January 28, 2009

Home Nursing needs a lot of human psychology





PESAKIT perlu dibawa bersiar-siar menghirup udara segar di luar rumah.
KESIHATAN
ARKIB : 25/01/2009
Sokongan psikologi di rumah
Oleh RABIATUL ADAWIYAH KOH ABDULLAHadawiyah@utusan.com.my
SECARA umum, tidak ramai di kalangan kita yang mengetahui tentang kaedah rawatan atau proses pemulihan sesuatu jenis penyakit dengan mendalam sehinggalah kita sendiri atau ahli keluarga yang menghidapinya. Kurangnya maklumat atau pengetahuan berhubung sesuatu jenis penyakit menyebabkan kita beranggapan bahawa penyakit yang dihidapi itu sukar untuk dipulihkan atau sekurang-kurangnya diminimumkan.
Dengan adanya sokongan moral serta penjagaan khusus di rumah, ia mewujudkan persekitaran yang positif untuk pesakit.
Ramai yang tidak mengetahui, merawat pesakit di rumah dapat memberi sokongan psikologi keran dengan adanya keluarga mewujudkan suasana yang lebih ceria.
Lebih-lebih lagi jika pesakit terdiri daripada mereka yang tua atau uzur, kehadiran anak-anak dan cucu-cucu memberi semangat kepada pesakit untuk pulih.
Ia ibarat memberi kehidupan atau sinar kepada pesakit.
Oleh itu, Home Nursing Providers Sdn. Bhd (HNP) ditubuhkan sejak tahun 2004 yang diasaskan oleh Yakob Abdul Rahman W. Scholer mencetus fenomena baru bagi penjagaan dan rawatan pesakit di rumah.
HNP bertujuan menyediakan perkhidmatan jururawat dan perubatan ke rumah pesakit.
Menurut Yakob, HNP diharap dapat memberi kesedaran kepada masyarakat tempatan terhadap pentingnya mengetahui penjagaan dan rawatan orang sakit.
"Selain hospital, rumah boleh menjadi tempat rawatan yang boleh membangunkan psikologi pesakit. Orang tua secara semula jadi akan mengalami keuzuran fizikal selain beberapa penyakit seperti angin ahmar, diabetes dan sebagainya.
"Sekitar umur 65 tahun ke atas, keupayaan seseorang akan menurun dam mengalami masalah kesihatan. Bukan itu pesakit lain seperti strok juga memerlukan penjagaan yang baik di rumah," katanya.
Tambah Yakob, dengan adanya perkhidmatan menerusi HNP, keluarga boleh mempelajari kaedah rawatan berbentuk aktiviti fizikal yang akan ditunjuk ajar oleh jururawat HNP.
"Melalui pengalaman saya, ada segelintir anak-anak pesakit yang uzur tidak tahu menguruskan rutin harian pesakit termasuk bagaimana mereka mengurus pesakit untuk membuang air. Bukan itu sahaja, penjagaan pemakanan pesakit juga terabai. Perlu diingat, pesakit yang uzur memerlukan makanan seperti sayur serta buah-buahan yang segar," jelasnya yang berasal dari Jerman.
Selain itu, bagi mereka yang berkemampuan , pembantu rumah mereka boleh mempelajari kaedah rawatan pesakit yang lebih efektif.
"Berdasarkan pengalaman saya, kebanyakan pesakit uzur mengalami kesan melecet di belakang badan. Ini kerana pesakit itu tidak banyak bergerak sebaliknya hanya dibiarkan terlantar di atas katil. Persepsi ini perlu diubahkan kerana pesakit perlu menyedut udara segar. Dengan adanya penjagaan eksklusif di rumah, pesakit boleh merasai suasana yang baru," jelasnya.
Tambah Yakob, kebiasaannya pesakit menderita di bawah jagaan keluarga sendiri mahupun di pusat rawatan perubatan.
Walaupun pesakit itu sentiasa diberi perhatian dengan penuh kasih sayang dan layanan yang secukupnya tetapi penjaga kurang arif bagaimana hendak mengendalikan dengan betul.
"Kebanyakan orang tua dan uzur banyak menghabiskan masa di rumah dengan berbaring di atas katil. Terlalu sedikit aktiviti yang dilakukan. Pesakit sebenarnya boleh melakukan aktiviti fizikal seperti berjalan-jalan, renang atau berbual-bual bersama keluarga untuk menjadikan kehidupan pesakit lebih berkualiti," katanya.
