Organisational concept and structure of mobile nursing

Organisational concept and structure of mobile nursing

The population in Malaysia will increase annually. Correspondently so are more Senior Citizens in need of various degrees of care-taking and nursing supports.
The homogeneous family bonds are increasingly depleting, as migration of family members for job opportunities and carrier have become a reality. As a result, many Senior Citizens find themselves at the autumn of their lifespan alone, often as a result of not wanting to leave their place of stay since childhood. Children are, therefore, not able or willing to look into the physical, social, mental and health needs of these Senior Citizens. The ability of these “lost/misplaced/displaced” Senior Citizens to fend for themselves depletes as age advance.

For the same reasons as they often refuse to follow their children to a new place, they refuse to be placed in a residential home setting, resulting sometimes in development of deplorable conditions they slither in. Nonetheless these people have a right of a human worth living condition and care. Not to be under-estimated, is the special mental and psychological development these persons are experiencing, which needs a special handling of their situation. Gerontological care taking is a new field in this part of the world, and care givers have to possess a basic knowledge in this field, as well as the access to constant guidance and counselling.

Home Nursing Providers SDN BHD established in 2004 in Malaysia is aware of these special situations, and have gained some experience in the course of their service in dealing with the special conditions of such people, although the family thus far have been able and willing to bear the financial burden of the care-taking.

The system of care providing for senior, dependable and sick Citizens, is well known to the writer who has spend several years in this field in GERMANY. The basic human behaviours and needs do not differ from one country to another and transcends the cultural and religious affiliations. The basic human needs according to Maslow are applicable to every human being, and in the absence of the same we speak of “human unworthy” conditions or situations.

3 Categorisation of Clients’ Needs

As manifold as humans are their needs just as manifold also, objectively or subjectively. Care-giving should take this into account and should always be aimed at helping to restore self-help as far as this is applicable.
The support requirement of clients can roughly be put in three different categories:

Category I (substantial need of support)

Daily 90 Minutes, of which at least 45 minutes requirement of basic nursing, physical hygiene, and at least two times a week household up-keeping such as:
cleaning (maintenance)
washing and ironing/folding of clothing,
purchase of goods (shopping)
changing of bed sheets etc.

Category II (intensive nursing requirement)

Daily 3 hours’ need of which at least 2 hours in basic nursing, inclusive of 2 to 3 times a day:
general body hygiene,
preparing of nourishment,
assisting in the discharge of body waste,
2-3 times a week household up-keeping,

Category III (total nursing dependency)

Daily 5 hours’ need, of this at least 3.5 hours on basic nursing attendance requirement within 24 hours. This will include Category I and II with additional:
feeding inclusive of trans nasal feeding (Ryle’s tube)
dispensing of medication (which is prepared by a Nurse)
keeping in close liaison with health/welfare support services.

3 Special Requirements

At times it is necessary to attend to the Physical aspect of the living environment, providing intensive cleaning, assuring the environment is meeting with the basic requirement in hygiene and utilities.
Due to the fact that these Senior Citizens often have difficulties to control their body waste discharge, more laundry than generally expected is needed. For such purpose consideration should be given to make necessary provisions.

4 Establishing of Requirement (Assessment)

As mentioned above the requirements of support will vary from one client to another, not only in respect to their actual needs, but also how much the family members (if there are any) can contribute both financially and physically.
Family members should not be excluded but be integrated in the overall nursing process. External care-giving should be supplementary and financial compensation to a family member may be a first option. Leaving to the external support the activities that cannot be delivered by the family, such as:
wound management,
urethral catheters or Ryle’s tube insertion
nursing observation, Blood Sugar, Blood Pressure measurement etc.
Not to be underestimated is the need for psychological support and couching (technical know-how in nursing) to the primary care-giver and family members.

5 Assessment:

It is imperative in our experience that before any client is being given support an Assessment should be made to:
establish the IS situation
assess the family/community support
establish the objective and subjective needs
check on the physical/environmental requirements
assess the families ability and willingness to cooperate
make a nursing assessment, which includes nutritional requirements and body care condition besides an overall assessment.
At the end of such an assessment, at which besides the “reachable family members” also a competent Nurse (HNP) should be present, the respective Officer will analyse and recommend the steps to be taken, and decide on the optimal combination or arrangement to ensure the “best” for the care-seeker.
It is not unusual the situation can become more manageable by merely couching, professional stand-by and counselling of the family members, as far as such are available.

6 Services and Cost

The services Home Nursing Providers can deliver are as shown in the web site of the Company

WWW:HNP-HOME NURSING PROVIDERS.COM

CHARGES SCHEDULES
Medical Nursing charges
General Nursing charges
House Keeping charges
The charges are negotiable and “Special Rates” would form part of the contract between the Ministry and HNP Service Agency.
In each case a combination of services as required should be compiled to meet the client’s
needs and circumstances.

7 Patient call service
Consideration should also be given to the establishment of a 24-hour 365 day “PATIENT CALL SERVICE” which would enable clients in categories II and III to request for help and be attended to.

8 Conclusion

Home Nursing Providers would suggest a pilot Project in the Klang Valley, and the experience of a year’s ‘trial’ period should be a good basis for future development, covering also other areas in the country.
We would like to reiterate that the name (Sdn Bhd) should not be interpreted as primary money-making establishment, although the shareholders expect a return, we see ourselves as a catalyst in providing a much-needed and so far well solicited nursing and care giving service.
Our Team consists of a combination of highly qualified Nurses, Psychologist with Social Experience and trained and supervised Home Nursing Aids, working directly under our supervision and instruction and subjected to continuous training and counselling.

For further information on MOBILE NURSING/MOBILE DOCTOR contact:
006 03-78277202
www.hnp-mobilenursing.com
nursing@hnp-mobilenursing.com