Identification of a stroke

New Sign of a Stroke
Stick out Your Tongue

STROKE:
Remember The 1st Three Letters.... S.T.R.

My nurse friend sent this and encouraged me to post it and spread the word. I agree.I
f everyone can remember something this simple, we could save some folks. Seriously..Please read:
STROKE IDENTIFICATION:
During a BBQ, a friend stumbled and took a little fall - she assured everyone that she was fine (they offered to call paramedics) .....she said she had just tripped over a brick because of her new shoes.They got her cleaned up and got her a new plate of food. While she appeared a bit shaken up, Ingrid went about enjoying herself the rest of the evening.Ingrid's husband called later telling everyone that his wife had been taken to the hospital - (at 6:00 pm Ingrid passed away.) She had suffered a stroke at the BBQ. Had they known how to identify the signs of a stroke, perhaps Ingrid would be with us today. Some don't die.... they end up in a helpless, hopeless condition instead.It only takes a minute to read this...A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke...totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.RECOGNIZING A STROKE
Thank God for the sense to remember the "
3" steps, STR .
Read and Learn! Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke .Now doctors say a bystander can recognize a stroke by asking three simple questions:
S * Ask the individual to SMILE.
T * Ask the person to TALK and SPEAK A SIMPLE SENTENCE (Coherently) (i.e. It is sunny out today)
R * Ask him or her to RAISE BOTH ARMS.NOTE:
Another 'sign' of a stroke is this:
Ask the person to 'stick' out his tongue.. If the tongue is 'crooked', if it goes to one side or the other , that is also an indication of a stroke. If he or she has trouble with ANY ONE of these tasks, call an ambulanz immediately and describe the symptoms to the dispatcher.
A cardiologist says if everyone who gets this e-mail sends it to 10 people; you can bet that at least one life will be saved.

For help with stroke rehabilitation, MOBILE NURSING/MOBILE DOCTOR please contact:
www.hnp-mobilenursing.com
Home Nursing Providers 0603 78777202
nursing@hnp-mobilenursing.com

Manual Lymphal Drainage at the comfort of your homes

Various parts of the body will receive soft stroking massage

Lymphatic drainage massage LDM

Introduction
The treatment of lymphedema is based on an understanding of how the lymphatic system works. Therapists must understand this system in depth. Patients, and others involved in self-care steps, need to have at least a basic understanding of these functions. It is this basic level of understanding that is presented here.
The functioning of the lymphatic system is closely related to that of the circulatory system. To understand more about how these systems differ,

The Origin of Lymph

Lymph originates as blood plasma. The plasma of arterial blood is rich in “groceries” for the cells. In the capillary beds throughout the body the flow of blood is slowed so that plasma can leave and become tissue fluid. Tissue fluid is also known as intercellular fluid or interstitial fluid.
Tissue fluid delivers the nutrients, oxygen, and hormones required by the cells.
Tissue fluid collects and carries away some cellular waste products.
90 percent of the tissue fluid returns to the capillary bed. Here it again becomes
plasma and continues its journey throughout the body as part of the venous circulation.
Lymph is the 10 percent of the tissue fluid that is left behind. Normally the amount of lymph circulating in the body is one to two quarts and it makes

The Role of Lymph

The role of tissue fluid is to deliver the groceries to the cells. The role of lymph is to take out the trash that is left behind and to dispose of it.
As lymph continues to circulate between the cells it collects waste products that were left behind including dead blood cells, pathogens, and cancer cells. This clear fluid also becomes protein-rich as it absorbs dissolved protein from between the cells.

Lymphatic Capillaries
The lymphatic capillaries form a mesh-like network of tiny tubes that are distributed throughout the tissue spaces and are located just under the skin. These capillaries branch and interconnect freely so that they extend into almost all tissues.
Lymph capillaries are blind-ended tubes with no opening to allow the lymph easy access. The end of the capillary is only one-cell in thickness and these cells are arranged in a slightly overlapping pattern – like the shingles on a roof.
Pressure from the fluid surrounding the capillary forces these cells to separate for a moment. This allows fluid to enter, but not to leave, the capillary.
There are one-way valves within the lymphatic capillaries. These valves ensure the continued flow of the lymph away from the tissues.
Lymph Nodes

At birth there are between 600-700 lymph nodes present in the average human. Although these nodes can increase or decrease in size thoughout life, any nodes that have been damaged or destroyed, do not regenerate.
Afferent lymphatic vessels carry lymph into the nodes where waste products and some of the fluid are filtered out.
Lymphocytes, which are specialized white blood cells located within the lymph node, kill pathogens that may be present. Lymph nodes also trap cancer cells and slow the spread of the cancer until they are overwhelmed by it.
Efferent lymphatic vessels carry lymph out of the node to continue its return to the circulatory system.
Cancer cells that have left their original site travel first to nearby lymph nodes. For this reason lymph nodes play an important role in the detection and treatment of cancer.
The lymphatic system is known to be responsible for the protection of the human body from bacterial infections particularly those inflicted through the damaged skin.

Pathogens can set up infections anywhere in the body. However, lymphocytes will meet the antigens in the peripheral lymphoid organs, which include lymph nodes. The antigens are displayed by specialized cells in the lymph nodes. Naive lymphocytes (meaning the cells have not encountered an antigen yet) enter the node from the bloodstream through specialized capillary venules. After the lymphocytes specialize they will exit the lymph node through the efferent lymphatic vessel with the rest of the lymph. The lymphocytes continuously recirculate the peripheral lymphoid organs and the state of the lymph nodes depends on infection. During an infection the lymph nodes can expand due to intense B-cell proliferation in the germinal centers, this is commonly referred to as swollen glands.
History

Massages have been found in many ancient civilizations including Rome, Greece, Japan, China, Egypt, Mesopotamia and India.
It is now recognized in Europe as one of the treatments for oedemas.

Manual lymphatic drainage (MLD)
A very specialized type of massage called manual lymphatic drainage (MLD) is an important part of the treatment of lymphoedema. To be effective in treating lymphoedema, it is important to use the correct technique. The aim of the massage is to stimulate or move the excess fluid away from the swollen area so that it can drain away normally. Massage also encourages and improves drainage in the healthy lymphatics (which helps keep fluid away from swollen areas).
Manual lymphatic drainage differs from ordinary massage - it is very gentle and aims to encourage movement of lymph away from swollen areas. MLD is particularly useful if there is swelling in the face, breast, abdomen, genitals or elsewhere on the trunk.
Manual Lymph Drainage

Manual lymph drainage (MLD) is commonly referred to as M-L-D. This specialized massage technique is performed by the lymphoedema therapist to stimulate the flow of lymph from the affected area. MLD is based on specialized manual techniques that have been used successfully in Europe since the 1930’s. As shown in this illustration, MLD is a gentle and pleasant treatment.
Massage is the treatment and practice of soft tissue manipulation with physical, functional, and in some cases psychological purposes and goals
Light sweeping MLD movements encourage the flow of lymph into the lymphatic capillaries that are located just under the skin.
Stronger MLD strokes cause the lymph to flow into the lymphatic vessels deeper within the tissues.
Specialized stronger MLD movements are also performed to soften fibrotic tissues.
The MLD portion of the treatment session usually lasts from 30 to 60 minutes, depending on the size of the limb(s), the severity of the symptoms, and the amount of fibrosis.
Side benefits are: relaxation, unwinding from strain, improved immunity, reduction of blood pressure, reduction of sub clinical depression.

Contraindications for MLD

If potential contraindications are present, the therapist may consult the patient’s physician before an MLD treatment is provided. MLD should not be performed if any of the following conditions are present or are suspected:
Cellulitis or any other acute infection.
Fever or other indications of a developing infection.
Deep vein thrombosis, bleeding disorders or taking blood thinner such as wafarin, damaged blood vessels, weakened bones from cancer,osteoporosis, or fracture, and fever.

Heart failure, or other cardiac condition.
Any other major health problems that are not under control unless this treatment has been approved by the patient’s physician.
Some women find deep abdominal massage to be uncomfortable during their menstrual period and, for some, it increases the flow. If this type of massage is part of your treatment, be certain to tell your therapist when you are menstruating.

