(mobile) - nursing and related matters

Do not traumatise, do it correct, setting of male catheter

2009-11-21T16:19:00.004+01:00

Safe and Correct Way in the Insertion of Urethral Catheter for Males

By Yakob Abdul Rahman Wilhelm Scholer

In my many years of practice I have observed the worst in the insertion of catheters for male patients. Traumatisation may cause bleeding, inflammation to total blockage of the urethra, resulting in the necessity for supra-pubic catheterisation.

This is absolute unnecessary as a very simple method can help avoid unfavourable condition.

Every doctor or nurse who knows the male anatomy of the urethral system realises the lope near the prostate gland. It is usually here that the insertion tends to get difficult as the catheter has to ‘find its way’ around that lope thereby entangling itself or become bent if the catheter is very soft and small.

The trick that solves the problem is simple. Just place a small cushion a role-up towel under the pelvis before you proceed with the catheterisation procedure.

It is highly recommended to use the same role before removing the catheter.

This trick was taught to me on my first posting to a male urological ward. The chief nurse a very experienced person, made sure that no traumatisation would ever occur.

I, after 52 years in Nursing can assure you that I had never even once, when applying the above method met any problem in inserting a catheter.

Good luck!

For more information as to home nursing (Mobilenursing in Malaysia contact:

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

or Tel: 03 78777202

Hearing problem of elderly often misinterpreted

2009-11-21T16:03:00.003+01:00

Silencer in the ear!

By Yakob Abdul Rahman Wilhelm Scholer

Hearing:
People who suddenly discover a ‘silencing’ of their hearing may simply be suffering from a blockage caused by ear-wax.

In my experience I had many cases where in particularly elderly persons who suddenly complain of hearing problems get the comment, ‘ok, age is catching up’. Nothing is more disastrous than just to accept such a statement. It is not uncommon the cause is merely the ear being clogged. Some patients I attended to had such a blockage that it took up to two weeks to remove the blockage; in one case the patient had a 1.5cm sized ear-wax. It is not surprising the inside of the ear lining is accordingly affected.

It should be, as a matter of fact, that in any case of decreasing hearing capacity an ENT specialist to be consulted. He would be able to establish if the case is simply due to a blockage or any other condition.

The ENT specialist may, according to the finding, recommend a wax softener for a certain number of days, followed by an ear wash-out. Such a procedure is generally over in a few minutes of time and hardly painful.

What causes such conditions?

Well, ear wax is a natural process in protecting the skin of the inner ear from drying out. Often people tend to clean their ears with cotton butts which instead of clearing the ear-wax they push it further into the ear. This causes slowly but surely the wax accumulation in the deeper part of the ear and lead to this condition of ‘not hearing’.

Advice:

1. Consult your an ENT Specialist for your hearing problem,

2. Use cotton butts only in the outer area (wax will find its way outward)

As to informations about mobile nursing in Malaysia contact:

www.hnp-mobilenursing.com nursing@hnp-mobilenursing.com

TEL: 03- 78777202

Home Nursing Providers. www.hnp-mobilenursing.com nursing@hnp-mobilenursing.com

Tel 03-78777202

2009-09-13T14:44:00.004+02:00

Mobilization in Senior Citizen Residencies
By: Yakob Abdul Rahman. W. Scholer)

It is the general expectation and perhaps believe that when a senior citizen is being placed in a ‘home’ all his needs are automatically taken care of. Unfortunately that’s nothing more than just wishful thinking than reality particularly here in Malaysia. These homes have a range of names such as old folks home, senior citizen residency, recovery and rehabilitation homes, rehabilitation centres and many more such attractive names. No one really knows what or how to interpret such names. They may all but conform to the minimum standard of what their names really describe. The majority confirms that there is few exception. I have taken the pains to visit many of them, yet I have not seen one that deserves the names on their entrance.
One of the most striking problems these places seem to demonstrate is the total unawareness of what gerontological nursing is all about. Most of these centres are merely residencies of elderly and nursing dependent persons. These inmates or residents get their food and basic care, often provided by people who have never attended a single lecture in nursing, much less any professional knowledge or skill in relation to their duties. One of the most striking observations I made was the almost total absence of any form of mobilization of their residents. Besides appropriate nutrition and basic nursing is the aspect of keeping elderly people mobile. The benefit of mobilization can be found in the thousands of pages in the website ‘Google’. Yet, one gets the impression as if we are living in the 'stone age' of nursing care of senior citizen and the necessity of their capability to be mobile.
This is not surprising as many of these homes are managed by unprofessional profiteers, whose only concern is the amount of profit they get at the end of every month.
Families however often got misled by the well described flyers with pictures of all kinds of activities lined up for their residents. Some of these flyers even have 'comments' from alleged relatives of their residents, praising the homes for their professional approach.
Let us get back to the point of mobilization.
It is a well known fact that muscle depletion in the elderly is one of the most threatening developments due to under-using of the muscle. Senior citizens have a whole range of physical as well as mental conditions which makes them tend to become sedentary instead of being active. While physical conditions such as paralysis, joint ailments, overweight etc. are often a reality but no less is the emotional condition manifesting negatively such as condition(s) as depression and lethargy. In such situations it is not surprising that the unskilled care givers are at a loss in meeting with this dilemma, leading to the steady deterioration of the residents’ condition. When a person neglects exercises and mobility a whole range of medical and psychological conditions will crop up.
These centres have little choice but to engage qualified physiotherapists or exercises motivators (people specially qualified in dealing with elderly people).

Particularly when the elderly persons have specific needs and these must be understood and be addressed, to ensure a maximum of benefit approach for the residents.
Amongst these are: motivation, communication, application and creativities that not only are muscle benefiting but more entertaining and enjoying. Using music to create natural body movements are simple but most potent applications.

Group activities are a further stimulant as it creates a WE effect and can lead to croup cohesion.
A good therapist is one who manages to get the greatest response to his motivation.
Even simple forms of physical activities are better than none. Not providing physical activities is simply equal to neglect of residents’ care requirements.

For information as to:

Mobile Doctor

Mobile Nursing in Malaysia

Mobile Oxygen and other related Services kindly contact:

www.hnp-mobilenursing.com Or nursing@hnp-mobilenursing.com

or 03 78777202

Aids patient (mobile) nursing needs: professional and interpersonal skills

2009-09-11T07:04:00.003+02:00

Nursing AIDS patient not a special risk to the nurse

By Yakob Abdul Rahman W. Scholer

In many seminars and forums the topic or question often raised is: the chance of the nurse herself is being infected from giving care service to AIDS patients.

Contrary to the common believe nurses who work with AIDS patients are actually less at risk of contracting AIDS than those in the general wards. This primarily has to do with the fact that those who work with AIDS patients are much more conscious of observing standard operational procedures = S.O.P. in the handling of potential infectious materials, than those in the general wards. A nurse who complies with the S.O.P. in disposal of infectious materials has virtually nothing to be afraid of in respect to herself being infected by providing nursing care to AIDS patients.

Nurses in general wards have the tendency to assume that the young man admitted was due to an accident therefore he is regarded as “unlikely” to be infected with HIV or suffering from AIDS. Nothing is more erroneous than to be in the assumption that an accident victim or a dysentery patient etc. may not be infected with HIV often lead to a less stringent observation in handling of potential infectious materials.

In my 10 years of nursing AIDS patients in Germany University Hospital, MAINZ and until now I have never heard of a nurse being infected with HIV herself in the process of executing nursing care. This is simply the result of being an infectious ward staff everyone follow the S.O.P at all times and thereby be protected not only of HIV infection but also infections with other diseases such as dysentery, Hepatitis A, B or C, and all other transmissible diseases.

The adherence to proper hygienic observation in no way interferes with the interpersonal contact between patients and nurses. At times the patient will make the nurses aware of the need of wearing rubber cloves when dealing with potential infectious materials. The need to be very sensitive to the patient’s feelings when providing nursing care is most important. Moral judgements and curiosity as to the way to be infected are absolute taboo to a nurse. There is no difference between a reckless motorbike rider who meets and accident or a person contacting HIV, some due to mere ignorance and circumstances. As a nurse we have to be concerned about the patient’s welfare and not the way of transmission of his infection.

Indeed HIV patients are so grateful to be helped and cared for without prejudices and moral judgements. It’s this point which leads to the situation where many AIDS patients do not look for the most appropriate/professional nursing care, afraid of being subjected to reticule and rejection.

Families must also learn to accept the member who is HIV infected or perhaps suffering from AIDS. They need to be educated that living together in the family there is absolute no danger of anyone getting infected by observing basic hygienic rules. It’s sad to observe that some family members decree the AIDS victim to leave the house and find a place elsewhere to stay as they are not welcomed in the family environment. This is mostly due to the ignorance in the mode of transmission and the eagerness to “protect” the other family members from getting infected.

Too little of education is being provided to the public in this aspect. Public education limits itself to the ‘raised finger’ prevention, exhortation methods and morale exhortation.

Why should an aids patient to be treated less willingly and sincerely than any other patients placed in our care? The time of discriminatory approach has to end and every patient is in the first instance a nursing needy person and not to be subjected to moral judgement.

Let God be the judge of rights and wrongs, for He alone knows what is in the hearts of man.

For information as to:

Mobile Doctor

Mobile Nursing in Malaysia

Mobile Oxygen and other related Services kindly contact:

www.hnp-mobilenursing.com Or nursing@hnp-mobilenursing.com

or 03 78777202

Mobile nursing of babies and young people

2009-09-09T09:29:00.005+02:00

Mobile nursing of babies and young people

It is a fallacy to assume that only senior citizens are in need of nursing care. In the years of our operation we have taken care of many young persons, who were in need of nursing care. The problems these patients were afflicted with ranged from post operational, organ dysfunctional disorders, physical and cerebral dysfunction, or merely temporary parental inability to cope with post-Caesarean delivery, or physical overstressing often due to twin births. Others are those whose parents are in the professional field and desire just the best nursing care for their babies, whom they do not want to delegate to a maid.

Taking care of such newborns or young children needs special qualities besides being a nurse. Babies tend to cling very early to a particular person, bonding. This person should of course always be one of the parents. It’s therefore vital to have the baby as much attended to by its natural parents as possible and the nurse to be on hand for tasks which the parents either do not have the time for or otherwise incapable.

Young children on the other hand need to develop a lot of trust in the nurse who takes care of their needs. The mere fact of ‘being a nurse’ does not yet provide these qualification or presumes the trust by the young person. It needs to be understood that there should be sufficient time allowed for basic interaction between the nursing person and the young patient.

The young patient needs to be approached from a level of respect for the special feelings and must be dealt with in a way meeting his mental development and capabilities.

Families who consider the service of a mobile nursing service must have a clear understanding that they should never delegate their obligations to an outside help. Parents cannot and must not be replaced, as the young will have to continue the bonding process according to the various stages of development.

On the other hand parents do need to consider the need for the skill, knowledge and experience of qualified persons to avoid unfavourable developments. Here again the tendency to ‘over nurse’ is very real. Often do parents who are most of the time away ‘spoil’ the young ones with food and pampering. They to give excessive allowance to misbehaviour, which makes it difficult for the care-taking nurse to correct. When the youngster is confronted with different sets of behaviour allowances, he or she tends to create humdrum situation into a stressful situation for both parents/nurse as well as the youngster. Even a sick or handicapped child has to learn that there are rules to be abided by, lest it will develop into a tyrant. Frequent communication between parent(s) and nurse will be essential to ensure that the child experiences consistency in their approach. Well planned and professionally carried out support service will then be of benefit to the parents as well as the care receiver, which should always be the primary goal aimed for.

For further information about:

Mobile Nursing

Mobile Doctor

Mobile Oxygen

please contact: www.hnp-mobilenursing.com or nursing@hnp-mobilenursing.com

Tel: 06 03787 77202

Feeding tube, a life saver or human abuse

2009-09-01T05:58:00.004+02:00

The controversy around the Ryle’s tube feeding

By: Yakob Abdul Rahman.W.Scholer

To many non-Medical/Nursing professional the mere mentioning of Ryle’s tube = nasal-gastric feeding tube is equated to the patient’s health condition. Nothing is more erroneous as this assumption. Even though at times it is the only means of assuring that the patient receives adequate nutrition, it’s by no means an indication of the actual health condition.

Many illnesses may temporarily or permanently require a Ryle’s tube or a ‘PEG’ feeding, such as acute stroke condition, blockage in the intestinal system, unconsciousness, or difficulties in the swallowing reflex. Many of these might be purely temporary measure, while others may need long term or even continuous feeding by this regiment. Unfortunately many instances exist where elderly people, because of the difficulties of oral food intake, are placed on Ryle’s tube feeding for the mere sake of convenience as the care takers do not take the time needed by the patient to consume the food orally. While the medical requirement are beyond dispute, much needs to be questioned, where often in nursing homes patients are inserted with tubes for the sake of ‘easy feeding’. In most countries the decision of the need of inserting a Ryle’s tube is the sole responsibility of a doctor. However in many countries even non-doctors and untrained ‘nurses’ make such decision on questionable reasons.

While the nasal-gastric tube feeding might be the option of choice to ensure sufficient supply of nutrients, one must keep in mind that we deprive the person of the pleasure of taste of food. Certainly one of the pleasures the babies enjoy from the moment of first suckling of milk, and this pleasure is an innate need to ensure the intake of nutrients all along in our life time. Moreover the motion of chewing and swallowing results in production of secretion in the oral cavity keeping the mouth clean and moist and prevents fungal infection. Depriving a person of the use of his mouth merely for convenience of the care-taker is equivalent to torture.

Ryle’s tube feeding must be reserved as the last option and for as short a duration as possible. Not only the presence of such a tube in the throat is very unpleasant, I had the experience twice already, but also a source of infection due to the continuous friction created while renewing the tube generally every 14 to 21 days.

Here again it needs a lot of skill and sensitivity of the nurse to perform this procedure. No untrained person should ever do it. There are standard operational procedures - S.O.P. of inserting and controlling the correct insertion of feeding tubes to cause the minimum of discomfort and ensure the correct placement of the same.

In this way the often traumatic experience can be kept to a minimum. Experienced and skilled persons have a range of tricks which are very helpful while inserting the tube and getting the patient to cooperate with swallowing. I know of nurses who even enticed the person with small amounts of ice cream, or favourite drink (if aspiration can be prevented).

The next task is the correct use of the tube in particular when feeding a patient. The patient should always be in an upright sitting position, ensuring the head to be raised at least 30 cm above the stomach level, thereby preventing aspiration which is the most common and most dangerous complication resulting of Ryle’s tube feeding.

With proper care and skilful application there should be no major problem in Ryle’s tube or PEG feeding.