Yakob menjelaskan, pesakit tidak perlu hanya tinggal di atas katil untuk menunggu mati kerana keluarga atau penjaga boleh membawa mereka bersiar sekitar luar rumah untuk menghirup udara segar di luar.
Sebagai keluarga pesakit, kita perlu ingat layanan dan kasih yang tulus ikhlas dapat memberikan pesakit harapan untuk sembuh.
"Faktor inilah yang menyebabkan ramai pesakit lebih suka tinggal di rumah daripada di hospital atau pusat jagaan orang tua. Ini kerana mereka mengharapkan ahli keluarga terus memberi sokongan agar mereka dapat menikmati kehidupan yang lebih baik dan seronok," jelasnya.
Dengan adanya perkhidmatan HNP, ia dapat membantu pesakit yang tinggal di rumah mendapat rawatan dan penjagaan yang betul. Selain itu, ahli keluarga atau penjaga pesakit mendapat maklumat yang bermanfaat. Ini akan memudahkan mereka mengendalikan kesihatan pesakit di rumah.
Menyedari keperluan manusia terhadap bantuan perubatan tidak mengira masa, HNP sedia memberi perkhidmatan selama 24 jam.
"Kami ada lebih kurang 20 orang kakitangan yang terlatih sedia memberi perkhidmatan apabila diperlukan. Hanya dengan membuat panggilan, jururawat ini akan dihantar ke rumah pesakit.
"Mungkin ini kelihatan agak ringkas, tetapi berdasarkan pengalaman saya, ada pelanggan yang tidak tahu keperluan makanan pesakit. Petugas yang terlatih ini akan menjalankan tugas dari rumah ke rumah akan memberi tunjuk ajar," katanya.
Antara perkhidmatan yang diberikan HNP termasuk mengendalikan peralatan perubatan, merawat luka dan kecederaan, memeriksa tekanan darah tinggi dan memberi sokongan psikologi.
Selain itu, HNP membantu pesakit membersihkan diri melakukan senaman kesihatan, memberi makan dan penjagaan selepas bersalin.
Menurut Yakob, tugas ini lebih kepada kerja-kerja sosial kerana ia melibatkan orang-orang yang tidak sihat sama ada yang terlantar di atas katil dengan jururawat yang dilatih.
"Mereka ini akan menguruskan pesakit termasuk merawat dan melayan pesakit sehinggalah perkara membuang najis.
"Dalam pada itu, HNP menekankan kualiti dalam perkhidmatan yang diberi dan rawatan dibayar dengan harga yang lebih rendah berbanding pasaran luar untuk meringankan beban keluarga pesakit bagi menampung kos perbelanjaan Tidak ketinggalan, HNP mendapat khidmat nasihat dan kerjasama daripada pihak doktor, hospital, insurans perubatan, perkhidmatan perubatan dan kesihatan menguruskan HNP.
Menyusuri kisah hidup Yakob, dia pernah mengikuti latihan dalam bidang kejururawatan di Jerman selama empat tahun mulai tahun 1956. Kemudian, Yakob datang ke Malaysia untuk bekerja di bawah Kumpulan Perubatan Katolik dengan menyertai Kumpulan Perubatan Bergerak Malaysia. Selepas itu, Yakob melibatkan diri dalam projek penubuhan Hospital Fatima di Ipoh pada tahun 1963. Ketika bertugas di hospital, Yakob mula mempelajari tentang Islam tetapi sekadar untuk ilmu pengetahuan.
Yakob yang menjadi anak angkat Tunku Abdul Rahman telah mengambil keputusan memeluk Islam pada tahun 1975. Lima tahun kemudian, Yakob ke Jerman semula untuk melanjutkan pelajaran dalam bidang psikologi.
Selepas beberapa tahun, Yakob datang semula ke Malaysia dan menubuhkan Pusat Pemulihan Dadah untuk wanita di Kampung Bercham, Ipoh dan Program Latihan Pertama. Selain itu, Yakob menubuhkan Program Latihan untuk Pakar Terapi Penglihatan. Selepas kembali ke Jerman pada tahun 1990, Yakob bekerja di Universiti Mainz di samping membantu dalam penubuhan Employment of Mobile Service. Pengalaman membantu wanita berusia 70 tahun yang tinggal bersendirian di rumah dan dianggap seperti ibu sendiri mencetuskan idea untuk membuka HNP di Malaysia.