Alert

The patient can expect an increased need to urinate soon after a treatment and for several hours thereafter. This occurs because the excess fluids that were moved from the tissues have now been processed by the kidneys and are ready to be excreted as urine.
It is important that the patient drink plenty of water after an MLD session to replenish the fluids that were mobilized by this treatment.
Home Nursing Providers has now trained lymphoedema therapists, both male and female. They offer the service to the patient’s residence.
For further enquiries you may contact:

HOME NURSING PROVIDERS, MOBILE NURSING or MOBILE DOCTOR

www.hnp-mobilenursing.com

or nursing@hnp-mobilenursing.com

Tel: 06 03 78777202

Nursing Home versus Home Nursing

Nursing Homes versus Home Nursing!

The controversy of sending the sick and or aged to a nursing home is perhaps as old as nursing homes exist.

While there may be many reasons for people to send a family member into a nursing home/old folks home there are equal number of reasons not to fall for a quick and "comfortable solution".
Let us look from a client’s point of view what it means to be sent to a nursing home.
First and foremost such a person, if still mentally alert, must feel to be deposited, discarded by the family and those she/he has been sharing their lives in the past. It must be assumed that in most cases it is the children who will make such a decision. These are the very same persons who have for all their lives benefited from the care and concern of the now elderly and needy family member.
I wonder whether the persons who make such a decision have ever considered how they would feel, if in the future their children or grandchildren would ‘discard’ them.
Have they ever taken time and contemplate what the person would feel once deposited in a nursing home?
I guess that most people do suppress any thinking in this direction. They just feel that the needy person becomes a burden and since she/he is no more "productive" is ready to be discarded or disregarded.
In the many visits I have made in nursing homes I have observed only one prevailing condition. That was "APATHY and DEPRESSION". It is not surprising, therefore, that about 50% of nursing cases sent into nursing homes pass away within the first 6 months

Apathy and loneliness are the main triggers for depression. Depression in return reduces the immune system. A low immune system makes subjects the person to get infected easily and even a simple cold will be enough to cause the final journey (death). What reason has a burden, discarded, useless, problem-creating and money consuming old and sickly person to fight for?
Where has the filial concern at one time the trade mark of Asian families gone? It has been sacrificed for the money and convenience of those concerned.
I am not intending to go into the conditions that exist in most nursing and old folks homes particularly those run on a commercial basis.
But anyone who has visited some of these homes would have noted that they do not meet with the minimal standard of humanity, respect and dignity.

For sure there are such medically complicated cases where it might be very difficult to keep a person in the family home setting. However these cases should be placed in medical and nursing homes where they can be attended to in a professional and
competent manner. I guess that the percentage of such severe medical conditions is below 5% of all nursing cases.

However in my experience in more that 10 years of home nursing/mobile nursing has shown that with proper professional and caring teams anyone can be attended to in their own home setting.
Even comatose patients with tracheotomy can be managed in the family setting provided the family is willing to cooperate and give the necessary support.
What happened to a person who is "comatose"? Does he still register the surrounding? No serious scientist dares to make a conclusive statement on this matter. However my professional experience has shown many a time that people were making clear signs on stimulations by the sound of a family member, a close friend, and/or certain melody of which the person was familiar with.
It is not unusual that even doctors in the hospital advise the family to look for a nursing home instead of looking at the option of caring for the patient in their own home setting with the available mobile home nursing.
More people grow older and are more likely to become nursing dependent at their final stage of life. Home nursing/mobile nursing should be the first option for anyone to be considered. Nursing homes should be the last option and be left for the absolutely difficult cases.
Mobile nursing which is able to provide any amount of support from simply giving a bath to a 24 hours general or medical nursing care is the correct and appropriate way of managing those who have spent their whole life being concerned about our welfare.
"Let us treat our beloved the same way we want to be treated when we grow old and dependent".

For further information about MOBILE NURSING or MOBILE DOCTOR contact:

Home Nursing Providers Tel +6 03 78777202

nursin@hnp-mobilenursing.com

www.hnp-mobilenursing.com

MOBILIZATION OF STROKE PATIENTS

WHAT IT NEEDS TO DO SUCCESSFUL MOBILIZATION OF STROKE PATIENTS
A lot of times the need of people in the category of Golden Age is beyond the understanding or comprehension of other people. We often tend to forget that reaching the golden age has one‘s own afflictions and problems. These are inherent due to the age span with which goes for some more for some less complication directly related to ageing.
However a considerable number of people also tend to suffer secondary health problems and these are particularly related to strokes. I guess getting a cerebral stroke is to some even more scaring than to get a cardiac infarct. When a cardiac infarct ends up in survival well and good, if not it does not leave behind much to be worried. Unlike a brain stroke, where the chances of survival are much better yet the short and long term consequences are difficult to predict. One of the most common side effects would be paralysis of one or more limbs. Depending on the location of the stroke in the brain speech might also be affected. The scariest form of stroke is perhaps a stroke affecting the brain stem resulting almost always in severe or total paralysis.

The damage to the brain depends on the area affected and the most crucial factor is how soon the patient can receive correct treatment in a hospital. Those would be the main determining factors of the damage to the brain and subsequently to the handicap experienced.
To a great extent paralysis can be reverted. This however depends very much on the time frame of mobilization therapy after the patient has been stabilized. The sooner appropriate therapy is initiated the greater are the chances for recovery.
To understand how the recovery works we have to understand what is really appending to a patient with a stroke.
Stroke / Brain Attack

What is stroke?

Stroke, also called brain attack, occurs when blood flow to the brain is disrupted. Disruption in blood flow is caused when either a blood clot blocks one of the vital blood vessels in the brain (ischaemic stroke), or when a blood vessel in the brain bursts, spilling blood into surrounding tissues (haemorrhagic stroke).
The brain needs a constant supply of oxygen and nutrients in order to function. Even a brief interruption in blood supply can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen supply. The area of dead cells in tissues is called an infarct. Due to both the physical and chemical changes that occur in the brain with stroke, damage can continue to occur for several days. This is called a stroke-in-evolution.
A loss of brain function occurs with brain cell death. This may include impaired ability with movement, speech, thinking and memory, bowel and bladder, eating, emotional control, and other vital body functions. Recovery from stroke and the specific ability affected depends on the size and location of the stroke. A small stroke may result in only minor problems such as weakness in an arm or leg. Larger strokes may cause paralysis (inability to move part of the body), loss of speech, or even death.
According to the National Stroke Association (NSA), it is important to learn the three R's of stroke:
Reduce the risk.
Recognize the symptoms.
Respond by calling (your local ambulance service).
Stroke is an emergency and should be treated as such. The greatest chance for recovery from stroke occurs when emergency treatment is started immediately.
Stroke is the third largest cause of death, ranking behind diseases of the heart and all forms of cancer. Strokes kill more than 158,000 Americans each year. About 5.5 million US adults live today with the effects of a stroke.

IF BRAIN DAMAGE TAKES PLACE, HOW CAN A PERSON RECOVER?
That's a good question! The brain is a remarkable organ. When the blood flow is cut off, new pathways can take over and supply the blood to that damaged area. Also, the brain can make compensations. One area will take over the functions that were previously handled by a different area. Remember, people can and do recover from a stroke!

WHAT ARE THE STEPS OF RECOVERY FROM A STROKE?
Usually, recovery happens in phases. It takes place over a period of time that can vary from a few weeks to a few years. Every stroke is different and the extent of damage varies. Below are the general phases that a stroke patient can expect to go through.

TREATMENT FOR THE ACTUAL STROKE- This begins when a person first enters the hospital. Doctors will determine the type of stroke and will provide the appropriate treatment. This may consist of drugs to break up clots and thin the blood or surgery to repair a broken blood vessel. Treatment is aimed at preventing another stroke from taking place and limiting the amount of brain damage that occurs.
RECOVERY- After a stroke, some spontaneous recovery takes place for most people. Abilities that may have been lost will begin to return. This process can take place very quickly over the first few weeks, and then, it may begin to taper off.
REHABILITATION- This phase usually takes place while the patient is still in the hospital. Various therapists and specialists will work with the stroke victim to bring back lost skills. This can be a very frustrating time for the patient as they become aware of their limitations from the stroke. Oftentimes, this is the period where anger or depression can set in. It's good to remember that with proper therapy, many or most skills can be relearned.

RETURNING TO THE HOME ENVIRONMENT-
This can be a very exciting time, but adjustments may have to be made. Some of the adjustments might be temporary or some may last for a lifetime.
For the stroke victim, simple tasks such as tying shoes or fastening pants can be difficult. These are easy to remedy. Velcro shoes and drawstring pants can be worn. Other issues may not be as easy. But take courage. There will be many experts to ease this transition.