For information as to:

Mobile Doctor

Mobile Nursing in Malaysia

Mobile Oxygen and other related Services kindly contact:

www.hnp-mobilenursing.com Or nursing@hnp-mobilenursing.com

or 03 78777202

2009-08-26T16:27:00.004+02:00

Not just verbal warning, actions need to follow!

By Mona Hassan

I was being told the Ministry of Health warned hawkers at the Bazaar Ramadan over the news yesterday to mind their cleanliness and that of the food they sell. Unfortunately when my friend stopped by the Bazaar at Kota Damansara Section 6 all her favourite sweetmeats were not covered and big blue bottle flies flew over and/or perched on all the uncovered food. Surprisingly when she complained about the flies the stall attendants behaved as if nothing has gone wrong.

Please may I suggest MOH send officers to spot check on all these bazaars regularly. These are the favourite shopping areas for Muslims and Non-Muslims alike. Here and now we are worried about the possible 2^nd wave of H1N1 and dengue on the rise. Please don’t let us have an epidemic of dysentery!!

A Taboo that may cost the male his life

2009-08-22T09:49:00.010+02:00

The Taboo Subject - Prostate Gland cancer

Males are masters in suppression. This life experience is particularly evident when it concerns a male’s own body and supposedly deficiencies. However if his "manliness" is at risk the defensiveness overrules the response. The weakening organ is becoming the subject of male jokes or it becomes a TABOO issue.

A typical example for this reaction is the prostate gland. Over a long time it functions without ever showing a sign of negative reaction to the conscious mind. The walnut sized gland produces the secretion, which keeps the sperms nourished and active. The prostrate muscle contracts and leads it to ejaculation. The contraction of the organ which is highly concentrated with nerves is an essential stimulus for the orgasm of the male.

Nonetheless the mere thought about the prostate releases anxiety. As years go by the gland will grow to the size of a plum and may cause difficulties when releasing urine. Worse if cancer should develop, of which for example 12,000 males die annually of prostate cancer in Germany. It is amongst the most common cancer in males.

It is certainly a scary illness. Actually it is the typical suppressive and/or denial behaviour that makes it the real killer. In the early stages this problem can be very effectively be treated.

Early detection tests inclusive of PSA-test are widely available and can be done in most established clinics. Should there be an abnormality of the prostate gland comes the next difficult phase, decision on the mode of therapy/treatment needs to be made. After a thorough examination and a series of tests the Urologist and Oncologist will make recommendation to the treatment regime most applicable according to the individual situation. Procrastination should not be dragged on until the tumour cells has already spread to other parts of the body and making treatment more difficult.

The goal should be "detection as early as possible and treatment as soon as feasible".

Cancer diagnose is not a "death sentence". Not every tumour is life threatening. Some are aggressive, some grow slowly. In no case should a person make an ad hoc decision on which type of therapy/treatment to be applied. It takes an average of 4 weeks to get the opinion from at least two to three specialists. There are usually several options to choose from. The final decision must take the age, general health condition and personal mental frame into consideration.

Not every tumour must be treated. Some just need regular observation. This is particularly the case with very senior citizens who may unlikely ever suffer from the result of the tumour.

However the waiting has its limits. When a tumour turns aggressive, intervention is the only option. As long as the tumour is limited to the prostate gland chances for complete healing are very good. However once spread to other parts of the body a more comprehensive treatment regiment is required.

In some countries there is a tendency to subject elderly to radiotherapy while younger victims for radical prostate removal. In very early stages treatment with radioactive iodine capsules which are implanted in the prostate under ultrasonic methods have shown good results. At times both approaches from external and internal radio therapy follow one another. In cases of infiltration of the prostate capsule by the cancer cells radiotherapy is necessary in addition to operation.

In cases of operations the erectile nerves may be damaged and takes a period of time, up to two years to regain its former potency. Some patients may need medications to support the erectile function. However many patients are rather willing to sacrifice orgasm sex, and enjoy an otherwise healthy life.

Preventive measures

That prevention is better than cure is clear to everyone. But the application in one’s own life is a different subject altogether. We are at times more concerned about the regular service of a vehicle, proper tending to plants, regular attendance to hobbies than to a healthy lifestyle.

The male thinks about himself as "invincible" until he is being knocked out. It’s better to take precaution than to indulge in self deception.

Here some general points one should observe.

Well balanced diet

Diet that includes vegetable, fibrous food, at least twice weekly fish, limited red meat, sausages and fruits. Because a vitamin rich and low fat and low calories diet helps in the prevention of prostate cancer.

Smoking

Besides all other harmful effect of smoking it does in particular contribute to the development of prostate cancer

Alcohol

Alcohol seems to foster the development of cancer generally, but prostate cancer in particular.

Liquid

Sufficient consumption of liquid is regarded as a preventive measure of prostate and bladder cancer

"We should ask ourselves if following one’s religion in observation of health is all that WRONG"??

For information as to:

Mobile Doctor

Mobile Nursing in Malaysia

Mobile Oxygen and other related Services kindly contact:

www.hnp-mobilenursing.com Or nursing@hnp-mobilenursing.com

or 03 78777202

The various benefit of the Banana! One should know.

2009-08-20T07:45:00.004+02:00

I had, many a times, arguments with patients and their families in respect to the benefits of the banana fruit. Malaysia has a huge variety of bananas. However a lot of people do not recognise the value of these SUPER FRUITS and would rather purchase imported apples and pears and grapes etc. than the bananas (pisang) which are available everywhere. Many people claim that banana causes constipation and avoid giving to the elderly. In fact while it helps in managing purging, it is equally beneficial for constipation because of its high fibres which retains liquid and prevents hardening of stool besides other beneficial effects on the intestinal lining.

Energize Yourself

No matter whatever you call it but if you want a quick fix for fading energy levels, there’s no better snack than a banana. Banana containing three natural sugars - sucrose, fructose and glucose shared with fibred banana gives a direct, continual and considerable enhancement of energy.

The banana fruit is a chief source of calcium, phosphorus, manganese, vitamins A, B6 and C, pyridoxine, nitrogen, folic acid and many other nutrients and enzymes. These help to maintain the health of the skin, the eye and the mucous membranes, detoxify infectious bacteria, add to the body protein, build resistance to allergy and relieve constipation.

The lack of B6 in a diet can cause weakness, irritability and insomnia. The potassium found in banana helps to regulate blood pressure and may reduce the risk of high blood pressure and stroke. Potassium is also essential for helping muscles to contract properly during exercise and reduces cramps.

A medium-sized banana provides 400 mg of potassium -11% of daily requirement, and contains 110 calories and 4 grams of fibre. Bananas also contain plenty of carbohydrates which are the body's main source of energy. They are also easy to digest.

Healthy Banana

Snacking on bananas between meals helps to keep blood sugar levels up and prevent morning sickness.

Banana vs. Ulcer
Banana is the only fruit that can be taken by ulcer patients without any harmful effects. It can act as a dietary food against intestinal disorders because of its soft texture and smoothness. The ripe banana is very beneficial in ulcerative colitis. It also neutralizes over-acidity and reduces irritation by coating the lining of the intestines. Mash banana with salt cures dysentery.
Banana vs. Allergy
It contains only useful amino acids and do not cause any allergic reactions. It is low in protein and salt but has a high content of carbohydrates. It is beneficial in all kinds of kidney disorders.

Banana vs. Anaemia
Anaemia sufferers are also benefited, as augmented by taking banana. It is high in iron, so it can stimulate the production of haemoglobin in the blood.

Banana – Shield against Other Diseases
A drink of mashed banana in a glass of coconut water with either honey or glucose, this is a very nourishing drink for patients suffering from disease like tuberculosis jaundice, typhoid and smallpox. The banana calms the stomach and, with the help of the honey, builds up depleted blood sugar levels, and the mixture soothes and re-hydrates your system.

Banana contains potassium and magnesium which help the body recover from the effects of nicotine withdrawal, it helps people trying to give up smoking.

According to survey by MIND, people suffering from depression, many felt much better after eating a banana. Because banana contain trypotophan, by which body converts into serotonin, known to make you relax, improve your mood and make you feel happier. And when I am stressed my mood can be re-balanced with the help of a high-potassium banana. If you take banana as a cooling fruit then that can lower both the physical and emotional temperature of expectant mothers.

Students at Western University were helped through their exams by eating bananas at breakfast and lunch in bid to boost their brainpower. Because research has shown that the potassium-packed fruit can assist learning by making pupils more alert.

Banana Dishes

Green tipped bananas should be selected for cooking or ripening, yellow ones should be selected for eating and brown-specked ones should be selected for baking breads, muffins and cookies. As the bananas ripen, they will taste sweeter because the starch in the fruit will turn to sugar. Ripe banana can be served in fruit cups and salads, sandwiches, custards and gelatins; being mashed and incorporated into ice cream, bread, muffins, and cream pies. Banana Milk Shake, Banana Salad, Banana Cake and Banana Blueberry Muffins are few favorites banana dishes. Add diced banana in yogurt can make a change to the bland taste of plain yogurt and both of these are beneficial to health.

So, Go (for) "Banana"!!

For In formations as to:

Mobile Doctor

Mobile Nursing in Malaysia

Mobile Oxygen and other related Services kindly contact:

www.hnp-mobilenursing.com Or nursing@hnp-mobilenursing.com

or 03 78777202

Need to understand how the male 'thinks' in matters of health

2009-08-09T07:18:00.004+02:00

Medicine for HIM

Patient man the ‘strong gender' weakens in regard to health. How do men manage, to pay more attention for their health

Some men wants it subtle. The pharmacist Peter Gerhold has specialized himself in herbal medicine. His motto: To approach health complains of his clients as gentle as possible. However at times he has to take a clear stand. "Specially elderly gentlemen often refuse stubbornly to visit a doctor. They rather go to the pharmacy to acquire uncommited consultation, although they can feel that something is not OK with their health". Some times because the blood pressure is to high, or blood sugar level above normal, at times I just take the phone and in my hand and offer the patient with information which specialist is having a clinic in the vicinity

In respect of health it shows the strong gender its very weak point: He has a higher health risk and dies much earlier as the female gender. Males who are today 65 have a good chance to reach 80 plus, while the females may reach close to 90.

Experts recognize likely causes for this. Man are health provision lazy. And they are less prevention conscious. In any health related seminar one can note that females are outnumbering the males.

A study has shown that the participation in courses about physical activity, only 22 % and on issues related to stress, only 16 % were male participants. The male is in despair!

But why are the health courses and seminars so little the "bosses of creation"? Alone the mere word, course or seminar, is creating resistance. It has a lot to do with the approach. Particularly the elder generation has a very technical approach to there body. The body has to function, that is its purpose. Also men compare themselves more in terms of competition and success. And as such terms like "health management, or training" more appealing. The contend of such presentations have to be modified in its terminology to appeal to men. While a women prefers an experimental approach, the male looks for the competitive way to measure himself with others.

The acquired self-image in the head

Also the visit to the doctor is more difficult for males out of fear of a bad diagnostic result. As main breadwinner in the family have they be under heavy pressure and perceive that in case of illness their job be endangered or income stopped. Many however are convinced that 'doctors will always find something wrong'. That is why they suppress illnesses. They are not taking time for their illness, as long as possible the body has to function or has to get back to function respectively. Even though a seemingly harmless infection or affliction should be given time to cure properly.

It is a typical behaviour of males that they deny body symptoms and will only see a doctor when the pain and symptoms becomes massive. This might also be a result of a deficit in consciousness of their body. Males have been coached to be strong and courageous. "Sickness is regarded as a sign of weakness. Many males are feeling in case of an illness a comparatively helplessness. It can only be hoped that these fellows will ask for more professional help to express their fears and concerns to avoid becoming depressive.

A further reason to avoid visit to a doctor are wrong pictures they maintain. Most males associate problems with the prostate gland with potency and incontinence.

However in most cases are these just harmless prostate enlargements which respond well to medications. Many males are just too afraid of the examination. They have often a weird expectation of it, due to various stories circulating around. Although some experience the examination as unpleasant , mostly they do not experience pain and the procedure last for only 30 seconds. Often they will later express their surprise and say that, "if I had known that the examination was so simple, I would have had it done much earlier".

Five weaknesses of the male

Psych More and more males develop depressions. Latest discovery revealed that HIS suffering exhibits itself in untypical symptoms like range and fury attacks. The illness is therefore often been undiscovered

Cardiovascular 55 % of heart infarct death are males. They develop problems much younger than females. Frequent causes are high blood pressure, stress, overweight and lack of exercise. People with hypertension should check their blood pressure on a regular interval at home.

Intestine If intestinal cancer is discovered at an early stage are the chances for cure very good. Unfortunately do in particular males not go for regular tests, even if they are simple and painless.

Prostate Prostate carcinoma is the most common for of tumour in men. The trickiness is that they cause in the beginning hardly any complains. In benign cases of enlargement medications are very successful.

Penis About 25 % of all over 65 years old suffer from erectile dysfunction. But only 20 % of those afflicted will go to see a doctor. While it is very easy for a urologist to discover the reason and provide adequate treatment.

Do you need advise in respect to:

*Mobile Doctor

*Mobile Nursing

*Mobile Oxigen supply

or other related problem with mobile nursing care than contact:

www.hnp-mobilenursing.com or nursing@hnp-mobilenursing.com or + 03 78777202

How to cope with people with dementia

2009-08-06T06:30:00.006+02:00

Dementia: to deal effective with the issue

This theme should be taken out from the taboo image it still has, particularly in Asian countries.

Hardly any family is free from the reality of having a member become demented in their old age. In most cases the family will choose to take care of them themselves, till they reach the point of physical and psychological exhaustion. In this field relatives perform remarkable duties in the care-taking. However it is equally important that the families have the right support to cope with the difficulties.

To know more: and react correctly

If you know how the brain organs illness manifests itself on a relative, then you can anticipate what is to be expected as time goes by.

Initially we notice the increasing signs of forgetfulness, the short term memory declines. At a later stage the person will lose the sense of orientation and the ability to read, define objects and recognize friends.

Without help he cannot manage the daily affairs anymore. Familiar things would suddenly become strange. This causes fear and anxiety to the disorientated person, which in turn makes him suspicious and aggressive or withdrawn. We must recognize that all these behaviour changes are symptoms of the disease and not an attempt to hurt or provoke the people around them, even if at times it presents itself in such a picture.

The correct approach: active nursing

Even if it takes a long time and patience: let the affected person do the daily chores such as personal hygiene for himself even if it is time consuming, let them continue to assume responsibility for their own care-taking. This will stimulate a sense of perceiving respect and dignity. Give as much help as is needed and as little as is necessary.

Accept professional help

It is very difficult for any relative to cope with the physical and psychological aspect of the situation created by the disease.

