked about how by taking the medications out of their original covers
was potentially dangerous for patient care. Also professionalism was a big

part of our experience, we all dressed in our scrubs with our hair pulled back,
and all equipment present and cleaned. We were courteous with all of our
patients and respected their need privacy while maintaining the safest
environment possible.

Journal #5
Maximo Nivel: Costa Rica
1/5/16- 1/6/16: 5 hours Sonrisas
Nursing student
We switched things up for day three and four. Instead of visiting an
elderly home we were assigned to a day care facility called Sonrisas. Many of
the children at this facility are from extreme poverty. This is a government
funded day care, and gives children whose parents work a place to go during
that time.
When we were working with the children, we wanted to focus on health
promotion teaching. In order to do this, we set up four different stations
including: hand-washing, exercise, nutrition, a dental station. The goal with
the stations was to teach healthy lifestyle practices, and also to assess the
knowledge base the children already have. For the hand-washing station kids
were split into two groups, here one group went over technique and duration
of cleansing. The other group went over when they should be performing
hand washing, because communication was difficult we used a cartoon chart
with illustrations. At the nutrition station we had the children draw some of
their favorite healthy foods, if they were older we also had them write down
what it was in both Spanish and English. We also went through some healthy
foods that are important in their diet, and how they should avoid sugar. The
workers were telling us that sugar was a major problem with the children in

that area. Once at the dental station all of the children were given a tooth
brush and taught about the importance of dental hygiene. They were also
give a chance to clean their own teeth during this time. Lastly there was the
exercise group, this was the one that I helped run. We went over how many
days a week and for how long they should be active, we also went over
different stretches and exercises they could do. This was really fun because
we got them all moving and laughing, and all it took was for them to mirror
our example. These stations were beneficial to the children in that they were
able to learn about health practices in a safe environment, and the hope was
that they would take what they learned back home and show their families
also.
One of the things I was looking forward to most about this trip was
working with the children, this is because I may be interested in pediatrics as
a career. I have always believed that prevention is the best practice, by
educating the children we are hopefully preventing many different diseases
with basic health and hygiene practices and that is the major goal while
working with this population.
While we working at Sonrisas we exhibited scholarship of practice by
using the most current evidence based practice. For example, education
about hand-washing being the best way to prevent disease spread, and
exercise being the best way to reduce health anomalies. We were always
professionally dressed and had the appropriate equipment. Throughout the
whole experience are biggest concern was advocating for the communitys

health and giving them to skills and knowledge to take care of their future
health.

Journal #6

Maximo Nivel: Costa Rica

1/7/16- 5 hours
Nursing student
For our last day volunteering our plans changed and we went to a
different day care. There were about 50 children here divided by two floors,
the older children were more downstairs where there was an area to play,
some computers, and even three tiny classrooms. While we were here they
asked us to perform assessments on the children, they wanted us to look for
specific signs that indicated future health problems.
At one station we checked over the childrens eyes, ears, nose, and
mouth. In particular, we checked their teeth to see if there were any possible
cavities that needed to be fixed. We also checked all of the children for head
lice. Because the children are together in such close quarters an outbreak of
head lice can get out of control very fast without the proper treatment. Of all
the children there was only one girl that we found with head lice. The
organization that we were volunteering through noted this and helped the
little girl get the medication needed to get rid of the lice, this was cool to be
a part of.
Another station listened to the childrens heart and lung sounds, which
the children enjoyed and wanted to practice on us after. The last station that
I was a part of evaluated the skeletal system, here I checked the posture and
to see if they had any bowing in their legs. I also checked the arches of their
feet, for the children who had flat feet we would help them get special shoes.

The children who had problems with their feet were more likely to also have
back and joint problems later in life if it wasnt corrected. By identifying
children who were at risk for these problems the agency was able to get a list
and talk to families about helping them get access to the resources
necessary to correct the problem early.
This experience was very beneficial to me because it allowed me to
practice my assessment skills and also how to communicate with younger
patients. The whole time I was in Costa Rica it opened my eyes to what our
non-English speaking population must feel like, and that is something I will
keep in mind during patient care from now on.
We were all dressed professionally in scrubs, stethoscopes and our hair
pulled back out of our faces. At all times we were polite and culturally
sensitive. Another value from the nursing school that applies is that of
general nursing practice. While doing these assessments we organized all of
the results into a chart, specific to each child. By organizing these results,
we were able to determined each childs needs and get them the appropriate
care. Another value that applies is related to the Health care environment.
The entire time we were in Costa Rica we were advocating for not only our
patients but also the communities they inhabit. Through assessment,
teaching, and physical care we advocated for improved health for everyone
we made contact with.