In my experience the most crucial aspect is to develop a trust relationship between the therapist and the patient. The greater the trust relationship between the therapist and the patient the greater the chances of progress. While the techniques play a vital role in the recovery process, the cooperation between patient and therapist is the most crucial factor. The therapist is not merely an executer of certain limb movements and contractions of muscles; he is the stimulator, motivator and source of confidence.
It needs also to be understood that the approach to each client has to be adapted to his/her personality. Very important is the knowledge of biography of the patient. Basing on the patient’s interests, hobbies etc. motivation can be initiated.

Motivating the client might be initially the most difficult part of the patient management. Without a personal goal that is to be achieved little success can be expected. What does that mean in practice? As much as the stimulation of the limbs is important so is the continual stimulation in motivation which is a crucial necessity. That is why by merely attaching the patients to machines and instruments which move the limbs without intensive mental contact with the patients is of little benefit. The therapist primary objectives must be the constant motivation and giving feedback to his client. This includes the knowledge of how a stroke affects a patient in his/her day to day physical and mental state.
Only when all of these aspects are being taken in consideration the therapist will be able to provide a basis for successful mobilization.

WHAT ARE SOME OF THE EFFECTS FROM A STROKE?
Again, this will depend on which area of the brain is affected. Some common after-effects of a stroke are:
· Paralysis or simple weakness on one side of the body. Remember, this will be the opposite side of the body from which the stroke occurred.
· Difficulty with speech.
· Trouble with swallowing.
· Difficulty with urination.
· Balance and coordination problems.
· Problems with cognitive functions - the stroke victim may have memory problems or may have difficulty following directions.
· Fatigue
· Emotional upsets - these can vary from depression to bouts of spontaneous laughter.

WHAT ABOUT LONG-TERM DISABILITIES?
This can happen. It depends on each individual. Some strokes are mild and will result in complete recovery. Others are severe and will produce lingering problems.

CAN I PREVENT A STROKE FROM OCCURRING?
There are things that you can do to minimize your risk of having a stroke. Many strokes are caused by fatty deposits that reduce the blood flow to the brain. A proper diet, coupled with regular exercise, can keep your body strong and healthy.
Also, there is research that strongly suggests that consuming aspirin and vitamin E on a regular basis may help to prevent ISCHEMIC strokes. The vitamin E keeps the blood thin while the aspirin lowers the clotting ability of the blood. The drawback to this type of preventative course is that it can cause a small number of HAEMORRAGIC strokes. For many people, this type of prevention out weighs the risk. Remember, most strokes are ISCHEMIC in nature.
Do talk with your doctor before you undertake any type of self-treatment. This type of therapy is not appropriate for everyone.

FINAL THOUGHTS
A stroke can be scary, but recovery can and does take place. A positive outlook is one of the most useful tools during the rehabilitation process.
This does include also the environment of the patient. It is not uncommon that relatives and close friends, out of ignorance and pity, consolidate the negative mental state of the affected person. Here too the therapist has a role to play and influence the environment and to be couscous of their comments and impressions on the patient.

"A person will recover as much as SHE/HE sets the goal and believe in it".

For more information about "mobilization/rehabilitation" or MOBILE NURSING/MOBILE DOCTOR please contact:

Home Nursing Providers, Tel: 006 0378777202 or

nursing@hnp-mobilenursing.com

http://www.hnp-mobilenursing.com

"Under Nursing but Over Caring"

"Over Caring or Under Nursing"

To anyone who reads this heading their first reaction will be "HOW"??, Contradictory? NO!
In the years of my professional work and especially since getting involved in mobile nursing, this apparent conflicting phenomenon disturbs me. Confirmed through a visit of a relative in a nursing home, where most of the people were fitted with a nasal tube and received liquefied nourishment.
Obviously this home was not specially for elderly persons who had a problem with swallowing, but rather an issue of convenience to the caretakers, (assisting a person by spoon feeding may be very time consuming).
This experience and that of other observations, brings me to the issue of drawing awareness of the public to the issue of what is correct and professional nursing.
Certainly not:
Over caring, a phenomenon that arises when a person is attended 24 hours by a "care taker" which is being paid to take "good care" of the sick person.. From the point of view of the family, "we want to provide the best care". However from a professional nursing concept it is wrong, because the patient will solicit the service of the "paid " care taker and for all concerned unnoticed the sick person will not be motivated to start doing things for themselves but rely on the care taker do almost everything for him/her.
Thereby loosing very fast the competences and skills to help themselves. Experience has shown that, where the sick person gets only the complementary level of assistance the motivation to regain the former abilities is much greater than for those who have a special care taker. In the long run the developing of a mutual dependency, between that care taker and the sick, will reach a stage where the sick person has lost most of the abilities to do even basic functions and the family is in a stress situation, because sooner or later the financial burden becomes to great, yet the situation has become worse instead of improved. This is also observed in institutional settings, where the patient expects that everything is being doe for him. It is a well observed fact that recovery and regaining of abilities towards self help is greatly enhanced if the person is in his own home environment and fostered to increase his owns kills and abilities to cope with daily task to care for themselves, and is stimulated to pay attention to what is happening within his/her environment, grandchildren, pets, friends, family members etc.
Under nursing, is the other side due to lack of professional nursing. Obvious there is hardly anyone who does not want to provide the best "care" for the sick family member. However the motivation and good intention by it selves, does not compensate for the professional nursing.
A professional nurse needs 3 years of training before getting a certificate of competence, and many years of experience are needed to become skilled in dealing with sick people. And additional skills are required to work in a mobile nursing system providing service in a family setting. The most common problem arise out of lack of knowledge and experience in assuring improvements of the condition, and preventing worsening of the condition. To avoid the sick a lot of suffering and anxiety, the family distress, costly medical treatment and perhaps major hospitalization fees, professional nursing is needed, at least on an advisory level.
The most common problem arising out off:
a) Dehydration; Most elderly persons do not feel thirsty and will generally not ask for liquid, giving the impression that there is also no need for intake of liquid. In many cases of hospitalization of elderly there is always the symptom of dehydration in the forefront. This may result in renal failure, and a chain reaction of complicating problems. Many people have developed temporary "mental impairment" solely due to lack of liquid intake.
b) Improper intake of Medication: No one is fond of swallowing pills. Elderly persons have an aversion to pill taking, in particular when they are insufficiently informed of the working mechanism of the same and the consequences if they are not taken regularly. People like to see medications as a symptom reliever. "I don't need to take them today I am feeling very fine"! Elderly persons are forgetful, (particularly the short term memory) they may not remember if they have taken the medication or not, resulting in double intake or missing out of a doses. Either one may have, depending on the type of medication, severe consequences. Taking medication with liquid other than water, may result in impairment of the effect of the medication or cause avoidable intestinal complications
c) Bed sore: With sick persons who are temporarily or permanently bedridden or wheel chair bound, this is perhaps one of the most frequent problems encountered, yet in most cases avoidable. Simple aids and knowledge can prevent the same development and subsequent suffering and costly treatment to the sick person.
These are just a few of the problems that a family may encounter. In my training experience (of family nurses family members) I come across that care takers are often at loss as to what to do. Having outside nursing care may be too expensive and also infringing in the family setting.

The alternative is:
a) Professional nursing counseling with case assessment;
b) On the spot nursing coaching by experienced and examined nursing staff;
c) Attending of available training in coping with sick and or handicapped family members;
d) Soliciting professional nursing help, where and when needed, on a sporadic or regular basis as may be necessary or desired.
Conclusion:
We are steering to a situation where people become elder and live longer and this includes also more impaired (naturally due to aging) persons in our society. Modern medicine is as good as the surrounding supportive nursing care is available.

If you are looking for advise on correct nursing r MOBILENURSING/MOBILE DOCTOR please :
006 0378777202
Home Nursing Providers:

nursing@hnp-mobilenursing.com

www.hnp-mobilenursing.com

Dehydration and illness in elderly persons

Dehydration and illness in elderly persons

The problem of dehydration is in general not receiving the attention that is deserves.
Approximately 70% to 75 % of our body mass consists of liquid. The reduction of 5% can cause problems and above 10% can lead to a life threatening situation. The Emergency Rooms of Hospitals are meeting this issue day by day. But ones the patient is discharged to home little attention is given to the original cause of the hospitalization, which is dehydration.
Most people are not aware of what is the correct amount of liquid a person should consume a day.
That is because there is no "correct amount" that would apply to all individuals equally.
The amount could vary from between 1 ½ liters to 6 liters in 24 hours depending on the individual and his/her special circumstance.