The risk to wear oneself out, because the fact that one has to take care of the person with dementia around the clock, is very real. You may be the ‘personal expert of the afflicted person’ but do not attempt to deal with it all alone. "Only who takes care of oneself can take care of others" (don’t let your battery run flat). Use the support which is offered by mobile nursing services available in your area.

You are not alone

Don’t become irritated because the person is asking the same question five times already, nor should you assume self reproach. This is a classical behaviour which almost all care-takers of dementia afflicted persons have to cope with. It is important for the care giving-relative, to take sufficient time off, to take care of his own needs

and wishes. This should be done on a regular basis and to ensure its implementation. One should consider having an external care-giver employed for these ‘off’ times.

Understand language deficiencies

As a result of his dementia the affected person has increasing problems to understand other people as well as make himself understood by others. He is asking the same questions repeatedly and tells the same stories or insists, undeterred, the wrong thing. Do never attempt to correct it as it will unwittingly lead to unproductive conflicts and stress. Just overlook it and emphasis on the positive aspects. When he can no more express himself with words, he will likely do it with aggression or apparently inappropriate laughing or shows signs of depression, restlessness or crying, these can be better understood considering his condition.

Empathetic communication

Since the dementia afflicted person can no longer adapt himself, it is better that you adjust to his condition. This includes also distancing yourself from the role he played for you or you played for him. This can be very difficult; however some approaches will make it easier. Since you know his past, his abilities and skills, you can always refer to them and get him engaged in this way in a conversation. The more empathetic you can approach him the easier it will be for both and the atmosphere will be more relaxed the between you and the demented person. This makes many things much easier.

Also adjust one’s own speaking

There is no general rule as to how to communicate with a demented person. However some points should be considered. Do not adapt a ‘baby language’. Use short and simple sentences; speak slowly, lovingly and in a clear voice.

Communicating without spoken words

Show yourself to the afflicted person; do not speak to him from afar. Maintain eye contact and address him with his name. This way you get his attention. Interfering noise should be switched off, however with his consent. Instead of words, pantomime and gesture can also be used. Show your affection in body contact such hugging and kissing.

Support remaining skills

A housewife would of course like to be busy in the kitchen. A gardener in the garden...., Give the person the feeling that he is still needed and foster his still functioning skills as long as is possible. Accept the imperfection and don’t be too precise. As the Germans put it, "let five be a regular number".

Recollect the past: photo album

Psychologists use the biography as a form of therapy for demented persons. Listen to the life story and show interest in his past supports the self esteem. It is helpful to have a photo album for the afflicted person. This is a supportive approach to discover which episodes of his past that still have high relevance.

Dementia should not be a taboo theme

Support, may it be from medical or social side is only possible if we deal openly with the dementia of an afflicted person. Take the courage to share with your relatives and friends of the dementia of your loved one. Neither you nor the afflicted person is responsible for this condition. Although he might slowly withdraw from mixing with others, tactfully persuade to have him keep up some contact and not to isolate himself. Family parties and social events are good opportunities for this.

The early provisional steps

It would be extremely helpful if the afflicted person has made legal arrangements for himself. In case of the lack of written documentation, even the next of kin may not have the legal right to represent the person. Early arrangements of who and how in any eventuality should be documented. This includes the aspect of liability of the affected person.

Beware of damages which may be hidden in the liability claim.

Monetary provision

Enquire from the pension office as to how far monetary support is given in the management of the sick persons. Some supply free gadgets and equipments or pay totally or partially needed adjustments to the living environment: such as ramps for wheelchairs, holding rails supports etc. You may also be entitled for financial support for relieve care, or medical nursing. Often families are not aware of the help they are entitled to by various organizations and social institutions.

Are you looking for:

* MOBILE DOCTOR

* MOBILE NURSE

* MOBILE OXIGEN SUPPLY

* OTHER RELATED SERVICES than contact: www.hnp-mobilenursing.com

or nursing@hnp-mobilenursing.com or Call: + 03 78777202

GUIDE TO HOME NURSING a Guide for every Care givers

2009-07-17T03:03:00.006+02:00

GUIDE TO HOME NURSING
A book for caregivers
By pekwan Mmail
Created Wednesday, July 15th
Wednesday, July 15th, 2009 06:34:00

A STITCH in time can save nine - or perhaps more. That's the saying the founder of Home Nursing Providers Sdn Bhd, Yakob Abdul Rahman Wilhelm Scholer, always uses to describe how home nursing can help add days to a life.
The well known gure in the local auxillary health scene feels that it's time Malaysians possess first-hand knowledge of the subject with the launch of his book, Guide to Home Nursing.
"The book provides nurses, healthcare providers and caregivers with an idea of how to help patients who are being looked after in a home setting," he said.
Despite many wishing to care for their loved ones at home, Yakob expressed his concerns that they aren't aware of the proper techniques.
"The right techniques should be brought forward and explained," said the man who initiated Malaysia's first AIDS Awareness Committee, which developed into the present Malaysian Aids Council.
While medical literature is expensive, Yakob said: The book is at RM32 only available in MPH and POPULAR book stores in the country. In the international market, the books will be sold around US$29.50 each (RM72) or more. I feel that the Malaysian community should have it at a lower price."
Home Nursing Providers Sdn Bhd

First Mobile Doctor service in Malaysia

2009-07-17T01:12:00.007+02:00

What role a mobile doctor plays

We are proud to announce the service of Malaysia’s first MOBILE DOCTOR.
While house visits of a doctor are standard procedures in most European countries it is still a novelty in Asia.
This leads to the situation where in particular the elderly population has to travel to hospitals and clinics, seeking medical attention often for simple ailments and/or for a medical prescription of drugs, or taking laboratory specimens for analysis. This does not just cause a lot of discomfort for the patient but is also a time and cost consuming affair to the family which has to make the necessary arrangement often requiring ambulance transport service.
This is one of the problems we have been facing over the last few years of our mobile nursing service and we have decided to employ our own mobile doctor.
This mobile doctor does not merely serve our own clients but is also available to nursing homes, and family that might require medical attention for a family member who might find it difficult to get to a clinic or hospital.
The doctor has the back up of a Pathological Lab. Service, where blood or other specimens may be sent for analysis. Being attached to a mobile nursing service it might also facilitate swift and uncomplicated nursing attention as may be required by the patient.
The service is currently available in the Klang Valley. It comprises amongst others:
Medical check up
Taking of medical specimens
Providing medical prescriptions
Settings drips and other medical procedures
Advising and counseling patients and families in respect of the management of the illness
Liaise with hospitals (doctors) where the patient may be in treatment prior to discharge into mobile nursing care at home
Provide initial medical diagnosis and recommend further medical investigation or hospitalization as may be appropriate.
The Mobile Doctor Service is available from Monday to Friday from 9.00 to 6.00 pm, On Saturday from 90.00 to 13.00pm
Those needing this service may call: 03-78777202 asking for the Mobile Doctor Service.

Oxygen therapy and supply easy available in Malaysia

2009-07-05T02:50:00.010+02:00

Oxigen if used according to doctors advise and prescription is one form of therapy.
By Yakob Abdul Rahman W.Scholer

Perhaps hardly any form of therapy is as little known as that of oxygenation. Most persons relate to the use of oxygen in relationship to the severity of an illness. Litle has come to the understanding of the general public about the various applications of oxygen for different ailments.
Definition
Oxygen may be classified as an element, a gas, and a drug. Oxygen therapy is the administration of oxygen at concentrations greater than that in room air to treat or prevent stationary, portable, or ambulatory. Oxygen can be administered by nasal cannula or mask,
Oxygen is an essential element that is present in the air we breathe. Each of us has experienced the burning sensation in our chest and muscles that comes from physical exertion. This occurs because we have not provided working tissues the necessary supply of oxygen to fuel the cellular machinery that produces energy. Oxygen is also an important component in our body's defense system against many forms of disease. Conventional western medicine uses oxygen in its gaseous form to help treat many patients who suffer from pulmonary (lung) disease, infections, those who require surgery, and many others.
Use
Among the diseases which kill many millions of people world wide are lung cancer, COPD (chronic obstructive pulmonary disease), asthma, sarcoidosis, pulmonary hypertension, influenza, and pulmonary

At the point where an individual can no longer maintain a blood saturation level of 90% or greater, the physician will prescribe oxygen. The normal level is 95-97%; below 90% is called hypoxemia. Some insurance companies will cover oxygen therapy if the SP02 (Saturation of Peripheral Oxygen) is as low as 88%, others at 90%. One's physician will make the decision, as a prescription is required to receive oxygen.
The status of oxygen saturation can be established in a simple procedure with an oxymeter attached to a finger, toe or earlap. The reading is almost instant and indicated if the patient has a need of additional oxygen supply.
Normal results
A normal result is a patient that demonstrates adequate oxygenation through pulse oximetry, blood gas tests, and clinical observation. Signs and symptoms of inadequate oxygenation include cyanosis, drowsiness, confusion, restlessness, anxiety, or slow, shallow, difficult, or irregular breathing. Patients with obstructive airway disease may exhibit "aerophagia" (air hunger) as they work to pull air into the lungs. In cases of carbon monoxide inhalation, the oxygen saturation can be falsely elevated
Supply
To enable the patients in Malaysia needing oxygen to have easy and quick access to medical oxygen supply in their home environment, HNP-Home Nursing Providers has gone in cooperation with MOX-Linde.

This is to ensure that patients at any time day or night can have access to medical oxygen without much administrative procedures. Many people are not aware of the difference between ‘normal=commercial’ or medical oxygen. Medical oxygen provides the guaranty that it is free of any impurities that might be harmful to the recipient.

For information of supply of oxygen,

or mobile nursing, kindly contact:
www.hnp-mobilenursing.com,
nursing@hnp-mobilenursing.com or call +03 78777202

Some websites for reference:
http://www.clusterheadaches.com http://www.ouch-us.org/http://www.maplefallswebdesign.com/misc/oxygen/oxygen.htm http://www.mushys.com/kiwi/http://www.chhelp.org/mhni.html http://www.neurologychannel.com/headache/index.shtml http://en.wikipedia.org/wiki/Cluster_headache http://www.emedicinehealth.com/cluster_headache/article_em.htm http://www.chhelp.org/
The infomation is just for reading
http://lung-disease-treatment.suite101.com/article.cfm/pros_and_cons_of_types_of_oxygen_therapy

Nurses on call where and when needed 24 hrs x 365 days

2009-06-19T01:53:00.012+02:00

Star-News Tuesday June 16, 2009

NURSES ON CALL
By PATSY

Home nursing, though relatively new in the country, provides a much sought after service for patients and care-givers alike.
WHEN Ardy Susanto’s mother was diagnosed with Parkinson’s disease 15 years ago, she knew it would be a long road ahead. Her mother’s deterioration was gradual but eventually, she lost all mobility and could not even feed herself.
In the last five years before she passed away, Ardy and a maid had to help her with the most basic of needs. This included feeding her through a tube (that had to be changed every three months), and helping her with physiotherapy and occupational therapy every day.
Real helping hand: Mohd Naim Mohammad (left) and a nurse from Home Nursing Providers helping his mother, Wan Maimunah Wan Hassan, into a wheelchair at his house in Shah Alam.
Ardy, 48, became a part-time nurse as she learnt how to change, feed and attend to her mother’s other needs. She also learnt how to operate a suction machine used to help extract phlegm.
“My mother had to go to the hospital quite often. Sometimes we would get a doctor to come over. A general practitioner could also see to her medical needs but then that would be no different from making the trip to the hospital,” says Ardy, a senior manager in a publishing company.
That was when she discovered a network of nurses and even therapists, who were willing to make house calls. The private hospital which treated her mother as well as a shop that sold medical supplies recommended a list of places where she could find these “freelance” nurses.
“This was a boon to working mothers like me as it cut down travelling time. It saved the hassle of transporting my invalid mother and queuing at the hospital,” she says.
“These were nurses who had either retired or left their jobs at the hospital. I also managed to get a therapist working at a medical college to drop by after working hours. A nurse helped with the physiotherapy, phlegm extraction and changed the dressing (when my mother had bed sores). They were very helpful and taught my family some of the procedures so that we could do them ourselves to minimise hospital expenses and nurse visits.”
Mohd Naim’s father Mohd Che Leh, a stroke patient, being cared for by a nurse.
Costs varied between RM50 and RM80, depending on the procedure required and this, says Ardy, was reasonable as most private nurses usually charge between RM12 and RM17 per hour for their services.
Placing his aged parents in a nursing home was not an option for Mohd Naim Mohammad, 45, who’s in the construction line.
“I feel it’s our filial duty to take care of our parents. Besides, it’s better to have family members to take care of them and provide company rather than strangers,” he says.
Mobile nurses come in on a daily basis to attend to his mother, 74, who suffers from diabetes and since August last year, has to go for dialysis twice a week. Apart from bathing her, they check her blood pressure and sugar level, and attend to her other medical needs.
A doctor also drops by to provide physiotherapy three times a week for his father, also 74, who had a stroke in 2000. Although he is wheelchair-bound, he is quite independent, and eats and bathes by himself.
“My father is still quite jovial and I think interacting with the family helps keep his spirits up. A friend introduced us to Home Nursing Providers (HNP) and my father has been using their services since 2003 while my mother, who’s now bedridden, started last year,” says Mohd Naim.
Based in Selangor, HNP extends its services to other parts of the country as well. The company offers a team of medical professionals, nurses, physiotherapists and nursing aides. Its core values are geared towards improving the quality of life of the sick, disabled and elderly, and facilitating patient rehabilitation and empowerment.
“My siblings and I take turns to take my mother to the hospital for dialysis, and my children help their grandparents whenever they can,” adds Mohd Naim, who has six children aged five to 14.
“My mother is quite weak but still conversant, and although the two maids help spoonfeed her, we make it a point to eat together with her at the dinner table as a family.”
Although the standard of healthcare in Malaysia is admirable compared to our Asian neighbours, the concept of home nursing is relatively new in Malaysia. Nursing homes or rehabilitation centres differ from mobile nurses as patients usually opt for daycare or long-term stay. The main focus is basic and companion care whereas mobile nurses offer professional medical care. Mobile nursing services is usually made available through:
> A community outreach programme, often initiated by the government;
> Part-time individual agents providing part-time nurses (sometimes foreign nurses) or caregivers;
> Nurses who work full-time in hospitals and make house-calls on their own personal time;
> Private hospitals that extend their services to their own patients as a follow-up service.
Generally, charges are probably cheaper than a hospital visit but if you need a night nurse or nursing aide for longer stays, it may add up to quite a bit. But it’s still more cost-effective than being admitted into hospital (depending on the medical problem).
Some government hospitals offer home nursing services, whereby patients are allowed to recuperate at home under the watchful eye of family members with regular visits from appointed nurses. Hospital Universiti Kebangsaan Malaysia has a home nursing programme – available at a nominal fee of RM10 per visit – but this is only for patients within a 20km radius of the hospital.
Ailments vary from terminal illness to accident cases, and apart from handling medical needs like changing bandages, inserting or removing catheters and feeding tubes, and administering injections, these nurses on call also teach family members how to give emotional support and get the patient’s confidence going.
The home nursing team is chosen from different disciplines. Since the programme involves making important decisions, only senior nurses with at least five years’ experience are chosen.
Private companies that offer mobile nursing services, however, are few and far in between. This niche market is one sector that both the government and private sector should explore to improve healthcare services for the public.
One of the largest healthcare groups in the country, Kumpulan Perubatan Johor (KPJ), the Healthcare Division of Johor Corporation, offers such a service.
Another company, Nurses@Home in Sunway, Petaling Jaya, operated by Sunmed@Home Sdn Bhd (nursesathome.com.my), is hospital-linked and prefers to be called “a nursing solution provider”. It offers simple follow-up visits to comprehensive care plans that include nutrition, physiotherapy, carer training and other disciplines to help the patient achieve full recovery.
“The biggest difference between us and free agents is that we work together with the doctor as part of the treatment cycle (whereas they have no obligation to report to the doctor). We also work closely with pharma-companies by giving progress reports and monitoring the patient (for reaction and side-effects),” says general manager Asok Nair.
Almost 80% of its patients are recommended by various hospitals.
Nurses@Home provides clients with an alternative to prematurely sending aged relatives to nursing homes. About 40% of its services is geriatric care.
The company was set up in 2002 and its work processes are built on healthcare practices in Britain, the United States, Australia and Singapore.
Basically, two main plans are available: Home Visit Plans in which nurses make hourly visits, particularly for patients who need wound management, procedures such as feeding tube changes, catheter changes and even elderly care; and Personal Care Plans, when patients need extended care.
Only patients who are under the care of a physician are accepted.
“Their ages range from infants who are a few weeks old up to a 103-year-old patient. There were instances when our nurses had to accompany sick patients abroad,” Asok adds.
Better known as home health nursing (or clinician) in the United States, the service is usually recommended for hospital patients who are required to stay for a length of time, such as in post-cardiac surgery or trauma (accident) cases.
Devi Ramphal-Edwin, 44, who hails from Trinidad, worked as a registered nurse in the United States before going into mobile nursing in 2000.
“I opted for home nursing after I had my son, as it offered flexible hours. Usually, the nurse takes the lead in such cases and decides on the medical course for the patient – whether his or her condition has improved or deteriorated; needs more or different medicines; and the following course of action. Then she informs the doctor after one or two hours of evaluation,” she explains.
However, the patient must have a clinical problem and be home-bound to qualify for the service.
“Home nursing is seen as the third option after hospitalisation and nursing home or rehabilitation centres. For certain patients, for example, someone who’s had joint replacement, it’s better to be in a home environment. Nurses can easily make a call if the patient gets into distress.
“It’s also good to have a nurse to come around to have a look at mothers after a Caesarean, rather than going to the hospital with a newborn baby and risk infection,” says Devi.
Home health services range from blood testing to dressing wounds, and inserting or removing tubes, or physical therapy.
Home nursing cuts down the need for revisits, risk of infection from the hospital, and medical problems are sometimes detected faster. If there are complications or a higher level of care is needed, then the patient can be re-admitted.
Probably the most significant point to note in the American medical system is that the insurance companies call the shots there, without which optimal medical attention would be difficult to obtain.
“Home nursing doesn’t include geriatric care, unless the patient is certified to have a clinical problem,” adds Devi. who now resides in Malaysia and has since given up home nursing.
HNP-Home Nursing Providers are also assisting patients in SUPPLY of MEDICAL OXYGEN in cooperation with MOX-LINDE Sdn Bhd to improve the efficiency and speed of private home supply of medical Oxygen