Orang ramai yang ingin mendapatkan maklumat lanjut tentang HNP boleh mengunjungi HNP di 34 SS, 7/18 Kelana Jaya, Petaling Jaya, Selangor atau hubungi talian 03-78777202 atau 017-2809816.
Rawatan strok di rumah
Strok antara penyakit yang memerlukan lebih perhatian di rumah. Sementara itu, dengan adanya sokongan moral, pesakit ini akan lebih ceria dalam melayari kehidupan mereka. Strok merupakan keadaan yang berlaku tiba-tiba akibat rosak atau pecahnya salur darah otak yang boleh menjadikan seseorang tidak sedar diri, biasanya diikuti oleh kelumpuhan atau penyekatan salur darah oleh gumpalan darah.
Berikut merupakan sedikit panduan bagi rawatan pesakit angin ahmar atau strok di rumah.
l Sediakan stokin untuk mengelakkan berlakunya darah beku dalam saluran darah (deep vein thrombosis). Ia berfungsi untuk mencengkam kulit dan mengempiskan vena supaya darah tidak bertakung.
l Bagi mengelakkan kekejangan dan kaku otot, pesakit dan ahli keluarga pesakit dilatih cara-cara yang betul untuk mengalihkan kedudukan pesakit, membawa ke tandas, mengangkat dan sebagainya.
l jururawat membuat penilaian sama ada keadaan rumah pesakit sesuai untuk mereka ke tandas, katil dan sebagainya. Mereka juga akan membuat penilaian sama ada pesakit memerlukan alat-alat bantuan berjalan seperti tongkat, kerusi roda dan lain-lain.
l Pesakit yang menghadapi masalah gangguan pertuturan dan pemahaman dalam berkomunikasi akan dibantu oleh pakar pertuturan untuk bertutur.
l Bagi memastikan pesakit mendapat zat makanan yang mencukupi, pakar pemakanan akan menganggarkan keperluan kalori yang diperlukan.
Rawatan paliatif
Penjagaan atau rawatan paliatif ini merangkumi penjagaan semenjak pesakit dimasukkan ke wad di hospital sehinggalah penjagaan pesakit di rumah.
Banyak kes menyaksikan bagaimana ramai pesakit kanser yang terbiar dan terlantar tanpa sebarang usaha-usaha untuk mengurangkan penderitaan mereka dan pesakit-pesakit ini akan meninggal dalam keadaan yang sangat menyedihkan. Kaedah rawatan yang bertujuan untuk mengurangkan penderitaan pesakit kanser yang berada pada peringkat akhir ataupun yang tidak boleh disembuhkan lagi dinamakan penjagaan ataupun rawatan paliatif.
Penjagaan paliatif bermaksud penjagaan holistik yang merangkumi rawatan melegakan masalah fizikal, sosial dan psikologi pesakit.
Pesakit yang dimaksudkan di sini adalah pesakit yang menghidap penyakit-penyakit kronik yang serius dan tidak ada peluang untuk sembuh. Penjagaan paliatif ini juga meliputi penyakit buah pinggang dan lain-lain.
Walau bagaimanapun penyakit yang sering dikaitkan dengan penjagaan paliatif ini adalah penyakit kanser. Penjagaan paliatif telah bertapak lama di negara kita dan sehingga hari ini terdapat banyak pusat-pusat rawatan paliatif sama ada di Hospital Kerajaan ataupun swasta.
Ia dikendalikan oleh petugas-petugas yang datangnya dari berbagai-bagai latar belakang termasuk bekas-bekas pesakit sendiri.
Hampir di semua hospital-hospital besar kerajaan mempunyai pusat rawatan paliatif. Pusat-pusat rawatan paliatif ini akan mempunyai doktor yang bertugas, jururawat-jururawat dan sukarelawan-sukarelawan. Di tempat-tempat tertentu, pusat rawatan paliatif ini dinamakan Hospis. Penjagaan paliatif merangkumi aspek fizikal , mental (psikologi) dan juga sosial, dengan itu penjagaan paliatif ini memerlukan penglibatan semua pihak seperti doktor, jururawat, pekerja sosial, pakar psikiatri dan yang paling penting adalah penglibatan ahli-ahli keluarga yang terdekat.
If you are looking for MOBILE NURSING OR MOBILE DOCTOR please contact: www.hnp-mobilenursing.com or nursing@hnp-mobilenursing.com or +6 03 78777202