Factors that influence the need of liquid are;
Physical size
Physical activity
Age
Exposure to temperature
Health condition, such as fever
Medication (diuretics)
Intestinal infection with diarrhea
Endocrinological conditions such as diabetes
And other factors.

To know if a person has the correct amount of liquid consumed is when the urine has a color close to fresh pressed lime water. However most people will be far away from the ideal condition inviting long term consequences; such as
Confusion
Disorientation
Strokes
Kidney stones
Constipation
Fatigue
Wrinkles in the face (There is no cream that can substitute the water)
Cardiovascular problems
And many others………

Elderly people have a less significant feeling of thirst and hence tend to drink less. This can be easily compensated in that they have fresh fruits at their reach ready for consumption. Fruit juices are also more palatable to the elderly. Nutrients with added water such as porridge, jellys etc. are helpful to prevent dehydration. Liquid should be in such a place to be easily senn and available to the elderly.

If you have questions about care taking of elderly,
MOBILE NURSING/MOBILE DOCTOR PLEASE consult:

Home Nursing Providers 006 03 78777202
nursing@hnp-mobilenursing.com
www.hnp-mobilenursing.com

When a nurse is not a nurse

When a nurse is not a nurse!
In recent time we have come across a series of situation where we noticed that so called "nurses" are offering medical, as well as general nursing to the ignorant public.
These "nurses" have at times not more than some vague practical experience often only from observation from nurses, in care taking. These "nurses" are offered by various agencies as well as hospitals to take care of patients in Hospitals and private homes as "private nurse" or a sent to people’s houses to take care of sick people.

Since the word NURSE is not a protected term (only State Registered Nurse =SRN) these people give the impression to the public that they are trained nurses, and competent to do nursing.

We have also come across cases were foreigners on visit passes who do not have certificates of Nursing training from their home country, but do privat nursing They are not registered with the Nursing Board of Malaysia, but working in various institutes and privately as nurses.
The public is often in a situation where they are in urgent need of nursing assistance for their sick family member. They do not dare to ask if these persons are really trained and qualified. They are also not requesting to view the certificate of nursing registration by the Nursing Board of Malaysia.

One does not needs to have a vivid fantasy to imagine what can happen to a sick person, who is attended by such fake nurses who performs various medical nursing tasks without academically qualification or professional training and are lacking skill and knowledge of the task they are performing.

These persons even perform tasks which in developed countries are usually performed by medical doctors only, or specially qualified nurses such as setting of feeding tubes, urethral catheterization etc.

The public is most of the time relying on the words of the referring agency, which just uses the term "they are qualified" or they are "nurses with experience" insinuating that they have a formal training and qualification.

It will not be surprising if such cases will increase in the near future as the need for qualified nurses is constantly increasing, and the supply can not meet the demand.
Genuine qualified foreign nurses are in a predicament, as they will only get a visa if they have an employer. How to get an employer without registration and certification by the Nursing Board? How is the Nursing Board registering a nurse who can not submit her application for registration without a registered employer. How is the Mobile nursing agency getting registered if there are no legal provision for such a registration? A vicious cycle that is difficult to be solved.
The public in the mean time is at the mercy of such unscrupulous practices by fake "Nurses" which not only tarnish the name of the nursing profession, but place the patient in an unpredictable danger as nursing is a professional job which takes 3 years of training and many more years of experience.

No one would send his car to a carpenter for repair. But exactly this is what happens in cases of hiring an unprofessional person to nurse a sick family member.
We can only appeals to the public, to be on guards when hiring "private nurses", and ensure that they can show prove of their qualification.
"Better to be safe than sorry"!

If you are looking for qualified MOBILE NURSING/MOBILE DOCTOR
contact:
Home Nursing Providers
00603 78777202
nursing@hnp-mobilenursing.com
www.hnp-mobilenursing.com

The Wrong System Breeds the Wrong Product we should not be supprised with the results

The Wrong System Breeds the Wrong Product

I have written several critical comments about the quality of nursing in the country. It is essential to have a look and try to analyse the causes for the ‘poor’ products. To do so we have to look at the way our nursing system is being managed.

From my observation promotions are not based on quality, qualification and competency but rather merely on the automatic promotion based on years in service in the system.
This means that as times goes by even mediocre staff will get promoted to supervisory levels. In that a mediocre supervisor cannot deliver superior service is the logical conclusion. Not only are the staff working under such supervisors being poorly supervised and quided, even the patients have to be subjected to the same system. Little can be done by the more efficient and skillfull subordinates as the system will act as a blockade against the ‘smart ones’. These more efficient nurses would be marked as ‘acting smart‘ and most likely isolated and regarded as ‘revolts‘ by their superiors.

The real ‘good nurses’ will obviously and with merit be chosen for further education and subsequently promoted to higher levels of mainly administrative functions. This in return deprives the clinical sector of excelling skillful superiors. In other words, the skillful and competent nurses will not stay too long in the clinical ward service but will go up to the administrative sector, into works that at time could be done more effectively and efficiently by trained secretaries, instead of a promoted nurse. Here such a nurse will be wasting her nursing knowledge and skills, and struggle with administrative assignments just because the system is such.

Why can‘t the system be redesigned to provide ample promotional opportunities within the clinical nursing section? Why does a horde of highly qualified nurses have to man the nursing board, where most of the work is administrative? Does it need a nurse to prepare for the issuing of adninistrative work such as registration of nurses with the board?

Why not design a system where all nurses have to undergo continues learning particular in the field of patient management. This would prevent the practices of bygone times e.g. use of zinc oxide cream for bedsore etc. Why are the specially trained nurses not assigned to pass on the skills to the clinical staff in their practice of nursing. With the passing of nursing examination a nurse has indeed just begun to learn and develope her skills.

May I suggest that prior to the annual renewal of their licence nurses have to show proof of having attained the required number of hours in attending lectures and/or seminars to update and upgrade themselves. This is a way to ensure competence in nurses and upgrade the quality of nursing for the bebefits of patients.

On the other hand, each nurse must be sufficiently motivated to acquire additional skills and knowledge in the nursing field. Personal/job satisfaction in nursing depends, to a great degree, on the competence one has and can apply. The patient-care and communication can be so rewarding they act as a motivation to continuosly improve one‘s skills and competence.
We are faced with a peculiar situation in nursing that to my observation the nurses see themselve as assistants to the doctors whose directives are to be executed and instructions to be followed. Many a time I got the response: ‘the doctor did not give instruction’. But the issues of oral care, fungus prevention on the private parts of patients, decubitus prevention and dehydration are primarily the duties of nurses and only secondary to the doctors.
It is not supprising therefore that the nurses suffer from an inferiority complex due to lack of self confidence and competence. Nurses do not see themself as professionals working side by side with the other medical professionals but subservient to them. This obviously has to do with the lack of knowledge and skills the nurse is able to display. I have never felt that way but see the management of a patient as the combined role of a doctor and a nurse. No one is superior or inferior to the other, but each has the specific duties for which they are trained and skilled.
Perhaps it is time for the respective authorities to address this phenomena and act quickly on the shortcomings as abserved before the nursing profession takes a plunge into dangerous and criminally neglegent state.

I know of many concerned nurses in the country who are vocal and energetic in search for an answer to the problem. But do they get the necessary support, or are they running against a wall?

Let all concerned nurses in the country get together and have a "no barrier", frank and honest analysis with the authorities. Hopefully the authorities will implement the necessary changes without any delay or before it is too late.

Should you need further information about MOBILE NURSING/MOBILE DOCTOR contact:
Home Nursing Providers :
006 03-78777202 or
nursing@hnp-mobilenursing.com
www.hnp-mobilenursing.com

decubitus(bedsore) a criminal nursing neglecience

Bed sore a criminal nursing neglicience

By writing this article I am responding to my professional conscience.
Despite various and numerous approaches to reach the target groups I have not been able to activate or receive any response or echo.
Perhaps someone will stumble over this article and her/his nursing conscience gets activated.
Decubitus/Bedsore - a crime in the nursing profession!

Yes I am standing by this. Bedsore or decubitus as it is called in the professional language is a criminal negligence in the nursing process.

No matter how often it occurs in our hospitals, nursing homes and rehabilitation centers, or also in the private settings in patients’ homes it does not make it a non-preventable, painful and horrifying condition. Bedsores are in general preventable provided one understands the processes and conditions that contribute to its development.