FOR FURTHER INFORMATION AS TO THE NURSING SERVICE KINDLY CONTACT:
WWW.HNP-MOBILENURSING.COM
OR NURSING@HNP-MOBILENURSING.COM
or call +603 78777202

Mobile nursing on the rise in Malaysia benefits every one in the health section

2009-06-18T02:35:00.014+02:00

STAR-NEWS Tuesday June 16, 2009

NICHE nursing

TAKE the concept of meals-on-wheels and apply it to nursing services; that’s mobile nursing in a nutshell. Rather than trivialise the nursing profession, the imagery is intended to help people look beyond the conventional borders of the field.

Generally, the public is more familiar with nursing services in institutional settings like private and public healthcare facilities, clinics or nursing homes. In these environments, the nurse has clearly defined roles and scope of services.
‘Over 40% of patients in long hospital stays are only retained for nursing purposes,’ says Yakob Scholer. She (or he) is usually responsible for many patients at the same time, instead of just one exclusive patient.
In the hospital there’s easy access to doctors, where the nurse can call on for consultation, thereby creating the perception in the public that nurses are mere assistants to doctors.
“This is a misconception as both are professionals in their own right, and their respective duties and responsibilities are complementary to one another,” says Yakob Abdul Rahman W. Scholer, founder of Home Nursing Providers Sdn Bhd (HNP), claimed to be Malaysia’s first fully-integrated mobile nursing provider. It offers a comprehensive range of medical and nursing services in the comfort and convenience of the patient’s home.
“Mobile nurses are expected to have a higher degree of independence and discretion, and beyond observing medical conditions and administration of prescription, they are supposed to make initial investigations of the patient’s overall health. This is then communicated to the main caregivers with recommendation for further consultation with a doctor,” he adds.
Originally from Mainz, Germany, Nursing Consultant and Applied Psychologist, Yakob first came to Malaysia in 1963. He has since contributed to many health institutions in the country, including Yayasan Pusat Pertolongan and Yayasan Alkoholisma Malaysia in Ipoh, and initiated the first Aid Hot-line and the creation of Malaysia’s first AIDS Awareness Committee (now known as the Malaysian AIDS Council).
Today, Yakob helms HNP as its Nursing Consultant, and conducts various local and international seminars on proper patient care in the home environment. as well as lectures on prevention of bed sores. The nursing services provided by HNP are usually taken up by individuals who need post-hospitalisation care such as those who have had a major procedure done in a hospital, require proper wound management or even terminally-ill patients who need palliative care.
The main criterion is whether the family needs professional support in the care and management of a patient at home. This has to take into account time constraints, or the need for a skilled and qualified nurse due to the patient’s complex condition.
“For example, whilst the family can be coached to perform proper general nursing care such as bathing and feeding a patient, they will still need a qualified nurse to perform other tasks such as taking blood samples, changing the feeding (Ryle’s) tubes or urethral catheters, or performing complex wound management.
Devi Ramphal-Edwin: ‘Home nursing is seen as the third option after hospitalisation and nursing home or rehabilitation centres.’
“I’ve noticed that families who exhibit a deep sense of devotion and filial piety towards their sick family members are more inclined to engage mobile nursing services as they want to assure that the best care is given to the patient,” adds Yakob. If you look at the big picture, the nurses are also regarded as educators, councillors and motivators to the patients and their family members. Mobile nurses are also helpful for stroke patients who need to undergo full mobilisation training to regain strength and functionality in the affected body parts. Apart from having the right physical skills, they can also help motivate and encourage patients to push themselves to the limit. By having a qualified nurse to visit, the length of hospitalisation is reduced, thereby reducing medical costs and expenses for the patient. He or she is also spared the long waiting hours and repeated visits for simple procedures such as blood drawing or wound management at the hospital.
“It is reported that over 40% of patients in long hospital stays are only retained in the hospital for nursing purposes. A recent study in the United States revealed that patients suffering congestive heart failure who receive home nursing care services will require only half the length of acute hospitalisation in their lifetime as compared to those who did not,” explains Yakob, who feels that some patients can recuperate faster in the family setting.
“Then the patient will not feel a sense of loss or rejection which can lead to severe depression, a common occurrence with the sick or elderly placed in a nursing home or long-term hospital care.”
In countries like Germany, the United States and Australia, mobile nursing is officially recognised by government institutions and covered by government-funded social insurance programmes. The family will receive financial support for taking care of the patient at home, based on the severity of the illness and nursing dependency.
There are a total of 11,500 mobile nursing agencies in Germany while the United States has over 10,000 agencies, the majority of which participate in the government’s Medicare insurance programme.
Some countries have streamlined their mobile nursing operations based on areas of specialty and scope of services such as geriatric or paediatric home care, and some focus specifically on terminal and respite care.
“In Malaysia, however, mobile nursing is still a new venture and there is a lack of public awareness of this niche area of medical nursing services. As such, it is yet to be recognised for government financial assistance purposes or private health insurance coverage,” says Yakob.
Based in Kelana Jaya, Selangor, HNP provides consultancy and education, basic and professional nursing, disease and wound management as well as mobilisation, physiotherapy and rehabilitation services. The independent company is private-owned and not attached to any organisation.
Currently, its services are available in Kuala Lumpur, the Klang Valley, Seremban, Malacca and Ipoh. Upon special request, the company has provided services to patients in Penang and Langkawi as well.
The medical and administrative personnel are full-time employees and the nurses, mostly Malaysians, are qualified State Registered Nurses, including male nurses who cater to the needs of male patients.
Recently, HNP has also established its Home Oxygen Therapy arm in collaboration with MOX-Linde Gases Sdn Bhd to supply the products and administer Medical Oxygen Therapy to the Home of patients. – By Patsy Kam

For more details on Nursing Service and Oxigen supply, call the 24-hour hotline ( 03 -7877 7202) or log on to http://www.hnp-mobilenursing.com/. or nursing@hnp-mobilenursing.com

Psychological Family Implication in Mobile Nursing

2009-06-15T03:06:00.003+02:00

Psychological Implications in Families with a Nursing-dependent Family Member BY
Yakob Abdul Rahman Wilhelm Scholer

Home Nursing is a fledging program in our country (Malaysia) and perhaps in Asia.
While it is regarded in most European countries as a solid Pillar of the Health System, here, mobile home nursing is a rather un-systemized, with various forms of home nursing care, and its importance for the future is grossly under estimated.
We are faced with a series of difference although the pure nursing aspect and the patients’ needs do not differ from that in other countries, or anywhere in the world.
Let me highlight a few differences between the mobile nursing here and those in the European countries.
Finance
In Europe
The cost is borne by the insurance system or public health care funds, or welfare aid.
In Asia
The cost of mobile nursing services has to be borne exclusively by the clients or their families.
Medical Home-Care
In Europe
Family (house) doctors are compelled to visit and attend to very sick people even in their home setting – during regular working time. Some doctors even set aside an afternoon a week to make regular house calls to chronically ill patients and impaired Senior Citizens.
In Asia
There is no regulated house-call system and doctors are generally reluctant or even refuse outright to visit patients in their home, even if the same doctor has attended them in the clinic for decades.
Family System
In Europe
Most senior citizens live in their own residence alone, and their children are wage earners, staying away from the city or region.
In Asia
There is still a common practice of extended family system where 2 to 4 generations live under the same roof. The role of the matriarchal/patriarchal system is not to be underestimated.
Treatment Regime
In Europe
The majority of patients receive treatment according to “Western Medicine” standard medical procedures
In Asia
Still a lot of patients follow traditional medicines and customs, simultaneously or intermittently also the classical western approach of “Western Medicine”
These factors alone have enough potential for conflicting situations, since the more ambiguous situations exist the more space is available for conflicts.
Case descriptions
(All Names have been changed)
Case 1
En Mokhtar, an 84 year old patient suffering of multiple strokes, dementia and diabetes was admitted to a Private Hospital, for removing of slough from a bed sore at the sacrum. The Private Hospital requested the family to contact us for further wound management. Initially we met only two of the daughters of the patient. On discharge from the hospital the rest of the family “surfaced”, lastly the only son who was a medical Doctor. The Patient had developed multiple bedsores, 6 all together. The family of one of the daughters where the patient put up could be described as a real caring “motherly type”. Always interested in what was needed to be done. The wife of the patient being the “matriarch” of the family (after the incapacitation of her husband) would rather listen to the son, “who as a medical doctor is most qualified to judge on medical aspects”. However, this son hardly ever appeared on the scene and met with the nursing staff only after more than 7 months since HNP has taken over the nursing of the father.
The female siblings noting the lack of interest of the brother and the total absence of monetary responsibility, could hardly accept that for any issue of nursing care, the mother would consult the son, who without seeing the father would give some “pacifying advice to the mother” usually agreeing to her opinion, and thereby giving the mother the needed lever to direct whatever kind of nursing and wound management was suppose to be ‘appropriate’.
The modern style of moist wound treatment was for her not acceptable (“it caused smell”) and on pestering the son to change it to a method of drying out the wounds, he finally consented and used “a traditional Indonesian treatment” to dry out the wounds only to terminate the same again 4 days later after noticing the increase of tissue damage caused by the herbal application on the wounds, which were indeed dry, but also caused additional tissue damage. As time went by and the patient suffered a few more minor strokes, the issue of sufficient nutrition consumption arose and to the nursing opinion enteral feeding was pertinent and was recommended by the Hospital on discharge.
However here again the mother/son bond went against the professional opinion of the consulting doctor and the nursing team, causing stress to the rest of the siblings who could observe the decline of their father’s condition and were helpless, as the mother would not allow the insertion of a Ryle’s tube. Ironically, only when the condition became imminently serious, did the mother attempt to ask her son to come and do the needful to improve the condition. Despite of several days of pleading the son did not turn up and only arrive when the cortege had left the house.
Comment
Much suffering of hunger and thirst by Mr. Mokhtar could have been avoided if the family, the son in particular, would have liaison with the nursing team. The atmosphere of tension in the house could be much lessened and be more conducive to the patient’s condition.
Case II
Mr. Firuz is another patient with multiple strokes, diabetes, Parkinson’s, dementia and bedsore.
His children are highly educated and holding responsible position in the society.
Mr. Firuz actually lives in a neighbour state, but due to his illness and the age of his wife the children decided to take him in their own home setting.
We were called by the son with the hope to assist in the professional care of the father.
After the Assessment we made out a plan for a twice-weekly visit, which would include a full bath (shower), colonic washout (due to chronic constipation) and mobilization.
Every family member was agreeable. The request for a hospital bed and a special wheelchair on hire was complied with. The intention was to provide optimal professional nursing care. Due to his mental state Mr. Firuz would scream at the slightest touch on his body, sometimes even before reaching his body.
The procedures of bathing, colonic washout and mobilization were accordingly accompanied by the “obligatory” screams of the patient. In many tests I showed the family that his screaming was not related to the actual procedures but rather part of his mental state.
While the children could observe the situation and were accepting the explanation, the devoted wife was showing her doubts. While the patient refused to sit in the wheelchair the wife insisted on a headrest to provide more “comfort”, and get his cooperation for mobilization. The patient however would only sit “normally” in the wheelchair when the attending nurse places him in it, he refuses to sit in the wheelchair when the family members wanted to place him inside - he refuses to bend his knees and hang in like a “pole”. This caused the family to return the wheelchair plus the special head support on the request of the wife, who did not want the husband to be under “stress”. Expectedly the service of the nurse was terminated, so as to conform to his wishes and the wife’s request. Only a short period later Mr. Firuz decided that decided that sleeping on the floor would please him more than on a hospital bed. Again the “devoted wife” would consent to the “wish of her husband” and requested the return of the hospital bed. The children were under quite a lot of duress created by this: for them it was illogical to conform to the father’s demands yet were unable to influence against the demand and desire of their parents. The attending nurse found himself in a conflict of nursing requirement and the demands of an irrational patient and devotion of the wife.
Consequently we had to withdraw from nursing the patient and allow the family to manage the case as best as possible.
Comment
Over devotion of the wife and the filial cultural mentality of the children were over ruling any sensible and appropriate nursing care. There was no question that the children disagreed with the father’s demand and the mother’s request. But not breaking with the culture and resisting parental request, they would rather allowed the matter to be left to the parents’ control.
Case III
Mrs. Lim, a lady in her early seventies, with unstable diabetes and multiple strokes (on medication) was discharged from hospital and stayed with youngest daughter. Her eldest daughter-in-law called in for our service for regulating the lady’s blood pressure, blood sugar and mobilization. The lady has been unable to swallow properly. We suggested naso-gastric tube feeding but the idea was rejected. However, the youngest daughter is a staunch believer in traditional Chinese medicine/treatment. She took matters into her own hands and stopped all medications from hospital, gave her mother ‘normal’ soft diet (porridge), which she could hardly swallow. One afternoon the maid found the lady unconscious and foaming slightly from the mouth. An emergency call was made to us and we found the lady in a severe hypoglycaemic state. We managed to revive the lady after emergency nursing administration rendered. Only then the youngest daughter consented to her mother to have a naso-gastric tube. Things went on well for a while. After a couple of weeks the old lady went into another crisis - aspirated pneumonia. Apparently the youngest daughter was ‘advised’ by a ‘traditional healer’ to remove the naso-gastric tube, believing that it was the cause that the old lady could not swallow and the tube would cause infection to the stomach. The young lady followed the advice and the mother ended up in a hospital.
The family conflict in traditional and modern medical management became so bad that the eldest daughter-in-law gave up (in order not to be blamed should anything happen to the mother-in-law) and curtailed our service.
Comments
Traditional believes and interpersonal siblings’ altered rolls was making it impossible to provide appropriate nursing that could have helped the patient to ensure a certain degree of life quality.
Summary
Most families here are still a closely-knit entity, where the role of each family member is not always as clear-cut as one may assume. This leads to certain conflicts, particularly when different siblings manage the needs and wishes of the patient and the financial aspect. This is especially so when the nursing requirements and financial limitations do not correspond.
Sibling-rivalry and family conflict may manifest when the issue of nursing care, and medical approaches are an unresolved entity. While on one hand a sibling may have to carry the sole financial burden, the other members of the family may not spare the making of suggestions and remarks as to how best the situation could be dealt with.
The position of a maid who may have made ‘in-road’ into the family system and the skillfully manipulates the family environment to her own end, placing the family at times in a position of being threatened and/or at her mercy.
The nurse, being subjected to manipulation, and solicited by the various sources must survive in this “emotional mine-fields”, perform one’s professional duty without getting entangled in the family dispute or conflict.
Evaluation/Response
The nursing personnel in a mobile-nursing setting must be made aware of these potential dangers and needs information on potential conflicts and guidance in dealing with such situations. To stay neutral and restrain her/his own emotional feelings a nursing agency must have a system where the nursing personnel can turn to in conflicting situations and get the needful guidance such as supervision, group session and individual counseling.
At the end of the day it is the patient who needs the care, and is mostly unable to intervene or make decisions.
Surely this problem is not limited to Malaysian families alone, but will always manifest in situations where:
A. A decision making member of the family has not been appointed,
B. Where money responsibilities play a role,
C. Where neurotic personalities are involved,
D. Where cultural aspects are abused for ones own end