January 19, 2009

Understanding the five point Blood Glucose measurement

Understanding the five point Blood Glucose measurements

Diabetes is perhaps one of the most common problems affecting the global population. In fact, the World Health Organisation estimated that diabetes has become one of the leading causes of deaths in many first world and developed nations. It is also projected that there will be over 300 million people with diabetes worldwide by 2025.
Blood glucose test has become a benchmark measurement in identifying and managing diabetes.

In recent years, the blood glucose test has taken the place of urine testing in laboratories and healthcare facilities due to its accuracy in diagnosing diabetes at an earlier stage as compared to the former. Furthermore, the advent of technology and the development of portable, affordable and user-friendly products like the glucometer and glucose strips for example, have also allowed these tests to be conducted at screening centers, public places and even at home by concerned individuals and non medical professionals.

There are many variations and means to the test according to experts. The American Diabetes Association has identified the following tests to measure the amount of glucose in a person’s blood; fasting blood glucose test, random blood glucose test, post prandial blood glucose test and the oral glucose tolerance test (OGTT)3. These tests have become common in Malaysia. However, as a practicing nurse in Europe for many years, I have found the five-point blood glucose test to be more commonly practiced there.

The five-point blood glucose measurement also known as the gluco-quant method is carried out by combining elements of the above-mentioned methods into timeline specific series of tests conducted at precise intervals whilst a person go about his daily activities. Generally, it is recommended that the blood glucose test be carried out at least three times a day by a person at home. However, the gluco-quant method requires the individual to carry out the test up to five times in a day in order to identify a specific pattern to a person’s glucose distribution levels, which will inadvertently result in a more accurate picture of his or her condition.

With the five-point blood glucose test, a person will take his first blood glucose test early in the morning before breakfast, similar to the fasting blood glucose test. This is followed by another test at about two hours after breakfast or the first meal and another test immediately after lunch or the second meal, both similar to the post prandial test. The fourth test will be carried out at about an hour before dinner or the third meal and the final test will be conducted at about one hour after the final meal.

Indeed, many have expressed some reservations of this method due to the frequency of the tests which is deemed as a hassle. Nevertheless, it has served the purpose of confirming a diagnosis of diabetes as well as identifying the severity of the situation for existing pre-diabetic and diabetic patients.

It is also important for individuals to understand the nature of the pancrease system. In many pre diabetes and diabetes patients, the pancreas is still able to produce a limited amount of insulin. This amount may be sufficient to process the sugar and carbohydrate consumed by an individual in the last meal prior to bedtime, as the person would then go into a fasting state of between 6-10 hours during his sleep, before his next meal in the early morning of the following day. This will result in a normal reading during an early morning fasting blood glucose test.
However, as the day progresses, a person will usually have at least several meals within a six to ten-hour period. Depending on the diet, this may lead to a saturation of carbohydrate in the bloodstream, which the limited production of insulin in pre-diabetic and diabetic individual may not be able to handle. This can explain why the early morning reading for a fasting blood glucose test can be normal, yet it may rise to dangerous and nerve damaging levels in the later part of the day. In such instances, should an individual only be tested for a fasting blood glucose test or at just two intervals during the day, his actual condition may not be accurately identified.