In the years of my profession as a nurse the most striking observation I made is the total apathy and ‘tidak apa’ (could not be bothered) attitude of the nursing profession. This unfortunately is being accepted by the medical profession which does seemingly have equally little understanding of this problem. Perhaps understandably, the prevention of bedsore is mainly a nursing issue.
Why is it that so many patients irrespective of the place of care are afflicted with single or multiple bedsores? The maximum spots of skin abrasions and lacerations we ever come across were counted as 15 spots. The hospital staff claimed that this was due to the complexity of her illness. However this was countered as the sores receded and healed within weeks of proper skin care and proper sore management.

With the necessary cooperation of the family we have been managing to heal all bedsores we were given the responsibility of management.
When the family members inquired how the bedsores developed they were told by the hospital nurses that it was ‘BIASA’ (usual state) as the patient was elderly and bed-ridden. What they did not tell the families was that they did not even know that bedsores were developing on the patient.

It is a common practice that the body care of many patients is taken care of by relatives or maids. Apparently with the noble intention of the Health Ministry that the family learn how to manage the patient once he is discharged home. However the teaching aspect by the nurses in the ward is nil. So how is the family or the maid able to detect early signs of bedsore development or prevention when there is no coaching? But rather brushed off as menial work on the patient?! How does a nurse know that the patient is at risk to develop bedsore if she does not even know the contributory factors that lead to the development of bedsores. In one case the nurse was informed of an abrasion at the buttock. The nurse did not even inspect the buttock but just passed zinc oxide cream to the maid to apply.

Do our nurses understand:
proper skin care?
pressure and counter pressure?
interference of gas-exchange (diffusion-interference)?
metabolism in cells?
damage to cell-walls?
nutritional requirements?
impaired mobility?
spinal cord injury?
para/hemi/tetraplegia (quardraplegia)?
coma?
friction/rubbing?
unsanitary conditions?
sedation?
anaemia?
exicosis (dehydration)?
moisture of the skin?
And many other aspects that contribute to the prevention or development of bedsore?

I am willing to challenge any of our nurses currently taking care of patients particularly of geriatric patients of the knowledge and skills in the prevention of bedsores.
In most hospitals that I visited the patients were placed on incorrect mattresses, diapers were changed according to schedule, not as to the need of the patients, knowledge of skin care was close to nil, nutrition seemed to be unimportant and much more.

Ironically my offer to provide seminars on the issue of bedsores to approximately 15 hospitals and nursing schools in the Klang Valley did not get even an enquiry response.
Perhaps only legally criminalizing of the negligence of nurses responsible for a patients’ development of bedsores would wake up the nursing fraternity and the medical sector.

It’s time that we get rid of the lackadaisical attitude of bedsores are ‘BIASA’!

Further information about managing of bedsore, MOBILE NURSING/MOBILE DOCTOR contact:

Home Nursing Providers 00603 78777202 or

nursing@hnp-mobilenursing.com

www.hnp-mobilenursing.com

Care and Management of Bedsore/pressure sore awailable in Malaysia

Pictures show improvement after professional treatment

Photos taken by treating nurse; Mona Hassan

Care and Management of Bedsore/pressure sore (decubitus)

It is surprising that the majority of the public and the medical/nursing profession is not aware of the fact that decubitus/bedsore wounds can be successfully treated.

This perhaps results the attitude and/or impression that if a bedsore develops the condition of the person must be so serious that it is not treatable or regard as time wasting in attempting to treat it.

Unfortunately many people are having the notion that the development of bedsore is an early sign of impending demise of the patient. I have heard people say, ”Oh, he already has bedsore so he will die very soon”

Ignorance and apathy are the main reasons for people to let their beloved die without attending to the sore, which in almost 100% of cases can be successfully rehabilitated.

In the first Instance it is imperative that a nursing assessment of the patient’s condition is being taken.

A bedsore can encompass many causes and until the main causes are identified by an experienced nurse in the management of bedsores it will be difficult to make a treatment/management plan.

A treatment and management plan must include the following points:

overall health condition of the patient
bed and beddings
nutritional aspect
hygiene of the patient
skin care
medication

After that the nurse will then be able to make recommendations for the care taking person.
The family will be informed of what dressing materials are required and how often the dressing has to be changed. In the early stages this should be done by the nurse to ensure that proper hygiene and monitoring of the wound is adhered to. At the later stage when the wound has improved and become superficial, dressings can be left in-situ for 3-5 days and the care taker may be able to renew the dressings.
Not every wound is the same, so the conditions of the patient and in any case even the patient’s condition may change, high temperature, exicosis, sepsis etc. and require medical intervention.

The family must have a lot of patience and cannot expect a quick healing process particularly if the sore is deep and ‘pockets’ have developed.
Paramount in the healing process is that the nurse’s recommendations are being followed as these are aimed to improve the general condition of the patient and subsequently expedite the healing process.

For further information about MOBILE NURSING/MOBILE DOCTOR we recommend to contact: Home Nursing Providers Sdn Bhd,
TeL: +6 03 78777202

www.hnp-mobilenursing.com

nursing@hnp-mobilenursing.com

senior citizen charter of malaysia is a guide to any one.

THE MALAYSIAN SENIOR CITIZEN'S CHARTER

PREAMBLE

The 20th century witnessed a historic demographic transition whereby life expectancy increased at birth and at all ages, including old age. The global net balance of older people has been increasing by about one million persons a month, of whom two-thirds live in the developing world. The rate of growth of the oldest old, that is those over 80 years, is growing fastest of all, in all parts of the world.

This demographic shift towards an older population has to be seen in the context of rapid economic change, shifting attitudes towards social welfare and large-scale migration. International migration and rural-urban migration have led to major changes in family structures and the older people's role in their own communities. Epidemiological transition as a model proposes that as populations "modernize" and age, the patterns of causes of death and morbidity change. The change is characterized by a shift from the predominance of infectious diseases and pandemics to more chronic or degenerative and lifestyle diseases. Positive medical interventions, advanced medical technology, improved standards of living, nutrition, education, hygiene and housing have been contributory to this change.

To understand the norms that older people will bring into this century, it is important to look at it from the following perspectives - social, economic, cultural and personal. Older people are as diverse socially, culturally and economically as any other age group though there are some distinguishing features.

Life expectancy in Malaysia has increased from 55.8 years for men and 58.2 years for women in 1957 to 70.2 years and 75 years respectively in 2000. The increased longevity helped by declining mortality rates has resulted in an increasing older population, from 5.2% in 1970, 5.7% in 1980 and 5.9% in 1991, to 6.2% in 2000 (Source : Social Welfare Dept., 2004). It was projected that by 2005, Malaysia would enter the ranks of the 'Ageing Nations of the World' with 1.7 million or 7.2% of the population being senior citizens (United Nations source, 1993). By further projections, 15% of the Malaysian population would be old by 2025.
THE MALAYSIAN SENIOR CITIZEN'S CHARTER AFFIRMS THAT THE OLDER PERSON HAS A RIGHT TO :
· Safe shelter, proper healthcare and income-generating opportunities that are elderly-friendly;
· Clean, hygienic, stress-free environment and adequate nourishment that promote a healthy quality of life;
· Recreational facilities, family-care and community-harmony that promote physical and emotional well-being;
· Educational facilities and life-long learning opportunities that promote social and mental well-being; and
· Inter-generational initiatives to blend the experiences of older persons and the talents of the younger generation to promote a society for all ages.

Prepared by the MMA Committee for the Health of the Older Person, and launched during the 45th MMA Annual General Meeting in Melaka on 28th May 2005

For Information of nursing for Senior Citizen,MOBILE NURSING/MOBILE DOCTOR contact:

006 03-78777202
nursing@hnp-mobilenursing.com
http://www.hnp-mobilenursing.com/

Does and don’ts in nusing THAT MIGHT SAVE MONEY AND PREVENT A LOT OF SUFFERING

Te following are some experiences in nursing that proved helpful or detrimental when applied, even though very common practiced.

Don’t:

1.) Use of soap in elderly patients removes the acidic (oily) layer from the skin. The loss of this protection will cause drying out of the skin, and create micro fractures of the skin allowing bacteria’s and fungus to enter and cause irritation/itch and leads to scratching leading to infections and sore of the skin. Elderly persons can be washed with plain water using a small towel to mildly massage the skin. Hairs can be washed with a mild (baby) shampoo.