If you are looking for A MOBILE NURSING SERVICE OR A MOBILE DOCTOR PLEASE CONTACT US www.hnp-mobilenursing.com or
nursing@hnp-mobilenursing.com or Phone +603 78777202

Know more about Vital Datas

2009-06-12T13:21:00.014+02:00

VITAL SIGNS STANDARD
By Yakob Abdul Rahman Wilhelm Scholer

The following are the standard readings applicable in most countries and as a guide to the layperson who may be at lost as to the actual interpretation.

However we recognize that other organizations and schools may vary slightly in the value and reading.
The guide is for persons while awake. In sleep the rates will be (normal) much lower.

Blood Pressure (BP)
(Adult)
Normal 120-150/90,
High 160-180/100,
Very high >190/100,
Low 110-90/70,
Very low <90/60>

Pulse Rate
Adult
Normal 60-80,
High 85-100,
Very High >110,
Low 50-59,
Very Low <49>

Children
Normal 100-120
High 121-130
Very High >131
Low 80-99
Very Low <80>

Babies and Toddler
Normal 120-140
High 141-150
Very High>150
Low 100-119
Very Low <100>
Breathing
Adult
Normal 18 p.m.
High 25 p.m.
Very High >25 p.m.
Low 12-17 p.m.
Very Low <12>

Children (from 4 yrs)
Normal 25 p.m.
High 30 p.m.
Very High >30 p.m.
Low 20-24 p.m.
Very Low <20>

Normal 30 p.m.

Toddler (from 1-3 yrs)
High 35 p.m.
Very High >35 p.m.
Low 25-30 p.m.
Very Low <25>

Babies
Normal 40 p.m.
High 45 p.m.
Very High >45 p.m.
Low 30-35 p.m.
Very Low <30>
Temperature
Normal 36.0C-37.0C,
Increased 37.0C-38.0C,

Fever 38.0C- 39.0C,

High fever >39.0C

Difference resulting in;
Axillary 37.0 0C
Rectal 37.5 0C
Blood Sugar
Before meals 5-7.2mmol/l,

After meals (90min.) 10mmol/l,

Bed time 8mmol/l

In case you look for Mobile Nursing Service or Mobile Doctor you may contact:
http://www.hnp-mobilenursing.com/ or nursing@hnp-mobilenursing.com or +603 78777202

The value of natural fruits and vegetable to the human body

2009-06-12T13:03:00.005+02:00

Subhanallah... Alhamdulillah... Allahu akbar

I wonder if nature is trying to sent us message? Perhaps we need to be at times simplistic to understand more of what the CREATOR has provided us!

A sliced Carrot looks like the human eye The pupil, iris and radiating lines look just like the human eye...and YES science now shows that carrots greatly enhance blood flow to and function of the eyes.
A Tomato has four chambers and is red. The heart is red and has four chambers. All of the research shows tomatoes are indeed pure heart and blood food.
Grapes hang in a cluster that has the shape of the heart. Each grape looks like a blood cell and all of the research today shows that grapes are also profound heart and blood vitalizing food.
A Walnut looks like a little brain, a left and right hemisphere, upper cerebrums and lower cerebellums. Even the wrinkles or folds are on the nut just like the neo-cortex. We now know that walnuts help develop over 3 dozen neuron-transmitters for brain function.
Kidney Beans actually heal and help maintain kidney function and yes, they look exactly like the human kidneys.
Celery, Bok Choy, Rhubarb and more look just like bones. These foods specifically target bone strength. Bones are 23% sodium and these foods are 23% sodium. If you don't have enough sodium in your diet the body pulls it from the bones, making them weak. These foods replenish the skeletal needs of the body.
Eggplant, Avocadoes and Pears target the health and function of the womb and cervix of the female - they look just like these organs. Today's research shows that when a woman eats 1 avocado a week, it balances hormones, sheds unwanted birth weight and prevents cervical cancers. And how profound is this? .... It takes exactly 9 months to grow an avocado from blossom to ripened fruit. There are over 14,000 photolytic chemica l cons tituents of nutrition in each one of these foods (modern science has only studied and named about 141 of them).
Figs are full of seeds and hang in twos when they grow. Figs increase the motility of male sperm and increase the numbers of S perm a S we ll to overcome male sterility.
Sweet Potatoes look like the pancreas and actually balance the glycemic index of diabetics.
Olives assist the health and function of the ovaries.
Grapefruits, Oranges , and other Citrus fruits look just like the mammary glands of the female and actually assist the health of the breasts and the movement of lymph in and out of the breasts.
Onions look like body cells. Today's research shows that onions help clear waste materials from all of the body cells They even produce tears which wash the epithelial layers of the eyes

If you are looking for nursing care you may contact:
Home Nursing Providers www.hnp-mobilenursing.com or nursing@hnp-mobilenursing.com
or call us +603 78777202

A truly filial son

2009-06-11T04:28:00.004+02:00

A truly filial son!
I home-nursed a 56 years old patient, suffering from lung cancer, with metastasis to the brain. The hospital had sent him home in the “care of the family”. Each time I visited that patient I noticed the 15 year-old son was sitting near his father, at times reading or reciting verses from the Holy Koran; or just to hold his hands, wipe his fore head, or show attention and affection to his father. The young man was of quiet nature and displayed an unusual “maturity” for his age.

I would just admire his way attending to his father and assisting in taking care of him.
On the day of the father’s demise had, I happened to follow directly behind the hearse, which arrived at the cemetery well ahead of the rest of the family members and friends due to severe traffic congestion at the time. This young son followed in the hearse and while we were waiting for the others’ arrival I approached him and asked, “How are you feeling?” He replied instantly with a certain smile, “I just feel good! I will deeply miss my very beloved father but I think I did all I could do for him while he was sick and that gives me a good feeling of contentment and inner satisfaction even though he is now no more around”.
This incident happened more than 3 years ago, yet it is so vivid in my mind that I just feel I to have share it with you.
Are we not all having a beloved parent or spouse or partner in our life? Can we one day feel the way this young man did and say the same? Can we live with the way we treat our parents and others close to us once they have left us?

In the process of caring for the sick particularly those close to us we should always be able to say:
“I did all I could for her/him while she/he was still with us”

Medicinal use of honey and its effects

2009-05-29T08:34:00.007+02:00

Medicinal uses and health effects of honey
For at least 2700 years, honey has been used to treat a variety of ailments through topical application, but only recently have the antiseptic and antibacterial properties of honey been chemically explained.
Wound Gels that contain antibacterial honey and have regulatory approval for wound care are now available to help conventional medicine in the battle against drug resistant strains of bacteria MRSA. As an antimicrobial agent honey may have the potential for treating a variety of ailments. One New Zealand researcher says a particular type of honey may be useful in treating MRSA infections. Antibacterial properties of honey are the result of the low water activity causing osmosis, hydrogen peroxide effect,and high acidity Honey may also be used to alleviate the effects of a sore throat. It is mixed with lemon juice and consumed. The mixture coats the throat alleviating discomfort, and the antibacterial, antiseptic properties are good for the throat as well.
Osmotic effect
Honey is primarily a saturated mixture of two monosaccharides. This mixture has a low water activity; most of the water molecules are associated with the sugars and few remain available for microorganisms, so it is a poor environment for their growth.
Hydrogen peroxide
Hydrogen peroxide in honey is activated by dilution. However, unlike medical hydrogen peroxide, commonly 3% by volume, it is present in a concentration of only 1 mmol/l in honey. Iron in honey oxidizes the oxygen free radicals released by the hydrogen peroxide.
C6H12O6 + H2O + O2 → C6H12O7 + H2O2
When used topically (as, for example, a wound dressing), hydrogen peroxide is produced by dilution with body fluids. As a result, hydrogen peroxide is released slowly and acts as an antiseptic.
In diabetic ulcers
Topical honey has been used successfully in a comprehensive treatment of diabetic ulcers when the patient cannot use other topical antibiotics.
Acidity
The pH of honey is commonly between 3.2 and 4.5This relatively acidic pH level prevents the growth of many bacteria.
Nutraceutical effects
Antioxidants in honey have even been implicated in reducing the damage done to the colon in Such claims are consistent with its use in many traditions of folk medicine.[44]
Other medical applications
Some studies suggest that the topical use of honey may reduce odors, swelling, and scarring when used to treat wounds; it may also prevent the dressing from sticking to the healing wound
Honey has also been used as a treatment for sore throats and coughs for centuries and according to recent research may in fact be more effective than most common medicinesHoney has been shown to be an effective treatment for conjunctivitis in ratsHoney (especially when combined with lemon) is often taken orally by pharyngitis and laryngitis sufferers, in order to soothe them.
Though widely believed to alleviate allergies, local honey has been shown to be no more effective than placebos in controlled studies. This may be because most seasonal allergies are caused by tree and grass pollens, which honeybees do not collect.
Note:The Holy Koran explicitly mentiones the medical benefits of honey for humans.

