Mobile HOME Nursing as A WAY of cutting hospitalization cost

By: Yakob Scholer, Nursing Programme Director, Home Nursing Providers

Why choose mobile home nursing care?
The need and interest in home health care (mobile home nursing) has grown in Malaysia and most European countries in recent years. This can be attributed to many reasons. Medical science and technology have improved. For example, many treatments and operations that could only be done in a hospital previously can now be done in outpatient clinics.

Nevertheless, it is a well known fact that long stay in hospitals is at times necessary due to the complexity of certain medical conditions or severity of diseases.

However, many who require post surgery care and rehabilitation may find the high costs involved difficult to maintain. The logical consequence is that hospital stay is expensive.

Home nursing is certainly much less expensive and favored by most patients and just as effective as care in a hospital or nursing facility. Nonetheless most patients and their families prefer to stay at home which is their natural environment rather than stay in a hospital or nursing home.
HNP provides a 24hrs x 365days service and attendance where and when needed

What is mobile nursing care?
"Mobile home nursing" is a simple phrase that encompasses a wide range of health and social services and "mobile" denotes the mobility of our nursing service. Mobile nursing care is a cost effective alternative to hospital and nursing home stays. Generally, home care is appropriate whenever a person prefers to stay in his own home setting but needs ongoing care that cannot easily or effectively be provided solely by family members. It is a health care option that includes skilled nursing care, as well as other skilled and non-skilled care services, like physical and occupational therapy, personal care, homemaking and respite care.

The whole range of medical nursing services are provided by our Agency.
Mobile Nursing by qualified nurses is clearly a means of cutting hospitalization duration and subsequently cost, and reducing the risk of relapses and deterioration of condition after discharge from the hospital.
It is an international experience that most patient stay in hospitals, is not solely due to the medical needs, but rather a result of lack of proper nursing care availability ones the patient is discharged in the family care. Consequently patients stay in hospital not always being prolonged for medical reasons but merely for nursing requirements.

Prolonged Hospitalization is in many cases is also counterproductive as:
Patients tend to become overly "nurses dependent"
Acquire secondary infection like MRSA etc.
Develop increased insecurity of going home (hospital dependency).
Lack of "mobilization" which often results in development of bed sores, thrombosis and muscle depletion.
Nursing in one’s own home setting has the advantage that the patient is:
Regaining a sense of normalcy
Developing increased mobility
Fostering of self-esteem
Adjusting to routine lifestyle
Patients stay in Hospital can be cut down:
postoperative
after stroke
after medical intervention is completed
when mere nursing care is required

The nurses in mobile nursing can:
*Keep closes monitoring of the patients condition while adjusting to the home environment.
*Ensure that the patient will acquire self responsibility of correct medicine intake (one of the major reasons for deterioration and relapses)
*Monitor vital data’s and keep in liaison with the respective doctor on any changes.
*Develop a physical activity program for the patient to regain self confidence in mobility
*Supervise and advise on any nutritional requirement
*Provide a 24 hrs on call service in case of any upcoming problem

Home Nursing Providers can also advise on the appropriate correct nursing gadgets, provide (purchase or rental) all basic nursing equipments as well as the correct disposables required in nursing or mobilization.

How quickly can services be provided? Generally, services provided by Home Nursing Provider can begin within 24 hours or less.

If we can help answer any other questions related to mobiele nursing or MOBILE DOCTOR please call us at:
+6 03 7877-7202.

or nursing@hnp-mobilenursing.com

http://www.hnp-mobilenursing.com/

HOME NURSING is much more than just performing technical task

Yakob Scholer helps a patient with upper body mobilisation.
With the establishment of a private mobile nursing agency, the elderly can now look forward to quality nursing within the family setting.

SUZANNA PILLAY writes.
WHEN the elderly take a turn for the worse and require constant nursing care, their families are often faced with a dilemma: to look after the patient themselves or to seek the services of professional healthcare providers such as hospitals or nursing homes. Sometimes, families elect to care for their ailing members, believing that they can provide the necessary psychological and emotional support that will expedite recovery. “This is true to a certain degree, but without proper medical nursing know-how, it gives rise to the over-caring and under-nursing of home-bound patients. The best place for recovery is the home setting, provided appropriate and efficient nursing care is assured,” said Yakob Abdul Rahman W. Scholer, founder and nursing consultant of Home Nursing Providers Sdn Bhd, a private mobile nursing agency based in Petaling Jaya, Selangor. Home Nursing Providers (www.hnp-mobilenursing.com) is Malaysia’s first structured mobile medical nursing team, emphasising quality nursing within the family setting. Additionally, they conduct courses in caring for sick or ailing family members, particularly those with long-term illnesses.

“Many family members feel that patients need to be pampered, but there’s nothing worse than doing everything for a patient who is able to do simple things for himself such as eating, drinking or even walking to the bathroom.