I myself has had a similar experience with a patient. About two years ago I was approached by a young man of 28 who shared with me his anxiety of developing diabetes. Having lost his father to the same condition earlier, he was apprehensive about going through a similar ordeal. Despite obtaining a normal reading for his fasting blood glucose test on several occasions, he was experiencing the common symptoms associated with diabetes and pre-diabetes such as fatigue, blurred vision, frequent urination and lethargy.

I suggested that we conduct the gluco-quant test and the result was that whilst he recorded a blood sugar level of 5.5 mmol/l in the first early morning test, his subsequent tests registered a blood sugar level of 10.8 mmol/l, 12.5 mmol/l, 14.0 mmol/l and 14.3 mmol/l respectively, indicating a high glucose level pattern consistent with diabetic patients. The patient was subsequently put on insulin by a specialist. This is a clear example of how the five-point glucose test have been able to save a person from potentially severe diabetes related medical complications in the future.

Despite its effectiveness in diagnosing diabetes and indicating the severity of a diabetic's condition, many may still question its feasiblity due to its frequency and the cost involved. However it should be noted that should an individual find it difficult to conduct the test on such a frequency at home, there are medical and nursing professionals who offer such services. A person may opt to be detained at a healthcare facilty for a one-day period to conduct the test or for his added comfort and convinience, the test can also be conducted in his home by certified nursing professionals who are also known as 'mobile nurses'.

Further, it should also be noted that the five-point blood glucose measurement is an effective diagnostic and management tool. As such it need not be carried out on a daily basis, suffice that a person take the initiative to conduct the test at a regular monthly intervals which would indeed save him the time, money and hassle, yet provide him with the needed information that can save his life.

-end-

ABOUT THE AUTHOR

Born and educated in Germany, Yakob Scholer has been in Malaysia since 1963 and was instrumental in the establishment of Hospital Fatimah, Ipoh. Since then he has played a prominent role in the creation of the first drug rehabilitation organisation in Perak the Yayasn Pusat Pertolongan and Yayasan Alkoholisma in Ipoh in 1974 of which he was the managing director and principal therapist.
In 1989, upon returning from the International AIDS Congress in Montreal, he initiated Malaysia's first AIDS Awareness Committee and Malaysian AIDS Hotline which subsequently become known as the Malaysian AIDS Council. In 2004, he founded a private mobile nursing agency, based in Petaling Jaya Malaysia. Today, as the author of “Guide to Home Nursing” Mr Scholer also lectures at a local university on Health Psychology and conducts
3 http://www.diabetes.org/

For further information as to the testing of BG, MOBILE NURSING or MOBILE DOCTOR you may contact: www.hnp-mobilenursing.com
or call Tel: +6 03 78777202 or nursing@hnp-mobilenursing.com

January 8, 2009

Cultural sensitive (home) Nursing

Cultural sensitive
(home) nursing

Information on a patient’s cultural background and the requirements associated with such a background are crucial elements in good nursing.
Malaysia is a country that boasts many different cultures and ethnicities. However, many still fail to understand the basic cultural elements and sensitivities of each other’s cultures. Such insensitivities are also apparent in medical personnel, which inadvertently lead to issues and conflicts when dealing with patients whose culture is neither understood nor observed. Many nurses and doctors see the patient more as an object rather than a person with his own personality and history. The patient is regarded primarily as a sick person who ONLY needs attention to his medical/nursing issues and not his personal requirements.
In this case, if the person’s cultural and personal needs are left totally unattended, it will result in the development of distrust and rejection towards the caregiver, nurse or any person attending to him. Trust and confidence are essential elements for successful therapy and these can only be cultivated when individual patients are seen in their own unique cultural history. Only by recognising a patient’s individuality and subsequently incorporating their cultural requirements into the nursing process will culture sensible nursing be assured.
A good culture sensible nursing approach means that the nurse must :
* acquire knowledge of the various cultural aspects of the patients she is attending to
* question her own prejudices, and cultural background
* develop the ability to cope with inter-cultural differences and conflicts
By following these three basic conditions, nurses and caregivers will be equipped with the knowledge and ability that will make it easy for them to meet the nursing needs of any client, irrespective of their cultural / religious background.