If you look for mobile nursing and wound management or a

"MOBILE DOCTOR" please contact:
+6 0378777202 or visit: http://www.hnp@mobilenursing.com/ or e-mail:
nursing@hnp-mobilenurisng.com

Elderly Citizen and drug poisoning

2009-05-29T06:56:00.004+02:00

The elderly and drug-related poisoning
By Dr. Abu Bakar Abdul Majeed

THE MONTH OF OCTOBER EACH YEAR has been assigned Senior Citizen Month. This is deemed appropriate as it is about time we pay tribute to the immeasurable contributions of people who have helped shape the "future" which we are now living in.
Some of them are already in the twilight years of their lives while others are still actively leading and guiding the younger generations in various fields to further orchestrate the shape of the future. No matter what, senior citizens are still a formidable force to be reckoned with in any civilised society. In Malaysia, the toils and hard work of senior citizens have really paid off. Today we are enjoying the fruits of the labour, every single minute of it.
The numbers of senior citizens in both developed and developing worlds are rapidly increasing. From 1988 to 2000, the world population will increase from 5,100 million to 6,100 billion. The increase in the number of senior citizens will be disproportionately large. The average population growth from 1988 to 2000 will be 20% in developed countries and 73% in less developed countries.
Over the years, the life expectancy of the male and female population in West Malaysia has also improved. Male life expectancy increased from 64.3 years in 1975 to 69.1 year in 1993. The same trend was also registered for the life expectancy of the female population, which improved from 68.7 year in 1975 to 73.8 years in 1993.
It can be urgued that the longer life enjoyed by both is due to better health facilities. Nevertheless, due to advancing age and natural physiological deterioration senior citizens are more prone to diseases and other hazards of living such as poisoning.
Poisoning in senior citizens is not restricted to ordinary poisons such as pesticides and other chemicals. The list goes beyond this. Some of the medicines used to help alleviate diseases may turn back on them and become poisons instead.
It is of no surprise that as a group, senior citizens are the major consumers of both prescribed and unprescribed medicines, referred to here as drugs. Because of their higher consumption of drugs and because of altered pharmacokinetics (what the body does to the drug) and pharmacodynamics (what the drug does to the body), senior citizens are likely to suffer more adverse drug reactions, some of which may manifest themselves as a form of poisoning.
For example, chronic usage of salicylates may lead to stomach disorders, prolongation in the blood-clotting time and delirium. Some high-dose vitamin preparations have been reported to induce liver diseases. True to the words of Paracelsus, the great alchemist of the sixteenth century, the dose makes the poison.
Why are senior citizens more inclined and exposed to drug-related poisoning? There are actually several contributing factors. For a start, senior citizens suffer from more diseases than young and middle-aged people.
The ageing process itself takes its toll. In a multi-centre hospital-based study, 76.7% of patients over 65 years of age were found to have one to three concomitant diseases, while the rest had four or more. In the same study, 81.3% of the aged patients were on prescribed drugs. Of these, 56.1% were taking one to three drugs while 24.2% were on four to six drugs.
In another community-based study, 87% of senior citizens over the age of 75 years were found to be taking medications regularly and one-third were on three to four different drugs.
The consumption of a number of drugs at the same time is referred to as polypharmacy. Polypharmacy inevitably leads to an increase in the incidence of drug-related poisoning.
As stated above, the ageing process leads to altered body response to drugs. For example, as a person grows older, the body's composition changes. Total body water and lean body mass are reduced in proportion to the body weight. The decrease in lean body mass could result in a relative increase in body fat. Drugs which are lipid soluble, like the sleeping pills diazepam and barbiturates, therefore may have prolonged action. Enzymes in the aged liver of senior citizens also tend to lose some of its capability to detoxify drugs. Thus, some drugs which are normally deactivated in the liver would have a prolonged action when taken by aged patients.
The other facet of drug-body interaction which might be altered in senior citizens is the excretion of the drugs via the kidney. As kidney function can reduce by as much as 35% between the ages of 20 and 90 years, drugs supposed to be excreted by the kidneys, when given in normal adult dose, will accumulate in the body instead. These include the antibiotics gentamicin and cephalexin. In these cases, smaller-than-normal doses would be prescribed by the doctor.
Another factor which may contribute to instances of adverse drug reactions and poisoning is non-compliance. Compliance has been defined as "the extent to which the patient's behaviour coincides with medical and health advice." Any form of action which deviates from the medical advice is deemed non-compliant.
This include ingesting more than the prescribed dose or taking medications more often than the prescribed dose or taking medications more often than the prescribed schedule. These types of non-compliance are particularly true in patients who are senior citizens, especially if they are forgetful, depressed or confused. For example, they tend to make more mistakes when they have to take three or more medications concurrently.
The doctor's influence on the patient's compliance is extremely important, as he or she prescribes the drugs, advises the patient and directs the pharmacist to fill the prescription. The pharmacist, being the last person to communicate with the patient before he or she leaves the healthcare premise, is in a good position to enhance the patient's confidence in the prescribed treatment, and can improve compliance by giving comprehensive counselling and writing clear instructions on the packages and containers.
In one study, pre-discharge counselling by a pharmacist for 15 minutes was found to reduce errors with medications, even in poorly-orientated patients. They were counselled on the nature and purpose of each drug and were instructed to destroy all hoarded tablets, and not to take other patients' medications.
Nowadays, there is a wide range of preparations that can be obtained without prescriptions. Senior citizens can literally walk into a pharmacy and select the products of their choice.
Needless to say, the pharmacist on duty has been specially trained to counsel patients and customers on the proper use of drugs. If he or she is not present, then make an appointment to come back later. In any case, senior citizens should insist on the proper drug counselling from the pharmacist every time they purchase or procure a new supply of drugs, including when they're having their prescriptions refilled.
The use of proper containers for the drugs consumed by senior citizens is also important. Plastic or glass screw-top bottles are ideal for tablets and capsules, while child-proof tops and foil-covered calendar packs are not. If the drug preparations are photostable, then clear bottles are ideal as many senior citizens recognise their medications by the shape, size and colour.
In order to enhance compliance, senior citizens should also provide feedback to the doctor and pharmacist. For example, they may want to highlight the fact that they have difficulty in handling small round tablets, or swallowing large round ones. Similarly, mental impairment, such as some degree of memory loss, if present, should also be made known.
Despite the fact that most senior citizens are able to take their own medications, some supervision is still essential.
For example, relatives, friends, home help and health visitors can assist in ensuring that the elderly patient is taking the right medicine at the right time and in the right amount. Compliance is absolutely vital in order to avoid untoward poisoning incidences among senior citizens.
In conclusion, senior citizens suffer from multiple diseases and consume more drugs than the young. Their ability and capacity to handle drugs are altered and they are likely to suffer from more adverse drug reactions. As non-compliance is a major problem in senior citizens, every effort should be made to improve compliance by counselling the patient, prescribing only the most essential drugs and thereafter regularly reviewing them. Whenever necessary, assistance should also be provided during the administration of the drugs.
The writer is a pharmacist specialising in Neurotoxicology at the National Poison Centre, Universiti Sains Malaysia, Penang.
For those looking for a mobilenursing agency may contact: www.mobilenursing.com or
call:+603 78777202 or mail to: nursing@hnp-mobilenursing.com

Patients responsibility serves not one self but help also others to achive the goal of recovery!

2009-05-29T06:53:00.005+02:00

PATIENT'S RESPONSIBILITIES
1. The patient shall ensure that he or she knows and understands what a patient's rights are and shall exercise those rights responsibly and reasonably.
2. The patient shall keep appointments and shall inform the health professional if unable to do so.
3. The patient shall provide accurate and complete information which the health professional requires about his or her health and ability to pay for health services.
4. The patient shall inform the health professional if he or she is currently consulting with or under the care of another health professional or provider of traditional health care in connection with the same complaint or any other complaint.
5. The patient shall ensure that he or she understands the purpose and cost of any proposed investigation or treatment before deciding to accept it. The patient shall insist upon explanations until adequately informed and consult with all relevant persons before reaching the decision.
6. The patient shall accept all the consequences of the patient's own informed decisions.
7. The patient shall establish a stable relationship with and follow the treatment determined by the health professional primarily responsible for the patient's care.
8. The patient shall so conduct himself or herself so as not to interfere with the well being or rights of other patients or providers of health care.
9. Every individual has a responsibility to maintain his or her own health and that of society by refraining from indulging in :-
o unhealthy food consumption;
o addiction forming substances such as dadah, tobacco and alcohol;
o lifestyles that have an adverse impact on health such as sexual promiscuity, reckless activities, and physical inactivity; and,
o contamination of the environment.
10. Every individual has a responsibility to accept all preventive measures sanctioned by law.
11. A patient is encouraged to have a family doctor, dentist and pharmacist to ensure that there is continuing health care for the patient and the patient's family.
12. Every individual has the responsibility to ensure that resources are spent wisely on social and health services.

Are you looking for home or mobilenursing or MOBILE DOCTOR service?

http://www.hnp-mobilenursing.com/ or nursing@hnp-mobilenursing.com

or Phone: +6 03 78777202

Patients Right as enshrined by the Malaysian Medical Association

2009-05-29T06:46:00.004+02:00

Patient's Right
I. RIGHT TO HEALTH CARE AND HUMANE TREATMENT
§ Every individual shall have access to competent health care and treatment regardless of age, sex, ethnic origin, religion, political affiliation, economic status or social class.
§ Health care services shall be available on the basis of clinical need regardless of the ability to pay and it shall be the responsibility of the Government to ensure that every person has access to essential health services.
§ Every patient shall be treated with care, consideration, respect and dignity without discrimination of any kind.
§ All drugs dispensed shall be of acceptable standards in terms of quality, efficacy and safety as determined by the Drug Control Authority of Malaysia.
§ Every individual shall have the right to prompt emergency first aid treatment from the nearest government or private medical and health facility.
§ Patients shall be interviewed and examined in surroundings designed to ensure reasonable privacy and shall have the right to be chaperoned during any physical examination or treatment, except in cases of emergency where such conditions may not be possible.
§ A child admitted to hospital shall, whenever possible, have the right to the company of a parent or guardian.

II. RIGHT TO CHOICE OF CAREA patient have the right to a second opinion at any time.
A patient shall have the right to know the investigations conducted, the results of these investigations and a copy of the medical reports and have them explained. The patient shall also have the right to authorise in writing another health professional to obtain a copy of the same and inform him or her of what they contain.
A patient shall, whenever possible, have the right to be treated at a hospital of choice and to be referred to a consultant of choice.
A patient who has received adequate information about his or her condition during consultation shall have the right to accept or to refuse treatment.
If a patient's health professional refuses to allow another health professional to be called in, or breaches any other provisions of this charter, the patient shall have the right to discharge that health professional and seek the services of another.

III. RIGHT TO ACCEPTABLE SAFETY
Before any treatment or investigation, a patient shall have the right to a clear, concise explanation in lay terms of the proposed procedure and of any available alternative procedure. Where applicable the explanation shall incorporate information on significant risks, side-effects, or after- effects, problems relating to recuperation, likelihood of success, risks thereof, and whether the proposed procedure is to be administered by or in the presence of students. A patient may refuse any treatment or investigation.

IV. RIGHT TO ADEQUATE INFORMATION AND CONSENT
§ A Patient shall have the right to know the identity and professional status of the individuals providing service to the patient and to know which health professional is primarily responsible for the patient's care.
§ A patient shall have the right to information regarding all aspects of medication, including :
· The right to adequate and understandable information on prescribed and purchased medicines.
· The right to the most effective and safe medicines. Safety must be ensured by the manufacturers and by legislative control.
· The right to convenient access to medicines.
· The right to choose among competitive products.
·
§ All medicines shall be labelled, and shall include the international non-proprietary name (INN) of the medicine, the dosage and how often the medicine has to be taken. In addition, the patient shall be informed about medication, including the following :-
· The purpose of the medicine
· The possible side effects
· The avoidance of any food, alcoholic beverages or other drugs
· The duration necessary for any medication prescribed
· The measures to be taken if a dose is forgotten or if an overdose is taken.
§ A patient shall have the right to an itemized account after any treatment or consultation and to have this explained.
§ If a patient is in hospital or any health care facility, the patient shall,unless unconscious be consulted about any decision to discharge or transfer the patient to another facility.
§ Where it is appropriate to a patient's condition or treatment, the patient shall be given advice about self-care, drugs administration, special precautions, which may be necessary or desirable, and the existance of special associations, facilities, aids or appliances which may be of assistance.
§ A patient's consent shall be required before any procedure is carried out and in the case of a minor the consent shall first be obtained from the parent or guardian. If a patient is unconscious and delay would be dangerous, a doctor is entitled to carry out any necessary treatment or operation.
§ A patient's consent shall be required for the inclusion of a patient in any research. The patient shall be adequately informed of the aims, methods, anticipated benefits and potential hazards of the study and the discomfort it may entail. The patient shall be informed that he or she is at liberty to abstain from participation in the study and that he or she is free to withdraw his or her consent to participation at any time. To ensure that the informed consent is not obtained under duress or from a patient in a dependent relationship to the health professional, the informed consent shall be obtained by a health professional who is not engaged in the investigation and who is completely independent of the official relationship between the patient and the health professional. In the case of a child the informed consent shall be obtained from the parent or guardian.
§ A patient shall have the right to have the details of the patient's condition, treatment, prognosis and all communication and other records relating to the patient's care to be treated as confidential, unless :
§ authorised in writing by the patient it is undesirable on medical grounds to seek a patient's consent but it is in the patient's own interest that confidentiality should be broken. the information is required by due legal process.

V. RIGHT TO REDRESS OF GRIEVANCES
§ A patient shall have access to appropriate grievance redressal mechanisms.
§ A patient shall have the right to seek legal advice as regards any alleged malpractice by the hospital, the hospital staff or by a doctor or other health professional.
§ A patient shall have the right to recover damages for injury or illness incurred or aggravated as a result of the failure of the health professional to exercise the duty and standard of care required of him or her while treating the patient.

VI. RIGHT TO PARTICIPATION AND REPRESENTATION
§ A patient shall have the right to participate in decision-making affecting the patient's health :
· with the health professionals and personnel involved in direct healthcare:
· through consumer and community representation in planning and evaluating the system of health services, the types and qualities of service and the conditions under which health services are or were delivered.

VII. RIGHT TO HEALTH EDUCATION
§ Every individual shall have the right to seek and obtain advice with regards to promotive, preventive and curative medicine, and rehabilitation to maintain or regain good health and a healthy lifestyle.

VII. RIGHT TO A HEALTHY ENVIRONMENT
§ Every individual shall have the right to an environment that is conducive to good health. This includes and extends to a healthy and safe work environment, a healthy and safe home environment, and a healthy and safe environment at the place where he gets his medical care and treatment.
Taken from:
Malaysian Medical Association 4th Floor, MMA House124 Jalan Pahang53000 Kuala Lumpur
© MMA Publishing Group Limited 2007. All rights reserved.
Last Updated : 09 March 2009

In case you need mobilenursing or a"MOBILE DOCTOR" contact the please following:
http://www.hnp-mobilenursing.com/ or nursing@hnp-mobilenursing.com you may als contact directly: +6 03 78777202

New Alphabet for Senior Citizen

2009-05-29T06:36:00.007+02:00

I came across this interesting in a friend’s blog.
No one seems to know where it originated from but it’s been going around via emails and blogs.
A is for Apple, and now A’s for arthritis;
B is for Boat,That used to be right, But now it won’t float!Age before Beauty is what we once said,But let’s be a bit more realistic instead, b’s the bad back,
C is the chest pains, perhaps car-d-iac?
D is for dental decay and decline,
E is for eyesight, can’t read that top line!
F is for fissures and fluid retention,
G is for gas which I’d rather not mention.
H is high blood pressure–I’d rather it’s low;
I for incisions with scars you can show.
J is for joints, out of socket, won’t mend,
K is for knees that crack when they bend.
L for libido, what happened to sex?
M is for memory, I forget what comes next.
N is neuralgia, in nerves way down low;
O is for osteo, the bones that don’t grow!
P for prescriptions, I have quite a few,Just give me a pill and I’ll be good as new!
Q is for queasy, is it fatal or flu?
R for reflux, one meal turns to two.
S for sleepless nights, counting my fears,
T for Tinnitus; there’s bells in my ears!
U is for urinary; big troubles with flow;
V is for vertigo, that’s “dizzy,” you know.
W is for worry, NOW what’s going ’round?
X is for X-ray, and what might be found.
Y is another year I’m left here behind,
Z is for zest that I still have…in my mind.
I’ve survived all the symptoms, my body’s deployed, and I’m keeping 26 doctors fully employed!