“An elderly person unlearns as quickly as a child learns, and loses abilities as quickly as a child acquires them. Unless an elderly patient is allowed to continue doing these things, the patient becomes totally dependant on his or her family because the caring has been overdone.” To be totally reliant on their family in turn, Scholer said, would diminish the self-worth of elderly patients who are by nature prone to depression.“If they depend on someone for everything, how can they not feel depressed and think they are a burden on everyone?

”Born and educated in Germany, Scholer is the author of A Guide to Home Nursing, which will be launched next month.

He has been in Malaysia since 1963 and was instrumental in the establishment of Hospital Fatimah in Ipoh, Perak. He has played a prominent role in the creation of the first drug rehabilitation organisation in Perak in 1974, as well as the setting-up of the first local AIDS Hotline in 1989.

In 2004, he founded Home Nursing Providers. Scholer said the elderly have special home nursing care needs which non-professional caregivers may be unaware of or underestimate. “The aged have a tendency to develop a whole range of medical complications, such as bedsores, embolism, pneumonia, malnutrition and dehydration.” There was, for example, the case of an elderly, homebound patient who was believed to be suffering from dementia. Instead, it was dehydration that he was suffering from.“He was so severely dehydrated that his brain refused to function. He had previously been drinking only one glass of water each day. I gave him one and a half jugs of water to drink, which would send a normal person to the toilet within 15 minutes. “However this gentleman was so severely dehydrated that even after one and a half hours, he didn’t need to visit the toilet because his body had absorbed all the water.”Scholer said elderly patients don’t have sensations of thirst and their tastebuds are not as active as when young. “Offer them drinks they enjoy and remember to always place fluids in front of them.” Another thing that is also overlooked is proper nutrition. When it comes to food, some elderly people are fussy. They like carbohydrates such as meehoon or rice but they don’t like vegetables and fruits which they cannot chew. “The body, thus, becomes malnourished, having not received adequate vitamins and minerals,” he said.Inadequate nutrition can cause skin and tissue to collapse, resulting in bedsores and other complications that can worsen the condition of the patient.

Scholer said hygiene is another sensitive issue often overdone by non-professional home caregivers here. “Most Asians, when caring for the elderly, believe in bathing them frequently with plenty of soap. However soap is very drying on the skin of the elderly, causing skin to break easily, thus making them more prone to bedsores.” Looking after an elderly patient requires a lot of commitment and patience.

Eventually, there might come a time when the family is at a loss on what to do and starts seeking external support.

“Some might even think of placing the patient in a nursing home, but they should only be placed there if they cannot be managed at all in the home setting. “A professional outsider like a nursing team that makes home visits can help ease the situation, particularly in the caring of long-term and chronic illness cases. It can help reduce the stress and anxiety of the family and the sick person, particularly when a family member has given up a job to take care of him or her.”

To receive more information on mobilenursing or MOBILE DOCTOR contact:

http://www.hn%20p-mobilenursing.com/

nursing@hnp-mobilenursing.com

Tel: 06 03 78777202

THE USE OF SOAP ON THE SKIN OF SICK AND ELDERLY CAUSES MORE HARM THAN BENEFIT

HOME NURSING PROVIDERS Sdn Bhd (644078-M)

JOB SCOPE : WRITE UP – The Importance of Skin pH

The Importance of Skin pHGil Yosipovitch, MD, and Judy Hu, MD

With commentaries by:

Yakob Scholer, Nursing Programme Director, Home Nursing Providers

In my experience as a nurse, particularly in the area of mobile nursing or nursing services in the home setting, I have often come across elderly persons suffering from a multitude of skin conditions. This could range from dry and flaky skin to sever eczema. Such conditions were not due to lack of hygienic practices or proper care by the patients or their family members. In contrast, the patients were often subjected to rigorous cleaning regime, involving soap and other harsh detergents. Nevertheless, many patients and their family members would often still complaint of body odour and skin problems that would result in such odour. Thus I am presenting the article below in order to help us obtain a better understanding on this issue.
Yakob Scholer
***
It’s well known that the skin is the first line of defence against all elements, such as microorganisms, wind, and pollutants. And it’s the acid mantle, a fine film with a slightly acidic pH on the surface of the skin that provides protection for the skin. It plays a very important role as an integral part of the barrier function of the stratum corneum. Recent studies have demonstrated that increased enzyme activity of phospholipase A2 is related to the formation of the acid mantle in the stratum corneum. This combination makes the sin less permeable to water and other polar compounds. It also contributes to the low pH of the skin surface. Normal skin surface pH is between 4 and 6.5 in healthy people, though it varies among the different areas of the skin.Newborn infants do have a higher skin surface pH compared to adults, but this normalizes within three days. It’s important to protect the stratum corneum because if it’s damaged, skin surface pH has been shown to increase, creating susceptibility to bacterial skin infections or skin damage and disease.
Providing Protection
The acid mantle protects the skin from bacterial and fungal infections. The acid mantle contains lactic acid and various amino acids from sweat, free fatty acids from sebum, and amino acids and pyrrolidine carboxylic acid from the cornification process of skin.The acid mantle:
• Supports the formation and maturation of epidermal lipids and therefore the maintenance of the barrier function• Provides indirect protection against invasion by microorganisms• Provides direct protection against alkaline substances (alkali neutralizing capacity)
If the acid mantle becomes disrupted or damaged, or loses its acidity, the skin becomes more prone to damage and infection. Washing skin with soaps or detergents can cause the loss of acid mantle. Repetitive washing alters the stratum corneum and barrier functions, including skin pH. Once damaged, it can take up to 14 hours to restore, by which time, it’s most likely under assault again from another washing. Most people wash their hands about three times a day, on average. Single washings shift pH to the alkaline region, which can shift back to normal within a few hours.
***
This however will be unlikely with persons who are bed ridden and suffering from various diseases as well as those whose skin has been damaged due to continuous exposure to an alkaline condition.
– Yakob Scholer -
Other Factors that Affect pHT here are many diseases that cause an increase in skin surface pH. Skin conditions that can cause this phenomenon include:
• Eczema