2.) Use of body powder in elderly particular bed ridden patients adds to drying out of the skin and blocks the skin from sweating, reducing natural re-oiling of the skin. It is better to use a moisturizing Lotion for dry skin to make and keep the skin soft and smooth.

3.) Use Donut ring popular with many, causes an impairment of blood circulation in the region of application and adds to the discomfort to the patient.

4.) Use Plastic/rubber sheets to prevent the soiling of the bed are very detrimental to the skin as they do not allow the free flow of air to the skin and trap moisture, which leads to the softening and damage of skin on the back and subsequently to bed sore.

5.) Use Multiple coverage of ripple mattress is obstructing the circulation of free airflow reaching the skin of the patient, and prevents the subtle massaging effect it gives to the skin stimulating improved blood circulation. These ripple mattresses are washable and can be easily cleaned.

6.) Over cover when patients having fewer will lead trapped temperature affecting the sense of wellbeing and stress to the cardio vascular system. Only when the patient has ragger(shivering) should he be covered well to help heat up the body. After this the patient should be covered with a light sheet (sarong) to allow the body temperature to escape.

7.) Talk about the patient but with the patient. Its common practice that the people surrounding tend to talk about the patient instead with the patient particular when the patient is in an impaired state of mental consciousness. It is vital that the patient is included in anything that has to do with his welfare. Keeping him informed and getting his consent re-establishes his self worth, thrust and confidence to his environment.

8.) Isolate the patient wither physically or socially but have them exposed to as much as “normal” life participation as possible. If feasible the bedridden patient should have his bed near the family’s main activity area.


Do:

1) Communicate in a normal way with the patient particular when the patient seems to be none aware of his surrounding. Keep him informed of pleasant family matters, news etc. this will stimulate his mental faculty and help to get out of a state of stupor.

2) Stimulate the patients by speaking to him, offer radio and TV. program to get his attentiveness reactivated. Small children should be allowed to be as much as possible be near him as this will act as a very subtle attention stimulant.

3) Activate the patient to do whatever he can do for himself (washing his face etc. Do assist as much as needed but encourage self reliance in all spheres of activities of daily life (ADL’s).

4) Mobilize as much as is medically allowed, to avoid the development of muscle atrophy and gradual disabilities to perform even simple task. The patient should be constantly encouraged to do some form of activity whether walking or moving his limbs, turning his body parts ect. Within his ability. If needed solicit an outside mobilization therapist as support service.

5) Nourish the patient correctly according to consideration of medical requirements. In particular sufficient intake of liquid is of utmost importance, as a liquid deficit (dehydration) can lead to serious health problems and detoriation of well feeling. The patients is well hydrated when his urine does not give a strong odor and the color is light, the opposite is always an indication of dehydration. Food should be served in a manner as the patient is most comfortable in eating. When chewing becomes a problem, soft food is optimal and meat etc. can be minced or blended to soft consistence. Ensure that patient gets regular fruits as this will ensure sufficient vitamin and mineral intake.

6) Expose to light having a patient to long in a gloomy room and not sufficiently exposed to sun light can add to depressive feeling. If taking a patient to outside the house is difficult his head should be near a window to allow regular sunlight (indirect) contact.

7) Regular medication control elderly patients often respond very different to medication as their body has a slowed down metabolism and tends to accumulate medication substance in the blood leading to over dosing and serious side effects. Especially patients with hearth and hypertension medication are affected. Have the doctor to review the medication dosage regularly.

8) Checking and recording of vital data’s will help the doctor to improve monitoring the patient’s medication. Patients react generally with anxiety end tension when in the presence of a doctor. This can lead to a higher as “normal” (in the home) reading of the blood pressure and pulse, and subsequently incorrect doses of medication. (“A stitch in time saves nine”.)

9) Activate your muscle There prevails a misconception that “part of aging is that the muscles will lose their strength and volume and are bound to deteriorate”. Muscles are developed by exerting them and the more they are used the more they will grow in volume and strength. The problem is that older people do not use their muscles as much as they did in the younger years and this causes them to diminish. To avoid this, patients should have regular exercise move as much as possible, do some physical activities and keep themselves busy and occupied. Swimming is one of the safest forms of sports to keep fit and does not cause undue strain on joints.

For further information about MOBILE NURSING/MOBILE DOCTOR contact:
00603-78777202
www.hnp-mobilenursing.com

nursing@hnp-mobilenursing.com

Bed sore Seminar Proposal that might be of benefir to the nursing Institute as well as the nurse's knowledge

Intensive Seminar on
“BED SORE”
(Decubitus)

CAUSE, PREVENTION and MANAGEMENT


Conducted by

Mr. Yakob Abdul Rahman Wilhelm Scholer

State Registered Nurse in GERMANY & MALAYSIA
Applied Psychologist
Nursing Director, Home Nursing Providers
Former Lecturer in Health Psychology UiTM

Intensive Seminar on “BED SORE”
(Decubitus) - cause, prevention and management HNP 2008

“OUR QUEST THEIR BEST”

BED SORE

The population of older citizen is rapidly increasing world wide. This creates a whole range of health problems directly related to aging. While Health Science has developed into a more sophisticated science with apparatuses oriented level of patient care, some of the basic knowledge of nursing has seemingly drifted into the background in the daily care of bed ridden patients.
As a result, many patients do not receive the required attention and care to prevent one of the most torturous nursing neglects = BED SORE.
Unfortunately, many teaching institutes do not put enough emphasis to the aspect on the development and prevention of bed sores, to the extent that many nurses mistakenly believe that development of bed sores is “normal and unavoidable”. Few do understand that the development of bed sores is the result of neglect in patient care, and can be a criminal issue. In many countries this is becoming a source of worry and concern as criminal proceedings are not just causing a serious damage to the good image of competence of an Institute, but are also costing huge sums of money in compensation and legal fees. Nurses can also be held personally responsible and eventually lose their licenses.

At least in 85% of all cases of bed sores is preventable. However to be able to prevent the development of bed sore one needs to have a comprehensive knowledge of the actual causes and circumstances that may lead to the development of bed sores.

THE MALAYSIAN SENIOR CITIZEN'S CHARTER AFFIRMS THAT THE OLDER PERSON HAS A RIGHT TO:
· Safe shelter, proper healthcare and income-generating opportunities that are elderly-friendly;
· Clean, hygienic, stress-free environment and adequate nourishment that promotes a healthy quality of life;
· Recreational facilities, family-care and community-harmony that promote physical and emotional well-being.

Life expectancy in Malaysia has increased from 55.8 years for men and 58.2 years for women in 1957 to 70.2 years and 75 years respectively in 2000. The increased longevity helped by declining mortality rates has resulted in an increasing older population, from 5.2% in 1970, 5.7% in 1980 and 5.9% in 1991, to 6.2% in 2000 (Source : Social Welfare Dept., 2004). It was projected that by 2005, Malaysia would enter the ranks of the 'Ageing Nations of the World' with 1.7 million or 7.2% of the population being senior citizens (United Nations source, 1993). By further projections, 15% of the Malaysian population would be old by 2025

As a nurse and “Care Provider”, you have the responsibility to understand the essentials of illness of an aged and bedridden person. Without such basic knowledge the patient will lack the necessary care and nursing competence leading possibly to nursing deficiencies and neglect of appropriate patient care.
Supervision and coordination of subordinates will be very difficult unless the responsible persons themselves have sufficient knowledge and skills in the field of gerontological patient care and specifically in the prevention of decubitus patient care as required.

Course Philosophy:

Knowledge and competencies in all form of nursing work is the personal responsibility of each individual nurse as well as of every institute that provides nursing care service.

Every patient who is admitted to an institution for the purpose of medical and/or nursing treatment has the right to the best of nursing care and competence. This however can only be provided if the care providers have the knowledge and skills needed to provide the optimal service.

Proper knowledge in decubitus preventive nursing and care is essential as it is very beneficial to both, the care giver as well as care receiver.

In this, the Activities of Daily Life (A.D.L.’s) are the basis of attention.
The Body, Mind, and Spirit are a unity and need be considered when attending to a sick person in particular senior citizen with gerontological symptoms.

The content of this Course is based on the general experiences we meet in daily activities when attending to the sick members in their home settings.

The Seminar will deal with the scientific aspects of:
1. What is a decubitus (bed/pressure sore)?
2. What are the factors that lead to decubitus?
3. How does a decubitus develop?
4. Prevention of decubitus development
5. Nursing management in treatment of decubitus

PREREQUISITES

The course is aimed at providing knowledge for:
· Nurses,
· Nursing aides,
· Care givers.