You too may need mobilenursing or a MOBILE DOCTOR SERVICE for your self or a "good friend"? than contact:

http://www.hnp-mobilenursing.com/ or nursing@hnp-mobilenursing.com or call:

+6 0378777202

Religion and Correlation of Health

2009-05-26T04:34:00.008+02:00

Religion and Correlation of Health/Lifespan
By Yakob Abdul Rahman W. Scholer

“Those who are deeply involved in religious activities have a longer lifespan and are likely to stay more healthy ”
(Mr. McCullough et al.) Healthpsychology – Linda Brennon and Jess Feist

HEALTH AND RELIGION
A century ago Emile Durkheim, a social Scientist, pondered on the benefit and influence of religious involvement to our health.
However many researchers found out that the community involved in religious activities were more likely to be sicker than others.
This PARADOX was further researched and an interesting finding was revealed.

EXTRINSIC - outside pressure and influence motivated persons, seemed to benefit less, indeed they seemed to have negative consequences of following the ritual requirement, without deeper love and understanding of the essence of their religion. These people are not deeply religious but follow attendance and rituals for their own ends.
INTRINSIC - inner motivation oriented persons whose whole life and action was guided by the spirit of their believes, had significant health benefits related to less sickness recorded and longer life span. They, in contrast, were deeply committed and their life was guided by their religion as part of their lives. They had internalized the creed and follow it fully.

Extrinsic religious orientated persons are quite prejudiced and narrow minded whereas those with an
Intrinsic orientation were less intolerant and less prejudiced.

In recent years researchers had become more interested in the correlation of Health consequences and religions involvement.

Study was done on three types of religious involvement:
• attendance at religious services
• the importance of religion is one's own life
• spiritual help seeking
These people had been examined for depression and the finding was that those who just attended religious services had no reaction on their depression.
The second group showed low level of depression suggesting that the benefit of salience improved their condition.
Those who sought spiritual guidance had a very low level of depression.

Another study showed that people who had an intrinsic religious orientation had a lower rate of:
• Cancer
• Hypertension
• Heart disease
• Strokes
There is an assumption that religion and health have a psychological link and it is assumed that the psychological resources provided by the religious involvement plays a vital role.
A leading German newspaper reporting on “Why Prayers are Healthy” revealed the following:
Prayer and religious activities reduce:
• Hypertension
• Cholesterol levels
• Depression
It improved the:
• Cardiovascular system
• Immune system
• Pain management
Yet another Study showed that people who suffered from a heart disease had a 93% improvement due to prayers that were performed for these people from spiritual persons from the various world religion.
Another study showed that People who attended community prayers at least ones a week lived an average 14 years longer than others.
Religion and prayer are not a substitute for medical help, but support and complement each other.
In Islam we are taught to take care of our body. To do all that keeps it healthy and to avoid all that harms it.
Moderation in all that we do, is part of the religious guidance in Islam.
I would like to come back to a point made earlier.
EXTRINSIC form of religious practices seems to become more of a problem than true help. This has to be understood in that the person is in an emotional conflict between believing and practicing. Performing rituals without the practicing spirit
In my experience I have over and over noted that people who did not practice what they ‘claimed‘ to believe were tensed up, “holier than thou”, prejudiced, envious, intolerant and unhappy, unable to accept that others might be happier.
Islam and other religions forbid the faithful to indulge in hatred, bitterness, jealousy and vengefulness. How do these abdominal behaviors influence our health.
• They cause emotional stress
• Negative stress causes reduction of the immune system.
• Reduced immune system again opens the door to illness
• Cancer is an immune reduction disease.
• Infections, viral as well as bacterial are flourishing in an reduced immune condition.
• The cardiovascular system, inclusive of hypertension, is being impaired by negative mental stress
• Mental Health is significantly influenced by negative thoughts and behavior
In the years of my experiences I have observed that a significant number of people who suffered cancer, heart infarct and strokes, had a prior period of (negative) mental stressful situations. Some where matrimonial related: illicit relationship, unfaithful partners, neglect and abuse or sudden loss of partner.
A study in Asia has found out that up to 60% of Drug abusers were victims of sexual abuse in childhood most within the family circle and become predators of sexual abuse in their adulthood.
Drug abuse connected to AIDS is one of the most serious problems facing our present society.
There is a (potential) workforce of approximately 250,000 people on drugs, unproductive and causing social as well as security problems, devouring millions of RINGGITS that could be used for a better purpose.
When looking at a problem like drug abuse we must also look at the potential underlying causes that leads young people to resort to chemical induced temporarily “contentment and gratification”. To condemn Drug users is a simplification of a problem and ignoring of our own failures.
THE NEED TO DO GOOD - Islam and most other great world religions, encourage their followers to do good deeds. Doing good deed is not merely a matter of performing good acts, perhaps to be seen by others. No, it is the good deed that may remain completely unnoticeable to others.
I would like to stress that the most important and fruitful deed is to pray for others.
We have heard how prayers can influence our environment. How it can help sick persons. It is free of monetary needs yet powerful and effective.
We can do it at anytime, anyplace for anyone. How about a friendly smile to someone whom we might not even know, a courteous greeting, holding a door open for someone with a load, offering a seat in a bus or LRT etc. giving way to another motorist, being courteous in our service with others etc. they are true and potent acts of good deeds, encouraging others to follow-suit and thereby changing our “world for the better”. I remember what my mother used to say, “ The good deeds we do return manifold in our own hearts” . Indeed, try to do a good deed and find out how happy, contended and satisfied you feel afterwards.
Happy feelings foster the our Immune System and lead to improvement of positive mental/physical and spiritual benefits to the individual.
Being happy and healthy can be so simple and effective, if only we would follow the spiritual aspect of Islam. It is not the ritual performance that will bring the benefit but the ‘ niat' which will automatically lead to the rest of observance of religious obligations
It is this mentality of being good to others that will bring us more benefit than the mere distribution of material things. Of course we should help the less fortunate materially as well, but never forgetting that the most potent of good acts is the good wishes and prayers we can offer for others.
Parenting and Prayer
Parents do not need to despair when they notice that their child goes through and adolescent crisis. It is a time when they are often confused and without orientation. If parents are cutting off ties with them, they create the feeling of rejection. Of course, we should not condone an unacceptable behavior of an offspring, nor should we reject the person because of our own pride or for fear of tarnishing our public image. Why not use the most powerful tool we have available, and that is PRAYER .
The nature of parenthood is such, that we cannot “deny” the existence of a child without undergoing severe mental stress.
Denying mental stress does not eliminate its existence or its harmful effect on us. Just the fact that they are ‘common' does make it normal. At times I hear people say that illness is sent by Allah. We should not question that Allah may have His own way of leading us through life. But if we lead a self-destructive life and then claim the consequences to be from Allah, we come close to blasphemy. Allah wants us to be happy. He gives us health. We, however, often lead ourselves into illness and sorrow.
We humans were made to be happy and healthy. Sorrow and illness are not normal. Otherwise we would have no right to strive for restoration of health.
It is the Person who has done all that is possible for his health, who will accept Allah's ways of leading and guidance of our life.

I like to close with an Arabic proverb that says:
"Thust in Allah but tie up your Camel"
If you are in need of mobilenursing or a MOBILE DOCTOR kindly contact: http://www.hnp-mobilenursing.com/ or 0060378777202 or nursing@hnp-mobilenursing.com

The power of touching

2009-05-26T03:39:00.007+02:00

Indeed a very sensitive issue.
Touching of others is so often associated with carnal desires or violence and ill treatments.However the touch that I am referring to has nothing to do with all of those but rather as an element of necessity for any human being.Most people have some reserve towards touching of other people; understandably we should go about it very sparsely as it is so precious that it should be reserved for the right time and the right person.Who then, are the right people that we should give that symbol of intimacy, care and concern?Our Parents, Children, Grandparents, Spouses, close Friends and those we have sincere motivation to express their care in a patient or people who ask for our help or support.Not long ago I met a young man who after a long counseling session and after sharing of his feelings of “being lost” I embraced when he was ready to leave. At that moment he burst out in a long intensive crying, hugging me and not wanting to be let loose. With sobbing and in staggered voice he exclaimed “Why did my dad never hug me in my life?”, “I am feeling so rejected and unloved and am longing to be held and given the feeling of being cared for and loved”. It is not the time to go into the analysis why his father had such a distant approach to his children but I am only using this incident to bring awareness of the need of human beings to feel that they are cared for and this being expressed with body contact.
So many times I have experienced similar incidences. Once, when I was in the University Hospital In Mainz, Germany taking care of AIDS patients, I had one patient who seemed to distant from me (or me from him), that despite looking after him almost every night for more than 2 months, we had a mere functional relationship. I was unhappy with this and could feel that there was something that needed to be done. On one of the nights when it was “calm on the ward” I went to his bed, sat beside him and just took his hands into mine and gave them a good squeeze. We were both silent, but the language of touch moved him and he burst out with tears streaming down his cheeks, time was no more a factor that was in the way. At last when he recovered his composure he said with shining eyes
“Yakob, this was the best you did for me in all these months you take care of me”.
It was a message that changed my life in respect of touching people that I take care of and I learned the meaning of the healing power of touch. Since then, I have experienced it over and over again, that people’s trust is stimulated via the touch of the person. Let us be generous with touching those we love or those placed in our care. Let the touch which communicates the sense of being wanted, cared for, recognized, accepted, loved etc. become part of our daily human interaction. Let us start recognizing the value that lies in this gesture.

“It’s (the sincere touch) free, it’s powerful, it’s healing and makes a person feels good”.

For mobilenursing care or MOBILE DOCTOR contact: http://www.hnp-mobilenursing.com/ or 006 03 78777202 or nursing@hnp-mobilenursing.com

Note changes in the human body when caring for sick and elderly

2009-05-03T07:46:00.008+02:00

Signs and Symptoms to be observed in a sick person
SKIN Pale Anaemia, internal bleeding, cardiovascular collapse Go to hospital (emergency)
Bluish lack of oxigen, brochial blockage, asthma Go to hospital (emergency)
Bluish spots (haematoma) injury, low blood platelets Go and see your Doctor
Yellowish liver problem or bile duct blockage Go and see your Doctor
Itchy, dry liver problem, diabetes, allergy, skin problem Go and see your Doctor
EAR LOPES
Bluish lack of oxygen, bronchial blockage, asthma Go to hospital (emergency)
LIPS/ FINGER NAILS
Bluish lack of oxygen, bronchial blockage, asthma Go to hospital (emergency)
URINE
Dark with strong odour dehydration Go and see your Doctor
Light red bleeding form bladder, ureter or kidney (stone) Go and see your Doctor
Dark red bleeding form bladder, ureter or kidney (stone) Go to hospital (emergency)
Dark red blood clots bleeding form bladder, ureter or kidney (stone) Go to Hospital (emergency)
Very light in color and "plenty" indication of high blood suggar Go and see your
Doctor
STOOL
Light colour, greyish lack of bile (gall bladder fluid) flow, liver problem Go and see your
Doctor
Watery, strong pungent smell intestinal infection, samonella Go and see your Doctor
Foamy, pungent smell intestinal infection, fungus infection Go to hospital (emergency
Hard, stone like pellets constipation, dehydration,
lack of fibres in food Change of diet, more liquid

For more information regarding caring for the sick and elderly, mobile nursing or a MOBILE DOCTOR please contact:
http://www.hnp-mobilenursing.com/ or 0603 78777202 or nursing@hnp-mobilenursing.com

Most people are of the assumption that muscle depletion is part of aging

2009-05-02T07:48:00.004+02:00

Muscle Building is also for Senior Citizen?
.

Muscle Building is also for Senior Citizen?
Most people are of the assumption that muscle depletion is part of aging.
This misconception is so much in the mind of the population that anything else would not be accepted or viewed with suspicion. However this very assumption is the primary problem and the reason why Senior citizens are very reluctant to engage in exercises and sooner or later have to deal with the implications of poor muscle strength and muscle mass.
There are many reasons why senior citizens and in particular males should pay serious attention in respect of the maintaining or regaining of muscles.
Muscle power declines faster, as a result of the force and velocity of muscle shortening, and to a greater extent than muscle strength. Power, or the ability to generate force rapidly, has been shown to be particularly important for maintaining the ability to perform activities of daily living (ADLs) such as stair climbing, walking and rising from a chair.

The Importance of Active Living
Regular exercise is the most effective way to slow and counteract the effects of age-related muscle and strength loss. Comparisons between active and sedentary older adults suggest that much of the strength loss with aging is due lifestyle factors. For example, individuals who continue to use certain muscles on a regular basis do not show the same age-related decreases in strength. In general, muscle atrophy, and thus strength loss, will occur any time when the muscles are not required to work against a given load. The result will be a decrease in protein synthesis accompanied by an increase in protein breakdown. Overall, the muscle atrophies and loses much of its strength, characteristics commonly seen in astronauts during space flight. Incorporating regular resistance training is the most effective means of attenuating this effect
Individuals vary in the rate at which they gain and lose muscle. Genetics, gender, age, physical condition, training program, and diet all have an effect or play a part. Under the best circumstances, the average male can build about 1.5 to 5 pounds of muscle per month and a woman will gain less. The rate of muscle breakdown also varies depending on diet, activity level, fitness level, and whether an acute illness is involved. In a state of complete inactivity, a significant amount of muscle is lost in the first three days, but it slows down after that.

The following is a list of the top twelve benefits of strength training after age 50 years.
Maintain Muscle
If existing muscle is not exercised properly, five to seven pounds of muscle tissue will be lost every decade of adult life, reducing the capacity to function and slowing metabolism.