• Contact dermatitis

• Atopic dermatitis

• Dry skin
Acute eczema with erosion can cause skin surface pH to shift from normal to 7.3 to 7.4. This is a 1,000- fold increase in the pH shift, as pH is measured in logarithmic function. The entire skin surface pH is increased on skin of people with atopic dermatitis. An increased skin pH contributes to Staphylococcus aureus colonisation, which can play a role in the genesis of atopic dermatitis, discoid eczema, and infective dermatitis as a superantigen.
Systemic diseases that can cause an increase in skin surface pH include:

• Diabetes

• Chronic renal failure

• Cerebrovascular disease
The explanation for the elevated pH in these diseases is not clear but is possibly related to low levels of phospholipase and to autonomic dysfunction causing abnormal sweat secretion. An increase in skin surface pH encourages bacterial growth. Patients with diabetes have an increase in skin surface pH in intertriginous areas, and it’s known that patients with diabetes are more prone to Candidal infections, especially in intertriginous areas. Studies have shown that Candidal skin lesions are more pronounced on skin with higher pH values, possibly due to a pH dependence of the yeast’s virulence capacity and/ or a modulation of the host defense capacity.
***
I can only appeal to those taking care of sick persons especially the elderly to refrain from using soap or other detergents. Normal skin is best washed with warm water and a soft cloth or washing mittens that can be purchased from your mobile nursing agency or pharmacy.
If you have the notion that the person will after some time start exude obnoxious body odour by stopping the use of soap, you can rest assured that this will not happen. This is because fungus and bacteria cannot grow and thrive on an alkaline skin pH. These fungus and bacteria are predominantly responsible for the creation of body odour. Thus, it is advisable to treat dry and damaged skin with a pH enriched skin moisturising lotion.

Yakob Scholer -
C.albicans is dimorphic, and an acidic pH favors the blastospore form, while an increased pH favors the hyphael form. The hyphael form of Candida is the initial invader that grows best at pH>6.5, and patients with diabetes have a decreased level of skin lactic acid. The use of skin occlusive products, such as dressings and diapers, are known to raise skin pH and are associated with skin infections caused by C. albicans.


Products to Use to Maintain pH Levels

There are three main categories of cleansing agents:

• Soaps

• Synthetic detergents

• Lipid- free cleansing agents
It’s been shown that soaps make the skin more alkaline than synthetic detergents. The irritancy potential of cleansing agents is dependent on a number of factors, which include pH, and soaps are known to increase skin surface pH.

Acidic cleansers are less irritating than neutral or alkaline ones, and people prone to dry skin are advised to use acidic cleansers. Agents with slightly acidic or neutral pH, nonionic surfactants, may be preferable for patients who are at increased risk for irritating skin reactions.

Therefore, advise patients with skin conditions to choose a mild cleaning agent with a low pH. Even minor differences in the pH of skin cleansing preparations can be important to the integrity of the skin surface. This should be taken into account when determining the optimal soap.

What’s Really on the Market
Since the effectiveness of low pH soaps and cleansers has been well documented, one would think that companies producing home care products in this fashion. However, the market in the United States carries very low- pH soaps and cleansers. Unless we, as clinicians, educate our patients about the importance of low- pH cleansers and what’s available, they won’t know to look beyond the most common soaps on the market. Most cleansers in the United States, with a few exceptions, are at a pH of 9.5 to 10.5. This pH is inherent to the formula, which is a sodium soap of fatty acids. The formulas that have a neutral pH are called "syndet." Chemically, they are not soaps, but a synthetic detergent in a bar form (thus their names).
***
For further information on appropriate skin care,MOBILE NURSING OR

MOBILE DOCTOR contact:
Home Nursing Providers ; +6 03 7877 7202 or nursing@hnp-mobilenursing.com
www.hnp-mobilenursing.com
Yakob Scholer -