What is culture?

Culture is a very complex term. Ask any ten people for their definition of culture and you will be rest assured of ten different answers. The word "culture" is derived from the Latin language, which means care taking of the body, but primarily of the spirit. Everything that humans have created and developed are cultural achievements.
Humans are on the one hand natural beings which mean they bear similarities to plants and animals in the biological dimension. On the other hand, they are also cultural beings, whereby they have to create their world to survive. These creations are what we now identify as cultural achievements. In nursing, it is very important that we take into consideration the biological as well as the cultural, social and religious
dimensions. If this does not succeed, we face the danger of viewing the patient as merely a biological being that is in need of purely medical or nursing attention.

What is culture sensible nursing?

Culture sensible nursing is a practice by which each individual patient is approached and observed according to his biography, religion, culture and gender-specific background. Upon observation, the caregiver or medical personnel will be open to the unique culture related needs and requirements of the said individual.
Key competencies of culture sensitive nursing include the willingness of the nurse to posses a certain degree of curiosity, interest, creativity, tolerance and the ability to manage stress.
Culture sensibility has been receiving an increasing amount of attention worldwide as there is practically no country in the world right now that is culturally homogenous. In Malaysia in particular, there is a need to increase our sensitivity to the cultural diversities in the day-to-day dealings with our fellow citizens, especially the elderly, sick and handicapped.
Culture sensible nursing ensures that a person in need of nursing will receive services that are respecting of his cultural and religious values. It is a key competence for the nursing personnel to be open to social learning and adoption and to have a good amount of curiosity for the individual interests, creativity and ability to cope with stress and frustrations.
Malaysia being a cultural potpourri demands a very high degree of cultural sensitivity towards its population. Such sensitivities should be even more so observed in the medical and nursing field where we have the most intimate contact with people of different races, religion, cultural and sexual orientation and needs
What does intercultural competence mean?
Every learning process needs intercultural competence. This is because, a prerequisite for learning is that an individual should have an interest in others and
new things. To be successful in this, one has to approach the other person without any prejudice or reservation.
Intercultural competence therefore means the ability of meeting, communicating and exchanging ideas with people of diverse cultural backgrounds. This includes the
language the person speaks or expresses himself and the different values he exhibits. It is paramount not to judge the differences, even if they are alien to our own, but merely to take note of the similarities. Intercultural competence means that one can indulge in self-reflection, posses the knowledge about different cultures, manage conflict effectively and holds a certain degree of empathy and inquisitiveness.

What is the purpose of intercultural nursing?

Intercultural nursing means that we can adjust to the differing biographic, social, religious and communicative needs of the patient. We have the ability to display the readiness to respect the different cultural background of the patient and his needs, thereby providing a sense of acceptance and security. The understanding of the cultural individuality and its respect and recognition has to be integrated into the nursing procedures.
Intercultural competence in nursing includes
Knowledge of the diverse cultures and religions within Malaysia.
Empathy for the nursing person who are of a different cultural background and the ability to express respect to such differences
Open-mindedness and curiosity for the individuality of the other person without coming to valuation conclusions.
Self-reflection and understanding the role as a nurse.
Conflict management and stress tolerance as well as flexibility and self-confidence.
Intercultural nursing in the above must not be newly learnt but is rather a reflection of their own inherent and fundamental abilities. Nurses who have competence in intercultural nursing are persons who have confronted their own fears and insecurity, and are also those who are conscious of there strength and weaknesses and can therefore accept the strength and weaknesses of the patient.
It is those persons who are curious, open-minded, and can approach others fairly, being free of prejudices. People who respect the decision of others, even if these would be in conflict with there own beliefs and culture will be able to accept others completely, with respect and empathy.
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