Objective:

· To provide an objective understanding of the problem of decubitus

· To understand the basic causes that are related to the development of decubitus

· To be able to identify potential areas that could lead to the development of decubitus.

· Understand the basis in the prevention and intervention of decubitus management.

· Psychosocial components related to the needs of elderly persons at risk to decubitus development.

· Provide basic understanding of appropriate nutrients in decubitus prevention.

· Have an overall understanding of the complexity of caring for elderly persons with gerontological symptoms and the ability to provide adequate sensibility towards the prevention of decubitus development.


PROGRAM: ·
Duration: 6 hours (1 day)
· Course contents include:
Introduction
· Provide the participants with an insight of the concept and philosophy of decubitus prevention.
Course Structure
· Lecture supported with Power Point slides
· Demonstrations
· Discussions
Lectures
· Basic introduction: What is a decubitus and how does it develop?
· Prevention of Decubitus (Pressure Sore = Bed Sore): What are pressure sores, how do they develop, identification of early signs and symptoms, and preventive measures.
· Gerontology: Who are candidates especially prone to decubitus development?
· Nutrition: What role does nutrition play in the prevention of decubitus?
· Prevention: What role does nursing play in the prevention of decubitus development?
· Intervention: The correct approach to prevent, or minimize the risk of decubitus development.

CORE PERFORMANCE REQUIREMENTS



At the end of the Course the participants will be able to:

· Identify patients at risk or prone to develop decubitus

· Develop intervention measures to prevent the development of decubitus

· Interact with “doctors and other nursing personnel” in the prevention of decubitus development

· To be able to detect early signs and symptoms of decubitus development

· Assess intervention requirements

· Supervise other “care-givers”: nursing personnel and eventually family members and/or volunteers

YOUR INVESTMENT

In the professional management of sick “Warga Emas” it is crucial that the involved personnel have a basic understanding of decubitus prevention of senior citizen.

The early detection of potential decubitus risk and accurate nursing needs does not only prevent a lot of suffering of the elderly sick it also saves a lot of cost with early intervention in the correct nursing management.

We are looking forward to give you and/or your staff the needful training to achieve your institution’s goal in providing optimal service to sick senior citizens in the prevention of decubitus development.

Number of Participants: Should not exceed 20 participants per group
Duration of training: 6 hours (1 day)
Training & Consultant Investment: RM 3000.00 for a maximum of 20 participants.
Individual participants will be charged RM 180.00 per person.
Special arrangements can be made for nursing students.

This investment includes:
· Qualified Lecturer and Assistant
· Information materials
· Lecture materials
· Demonstration equipments
· Supplementary hand outs
· Certificate of Participation


Excludes:
· Accommodation
· Conference Room/Hall suitable for approx. 30 pax.
· LCD projector or rental of RM 50.00
· Writing Materials
· Mileage from the companies office to training venue (80 per Kilometer distance)
· Air passage and airport transfer where applicable.

Please Note the following conditions:

All arrangements on venue, accommodation, refreshments and meals for participants and trainer(s), equipments such as LCD projector, white board and flip charts will be borne by the inviting institution.

Terms:
Payments shall be made upon submission of the Invoice at the end of the training.

Training:
a) The training program will be conducted in an interactive mode. There will be team exercise, role-plays, presentations and individual work. Some individual work requires to be handed in to the trainers and management.
b) There will be Experimental Learning activities to facilitate learning and skills transfer to the workplace.
c) The materials used will be customized to the requirement of your institution. The focus is to understand immediately what has been shared with the participants.
d) The participants will be encouraged to use the trainers as mentors for guidance and evaluation of the knowledge.

MISCELANEOUS

The list of participants with their full names, sex, and NRIC number should be submitted to the Home Nursing Providers Sdn Bhd. at least TWO WEEKS before the start of the program to enable the timely printing of Certificates.

The time schedule mentioned in our programs is standard time schedules. Depending on the participants of the group and their skills the time schedule might need adjustment, this however does not affect the training schedule.

Reservations:

Reservations can be made through telephone, fax or e-mail to the address below.

Special condition: In case a registered participant is unable to attend the training, the institution can replace her/him with a substitute participant.

* The organization reserves the right to postpone or cancel the training program due to unforeseen circumstances

Home Nursing Providers Sdn Bhd.
34 Jalan SS 7/18 Kelana Jaya
473001 PETALING JAYA
SELANGOR D.E.

TEL: 03 7877 7202
Fax: 03 7877 8202
E-MAIL: nursing@hnp-mobilenursing.com


ABOUT THE LECTURER

Yakob Abdul Rahman Wilhelm Scholer currently works with Home Nursing Providers sdn bhd. He can look back to over 50 years of nursing experience.

Mr. Yakob came to Malaysia in 1963 and worked under the Catholic Welfare Services, visiting rural areas and providing medical service to the people in the vicinity of Ipoh City, Perak.
In 1967 he assumed the responsibility of the building and management of Hospital Fatimah in Ipoh.

His engagement to help Drug users and Alcoholics started in 1973 in Ipoh, establishing the Yayasan Pusat Pertolongan and Yayasan Alcoholisma Malaysia of which he was the managing director and principal therapist.

From 1980 to 1983 he returned to Germany to study Applied Psychology and was employed as a nurse in Federal Prison in Wittlich, and Daytop Germany.

On his return to Malaysia he re-assumed his previous positions and established Malaysia’s first Addiction Therapist Training Program, as well as the first all Female Drug Users Rehabilitation Centre in Kg. Bercham, Ipoh.
In 1989 after returning from the International AIDS Congress in Montreal he initiated Malaysia’s first Aids Awareness Committee, which developed into the presently known Malaysia’s Aids Council. The first Hotline on AIDS information was set up and was managed 24 hours a day, 365 days. Talks throughout the country and in all prisons in Malaysia were held by him.

Returning to Germany in 1990 Mr. Yakob worked and continued improving his knowledge and skills in the management of AIDS patients, Gerontological nursing and Mobile nursing; assisted in setting up, and later working in a Mobile Nursing Agency, Ambulanter Dienst Gesundheits-Pflege in MAINZ, Germany. Expanding his knowledge in the field of patients nursing management, he placed great emphasis on holistic nursing and decubitus (bed sore) prevention.

After returning to Malaysia in 2004, he was responsible for the setting up of Malaysia’s first “comprehensive and structured” Mobile Nursing Program: Home Nursing Providers Sdn Bhd of which he is still the Nursing Director and Nursing Consultant.

He was lecturing “Health Psychology” at the University Mara, Faculty of Health Sciences, at Jalan Othman Petaling Jaya.

Mr. Yakob has in the span of his work, visited countries all over the world, attending Seminars and International Congresses, presenting working papers and sharing his experience in the fields of Addiction, Psychology and Mobile Nursing.

He has attended various seminars and workshops in the field of prevention of decubitus the latest in January 2008 in Berlin Germany
Mr. Yakob is also the Author of the BOOK GUIDE TO NURSING AT HOME
The Author can be reached by e-mail: yakob@hnp-mobilenursing.com


Treatment and management of bedsore,MOBILE NURSING/DOCTOR available from. Home Nursing Providers
006 0378777202
nursing@hnp-mobilenursing.com
www.hnp-mobilenursing.com

Healthy Longevity of senior Citizen is not just an unreachable dream

Perception of Mortality and the Psychological Well-Being of Older Persons
By
Yakob Abdul Rahman Wilhelm Scholer
Home Nursing Providers
Malaysia

Reigning measures of psychological well-being have little theoretical ground, despite an extensive literature on the contours of positive functioning. Aspects of well-being derived from literature are: self-acceptance, positive relationship with others, autonomy, environmental mastery, purpose in life, and personal growth.
Unquestionable these are very universal goals of the elderly, yet more often a dream than reality.
Happiness, however, is not being the only indicator of positive psychological functioning. Much literature has also been generated on well-being defined as life satisfaction. Prominent measures in this domain (e.g. Life Satisfaction Index, or LSI; Neugarten, Havighurst, & Tobin, 1961) were also developed for purposes other than defining the basic structure of psychological well-being. We have to differentiate persons who were aging successfully from those who were not.
Early retirement is supposed to give you extra golden years to enjoy. But that may not happen, a new study suggests.
A study of Shell Oil employees shows that people who retire at age 55 and live to be at least 65 die sooner than people who retire at 65. After rhe age 65, the early retirees have a 37% higher risk of death than their counterparts who retired at 65.
That's not all. People who retire at 55 are 89% more likely to die in the 10 years after retirement than those who retire at 65.
"This difference could not be attributed to the effects of sex, socioeconomic status, or calendar year of the study, although the poorer health status of some early retirees may play some part, noted Shan P. Tsai and colleagues at Shell Health Services.

The researchers looked at all past employees of Shell Oil who retired at ages 55, 60, or 65.
"Mortality improved with increasing age at retirement for people from both high and low socioeconomic groups,” they found. "Retiring at 65 was not associated with a greater risk of mortality than retiring at 55 or 60.” British Medical Journal.
What then are the reasons for earlier death in early retirement? Surely not overwork! There are hardly any sicentific studies that will shed light on the reasons of this evident phenomena.
Let me make some psychological assumption as to the possible reason of early mortality of early retirees. When I say early retirees I realy mean those who after their formal retirement also live in this retirement. This is not meant for those who after retirement embark on a new challenge in life. It is abvious from the above observation what complacency in retirement can mean.

Perception of Mortality and the Psychological Well Being of Older Person: By Yakob Abdul Rahman Wilhelm Scholer

A BIASED VIEW OF RETIREMENT
Are the daily activities of the retired engaging or alienating? We might see the retirees portrayed as alienated, withdrawn from society, disconnected from productive work, socially isolated from others and living an unfullfilled, boring, useless and routine existance. In this view retirement presents as jobless. In retirement people who have had a meaningful role are now seperated from themselves and others, with little attachement to productive activity.
In comparison to full time employees, those of retirees are more alienated in some aspect but more engaged in others. Retirees’ activities are more routine, provide less chance to learn new things, provide less social interaction with others, and they are especially less likely involved in problem solving activities. However, retirees’ activities are also equally enjoyable and more autonomous compared to those with full time work. Autonomous fullfilling activities which are enjoyable and provide opportunities to learn new things and integrated activities are all positively associated with a sense of control and negatively associated with psychological distress.
Journal Health and Behavior Catherine E. Ross & Patricia Drentea

Possible reasons leading to early death of retirees could be:
1. Lack of meaning in life. The retiree is suddenly removed from the respected position he/she had in the working life into oblivion, no more Yes Sir, No Sir, Please Sir, Good morning Sir, etc. While in Position he was some one. In retirement he is reduced to no one. This leads to a sense of emptiness and depression.
2. Empty nest syndrome. This refers to the often expirienced reality that prior to retirement their children who were part of the family have made the journey towards their own destiny. Leaving suddenly the house empty, quiet, abandoned. This physical feeling is also perceived emotionally. Creating a sense of abandonment and emptiness, not expirienced to this extend while in a working life.
3. Complacency. The long expected retirement has come, suddenly the “freedom” of job obligations are to be enjoyed. Time routines are changed, personal neglect developes, laziness surface, boredom creeps in etc.
4. Personal life style change. Boredom, feeling of emptiness etc. create a new demand for satisfaction, often resulting in a pleasure seeking behavior, in particular of oral satisfaction = eating. Not merely to fill the daily nutritritional demand but rather as emotional pacification, leading to overweight with all the subsequent health complications.
5. Financial constrains. Suddenly the bank account shows a reduced monthly statement. Yet obligations may not have deminished. Suddenly the previous life style can hardly be maintained. On the other hand the personally perceived, social obligations may have increased, such as marriages of children, arrival of grand children etc.
6. Social/Sexual activities. Many people equate retirement also with sexual passivity. Reduced social contacts with friends, and former working colleges, due to the declining economic status, or just as symptom of depression. This too often leads to a negative attitute towards sexuality particularly when the female spouse is still in employment. Retirement here influences also the balanced sexual life, which may be reduced to a mere obligatory function as the mental attitute towards sexuality has “retired”. However the oposite has also been noted, that retirees need to prove their sexual “attractiveness and ability” by overt sexual activities.

Happiness/Wellbeing

“Contours of Well-Being: Alternative Perspectives
The extensive literature aimed at defining positive psychological functioning includes such perspectives as Maslow’s (1968) conception of self-actualization, Rogers’s (1961)
View of the fully functioning person, Jung’s (1933; Von Franz, 1964) formulation of individuation, and Allport’s (1961) conception of maturity. A further domain of theory for defining psychological well-being follows from the life span development perspective, which emphasizes the differing challenges confronted at various phases of the life cycle. Included here are Erikson’s (1959) psychological stage modes, Buhler’s basic life tendencies that work towards fulfillment of life. (Buhlers, 1935; Buhler & Massarik, 1968), and Neugarten’s 1968, 1973) description of personality change in adulthood and old age. Jahoda’s(1958) positive criteria of mental health, generated to replace definitions of well-being as the absence of illness, also offer extensive descriptions of what it means to be in good psychological health”
If we look at the aspect of well-being = well-feeling, we can not but must view it in perspective of happiness. This again can not be viewed in isolation but needs to be seen in the various aspects of psychology.

Self Acceptance The most importance criterion of well-being is in the individual’s sense of self- acceptance. This is defined as central feature of mental health as well a characteristic of self-actualization, optimal functioning and maturity. Lifespan Theory also emphasizes acceptance of self and one’s past life. Thus holding positive attitudes towards oneself emerges as a central characteristic of positive psychological functioning.
Positive relation with others The important emphasis here is on a warm trusting interpersonal relationship with a spouse or other family, or social community member
Self-actualization The realization of fulfillment of ones potentials, independency, autonomy, tendency to form few but deep friendships, a philosophical sense of humor, a tendency to resist outside pressures and a general transcendence of the environment rather than simply coping with it.

“The highest fulfillment of all good achievable by human action is happiness”
Aristotle (1069)

Discussion
Taking into consideration the afore said we do have to make an effort to seriously question the way we look at and treat senior citizen in this country. Are they in general, particularely those from lower income groups, in any way meeting the aforesaid criteria?

Can we speak of human dignity when we visit “Old People’s Homes”? Are senior citizens given even the basic opportunity to be accepted as respected members of society, when they are:
· excluded from Health Insurances coverage,
· not eligieble for a Credit Card,
· not even considered to get a Bank Loan, even if they can produce securities,
· not served in their home setting by medical doctors,
· treated as non persons in hospitals,

· lacking of urgent nursing help in their home setting, because Institutions do not do their home work etc.

We should consider retired persons as sources of knowledge, inspiration and resources of human capital. For most do have a wealth of knowledge and expirience accumulated in the years of their life and service.
The present practice of sending government servant into early retirement just to give “way for unemployed
youth” is unrealistic and counterproductive. How does anyone justify to sent an expirienced Medical Assistant into early retirement while the country is short of nursing personel?
Where are the seniors who can pass the knowledge and skills to the juniors in the employment sectors?
Is the poor performance in various fields in the country not a result of “ousting” expirienced work force, to make way for the young unemployed, albeit also inexpirienced persons. Would it not make more sense to all concerned if the seniors reduce their working hours, but stay on to pass the knowledge to the juniors? This would not only benefit the young but also give credit to the seniors that they are not being looked at as an obstacle of the younger generation’s aspiration, but catalyst to the improvement of service quality and sources of knowledge for the young. A rethink here is of urgent importance.

This approach would very well go a long way in preventing the retirees feel a sense of uselessness and depreciation of their self worth.
Where are the Senior citizen ‘Towns’, where they can enjoy life in a senior citizen compatible situation and surrounding?

When do we change our mentality of sending “burdening” old sick senior citizens into strange homes instead of providing them with the needed care in their own home setting?
When will the building authorities wake up and insist that new houses and flats have senior citizen compatible bathrooms where also a wheelchair or commode can be moved in and out?
When is society starting to realize that everyone, even the newborn is likely to become old one day and needs help.

When does the government start a compulsory saving scheme that would be available for nursing care once senior citizen need it?
When do professional organisations and individuals stand up and demand from all concerned to ensure that senior citizens can live a life in dignity and solace?
When do I AND YOU put aside personal convenience and initiate what needs to be done in one’s own area of service, related to the issue of improving senior citizen’s plight?

“A country and society will be judged by the way it looks at and treats those senior citizens who have served it and contributed to its deveopement”.


For further information and care for the elderly,
MOBILE NURSING/DOCTOR contact:

006 03-78777202
nursing@hnp-mobilenursing.com
www.hnp-mobilenursing.com