*Maintain Metabolism
*Strength training helps maintain muscle tissue, thus increasing the metabolic rate, which boosts energy and decreases fat as individuals age.
*Add Muscle Tissue
There is no such thing as being too old to replace muscle tissue. Results can be achieved in as little as two 30-minute training sessions per week.
*Increase Metabolic Rate
As muscle is added, metabolism automatically increases, thereby burning more calories and producing more energy.
*Reduce Body Fat
Strength training increases both muscle mass and tissue activity, which produces an accelerated metabolic rate and higher daily energy expenditure.
*Increase Bone Mineral Density
Strong muscles lead to strong bones. Strength training helps to maintain bone strength and can serve as an excellent preventive measure against osteoporosis.
*Improve Glucose Metabolism
Exercise, specifically strength training, enhances glucose metabolism and helps to decrease the likelihood of adult onset diabetes.
*Speed Up Food Transit
*Strength training speeds up the digestive process. Research indicates that slow transit times for moving food through the gastrointestinal system increase the risk of colon cancer.
*Lower Blood Pressure
Whether done alone or in combination with endurance exercise, strength training lowers resting blood pressure.
*Improve Blood Lipids
Blood lipids include high-density lipoproteins (good cholesterol), low-density lipoproteins (bad cholesterol), and triglycerides (the storage form of fat). Several studies have demonstrated better blood lipid levels after regular strength training.
*Maintain or Improve Low Back Health
Well-conditioned muscles provide better support and shock absorption, which prepares the low back muscles to absorb forces that might otherwise overstress the spinal column.
*Reduce Arthritic Pain
Stronger muscles may be helpful for improving joint function and easing arthritic discomfort.

Adapted from STRENGTH TRAINING PAST 50 by Wayne L. Westcott and Thomas R. Baechle. Available at: www.HumanKinetics.com. $17.95 plus S/H.

Sure the above given points are more than enough reasons to seriously consider strengthening one’s body through exercise and mobilization. In most cases people who are afflicted with poor body control the reason is that they have extreme depletion of muscle tissue leading to instability and loss of body coordination. This may be due to a long spell of bed bound illness, or just the end result of physical inactivity.
You can build muscle at any age. It just takes a little longer as we age. The benefits by far outweigh the stress and initial discomfort. Doing exercises with a trainer or in a gym will add to the success.
However, particularly senior citizens who have hardly done any exercises in the past should do this under the guidance of professional health care workers such as Physiotherapists or Persons qualified in "mobilisation".
(For caption of a photo see attached)
In his age most elderlies do reduce the physical activity. However the 72 year old Klaus Noack wants more. "145 kilo" is his reply when asked what weight he stems in the gym. The pensioner from Delmenhorst Germany and two times senior citizen bodybuilder-master exercises three times a week and fights successfully against age related muscle depletion. In the shower room at times juniors of 30 years enviously look at the body contours of this senior. The muscles are real and his upper arms (biceps) measure 44cm certainly not developed in front of the TV.
The several times grandfather and great grandfather started 15 years ago.
The great grandson of Noack finds it fascinating and exclaims, "My Opa (grandfather) is cool". His doctor describes him as completely healthy! ("Senioren Ratgeber", www.senioren pro.de)

For further information about Mobilization and muscle strenghtenning, mobilenursing or MOBILE DOCTOR please contact:

www.hnp-mobilenursing.com or 0603 78777202 or nursing@hnp-mobilenursing.com

Understand the interaction of medication with nutrients

2009-05-02T07:38:00.005+02:00

Risky Combinations

Interactions A whole range of nutrients can influence the effectiveness of medications.
Not only do medications have interactive influence, but also a whole range of nutrients can cause serious reactions when taken together with certain medications.
High risk potentials
Alcohol, coffee, and other caffeine containing drinks such as cola or plain tea are totally unsuitable for the flushing down of medications. This is particularly important with asthmatic, antibiotic and pain killer medications.
It has been established that fruit juices can be a problem: it is proven that grapefruit has a range of interactive influence on the effectiveness of medication.
Grapefruit juice contains inhibitors of enzymes that influence the metabolism of drug. This can cause an increase of concentration of the active agent in the blood and causing undesirable effect. This is true with a range of medications such as blood pressure, anti-cholesterol, antibiotic, anti-allergy, heart, sedatives and high potency medications.

Milk and milk-products such as cheese, yoghurt, have a severe influence on antibiotic and osteoporosis (Bisphosphonate) medication.
Nutrients rich in Oxal-acid such as rhubarb and spinach are none compatible with iron medications.
Brie, Parmesan, or Roquefort-cheese, however also chocolate and banana contain vast amount of Theremin. Special precaution must be taken by persons who take anti-depressant medication of MAO suppressors especially Tranylcypromin.

This does not mean that one needs to abstain from these foods altogether. Generally it is sufficient to have an interval of a couple of hours between the consumption of the medication and the nutrient. This however does not apply to the grapefruit juice and Tranylcypromin as their active agent is effective for 24 hours and therefore these should not be combined at all.
In case of uncertainty it is advisable to consult your doctor or the dispensing pharmacist for direction.

Surely no one wants to take medication in a way that it is causing more harm than good. This also applies to the combined consumption of various medications at one time.
Never mix medication without the consent of your doctor or pharmacist; this applies in particular for none prescription drugs generally bought over the counter in pharmacies and other drug stores.

Not only ALL medications somehow have side effects when taken for long duration, there are also a range of herbs and herbal medications that have their own potential risks if taken together with other medication and without doctors’ consent or pharmaceutical clearance.

For INFORMATION ABOUT MOBILE NURSING OR MOBILE DOCTOR and others YOU may contact:
Home Nursing Providers 00603 78777202 or http://www.hnp-mobilenursing.com/ or

nursing@hnp-mobilenursing.com

Good nutrients play a major part in the management of cancer treatment

2009-04-28T09:19:00.011+02:00

Preparing Yourself for Cancer Treatment
Good nutrition is especially important if you have cancer because the illness itself, as well as its treatments, can affect your appetite. Cancer and cancer treatments can also affect your body's ability to tolerate certain foods and to use nutrients.
The nutrient needs of people with cancer vary from person to person. Your doctor, nurses, and a registered dietitian can help you identify your nutrition goals and plan ways to help you meet them. Eating well while you are being treated for cancer can help you:
feel better
keep up your strength and energy
keep up your weight and your body’s store of nutrients
tolerate treatment-related side effects
lower your risk of infection
heal and recover quickly
Eating well means eating a variety of foods that will give you the nutrients you need to protect your health while fighting cancer. These nutrients include protein, carbohydrates, fat, water, vitamins, and minerals.
Nutrients
Protein
We need protein for growth, to repair body tissue, and to keep our immune systems healthy. When your body doesn't get enough protein, it takes you longer to recover from illness and you have lower resistance to infection. People with cancer often need more protein than usual. After surgery, chemotherapy, or radiation therapy, extra protein is usually needed to heal tissues and to help prevent infection. Good sources of protein include lean meat, fish, poultry, dairy products, nuts, dried beans, peas and lentils, and soy foods.
Fats
Fats play an important role in nutrition. Fats and oils provide a rich source of energy for the body. They are used to store energy, insulate body tissues, and transport some types of vitamins through the blood. They also play an important role in food preparation by enhancing food flavor, making baked products tender, and conducting heat during cooking. You may have heard that some fats are better for you than others. When considering the effects of fats on your heart and cholesterol level, choose unsaturated fats (monounsaturated and polyunsaturated).
Monounsaturated fats are found mainly in vegetable oils such as canola, olive, and peanut oils. They are liquid at room temperature.
Polyunsaturated fats are found mainly in vegetable oils such as safflower, sunflower, corn, flaxseed, and canola oils. Polyunsaturated fats are also the main fats found in seafood. They are liquid or soft at room temperature. Certain polyunsaturated fatty acids, such as linoleic acid and alpha-linolenic acid, are called essential fatty acids, because the body cannot make them. They are needed to build cells and make hormones. Essential fatty acids must come from foods we choose.
Saturated fats (or saturated fatty acids) are mainly found in animal sources such as meat and poultry, whole or reduced-fat milk, and butter. Some vegetable oils like coconut, palm kernel oil, and palm oil are saturated. Saturated fats are usually solid at room temperature.
Trans fatty acids are formed when vegetable oils are processed into margarine or shortening. Sources of trans fats in the diet include snack foods and baked goods made with partially hydrogenated vegetable oil or vegetable shortening. Trans fats also are found naturally in some animal products, such as dairy products.
Carbohydrates
Carbohydrates give the body the fuel it needs for physical activity and for proper organ function. There are also good and bad sources of carbohydrates. The best sources of carbohydrates -- fruits, vegetables, and whole grains -- supply needed vitamins and minerals, fiber, and phytonutrients to the body’s cells. Other sources of carbohydrates include bread, potatoes, rice, spaghetti, pasta, cereals, dried beans, corn, peas, and beans. Sweets (desserts, candy, and drinks with sugar) can supply carbohydrates, but provide very few nutrients.
Water
Water and fluids are vital to our health. All body cells need water to function. If you do not take in enough fluids or if you are vomiting or have diarrhea, you may become dehydrated. In general, a person should drink about eight 8-oz. glasses of water or clear liquid each day to be sure that all the body cells get the fluid they need.
Vitamins and minerals
Vitamins and minerals are needed for proper growth and development. They also allow the body to use the energy (calories) supplied in foods. A person who eats a balanced diet with enough calories and protein usually gets plenty of vitamins and minerals. But it can be hard to eat a balanced diet when you are being treated for cancer and have treatment side effects that last for long periods of time. When that is the case, your doctor or dietitian may suggest a daily multivitamin and mineral supplement. If you are thinking of taking a vitamin or supplement, be sure to discuss this with your doctor first. Some people with cancer take large amounts of vitamins, minerals, and other dietary supplements to try and boost their immune system or even destroy cancer cells. Some of these substances can be harmful, especially when taken in large doses. In fact, large doses of some vitamins and minerals may reduce the effectiveness of chemotherapy and radiation therapy. During treatment, it may be best to choose one with no more than the Daily Value (DV) for all nutrients and one without iron, unless your doctor thinks that you need iron. Again, discuss this with your doctor first.
Antioxidants
Antioxidants are substances that protect the body's cells from damage caused by free radicals (by-products of the body’s normal processes). Examples of antioxidants include vitamin C, vitamin E, vitamin A (beta carotene), and selenium. If you want to take in more antioxidants, health experts recommend eating a variety of fruits and vegetables, which are good sources of antioxidants. Taking large doses of antioxidant supplements is usually not recommended while having chemotherapy and radiation therapy. Talk with your doctor to determine the best time to take antioxidant supplements.
Herbs
Herbs have been used to treat disease for hundreds of years. Today, herbs are found in many products, such as pills, liquid extracts, teas, and ointments. While many of these products are harmless and safe to use, others can cause severe and harmful side effects. Some may even interfere with proven cancer therapies, including chemotherapy, radiation therapy, and recovery from surgery. If you are interested in using products containing herbs, talk about it with your doctor or nurse first.
Safety considerations
Many people believe that if they find a pill or supplement in stores , it is safe and effective. The Food and Drug Administration (FDA) put out new rules in 2007 to help ensure that supplements contain what their labels claim they do. However, some of these rules will not be fully in effect until 2010. Even then, the supplement's safety and its effect on the body are not addressed by the new FDA rules. The FDA does not require manufacturers of these products to print possible side effects on their labels. The FDA cannot pull a dietary supplement or herbal product from the market unless it can prove that the product is unsafe.
Tell your health care team about any herbal products and supplements that you are using or are thinking about using. Bring the bottle(s) of the supplement to your doctor to talk about the dose and to be sure that the ingredients do not interfere with your health or cancer treatments. Some other safety tips:
Ask your doctor or nurses for reliable information on dietary supplements.
Check the product labels for both the quantity and concentration of active ingredients contained in each product.
Stop taking the product immediately and call your doctor if you have side effects such as wheezing, itching, numbness, or tingling in your limbs.
Some people with cancer take large amounts of vitamins, minerals, and other dietary supplements in an effort to enhance their immune systems or even destroy cancer cells. Some of these substances can be harmful. In fact, large doses of some vitamins and minerals may reduce the cancer-fighting effects of chemotherapy and radiation therapy.
For more information about mobilenursing OR MOBILE DOCTOR visit: http://www.hnp-mobilenursing.com/ or
06 0378777202 or nursing@hnp-mobilenursing.com

• New Book Information • Guide to Home Nursing

2009-03-24T09:56:00.007+01:00

Asia Publication
Guide to Home Nursing
Yakob Abdul Rahman Wilhelm Scholer
DESCRIPTION
The fundamental objective of this book is to provide crucial information on how to care for the sick and elderly in the home environment. It features a comprehensive guideline in providing for the physical needs of the sick or disabled whilst attending to their psychological and emotional well-being. These include encouraging their independency and boosting their self-esteem through excellent communications. The content of this guideline is based on general life experiences that one may encounter in his or her daily activities, thus enabling readers to relate better to the information presented. Nevertheless, it is important to note that this guide will not replace the need for professional medical treatment and advice. However, it can serve as a supplementary tool that will greatly enhance one’s knowledge on professional medical care and advice.

KEY FEATURES
• Emphasises on Activities of Daily Life (A.D.L’s.)
• Assists caregivers in providing the ultimate and optimal care to any person regardless of age and unique needs
• Covers the fundamental needs of nursing a person at home, be it by family members or through the assistance of mobile nursing agencies
• Simple language, with clear, concise and easy-to-follow instructions regardless of the patient’s background and home environment
• Acts as a supplementary guide to professional medical nursing

ABOUT THE AUTHOR
Yakob Abdul Rahman Wilhelm Scholer, an expert in the field, currently works with Home Nursing Providers Sdn. Bhd., Malaysia’s first "comprehensive and integrated" Mobile Nursing Agency. His experiences include working with welfare services, providing medical training, as well as helping drug users and alcoholics overcome their addiction and substance dependency. His dedication saw the establishment of Malaysia’s first Addiction Therapist Training Program and Female Drug Users Rehabilitation Centre. He was instrumental in the creation of Malaysia’s first AIDS Awareness Committee which is now known as the Malaysian Aids Council. In 2005, he started lecturing in "Health Psychology" at University Technology Mara (UiTM) Malaysia. The author also visits countries all over the world, attends seminars and international congresses, presents working papers and shares his experience in the field of Addiction, Psychology and Mobile Nursing.

TABLE OF CONTENTS
1. Health, Illness & Nursing. 2. Observation of Developing Illness, Signs and Early Interventions.
3. The Room for the Sick and Hygienic Provisions. 4. Body Positioning and Back-saving Work System.
5. General Nursing Functions. 6. General Toilet. 7. Prophylaxes. 8. Positioning and Supportive Aids.
9. Nourishment. 10. Executing Physician’s Instructions and Special Nursing Measures. 11. Medication. 12. The sick child. 13. The Aged Person and His/Her Illness. 14. Caring and nursing of pre-final patients.

REVIEWER QUOTES
"This book has a very detailed and systematic layout. It is a very useful guide on the know-how of caring for the sick, particularly for bedridden persons. This book will be an ideal reference for every family that find themselves in such a predicament. I strongly recommend it."
Dr. Zamri B. Abdul Rahim, MBBS (Malaya), M.MED (O&G) UKM, FICS (USA)
Consultant Obstetrician & Gynaecologist, Darul Ehsan Medical Centre.

"This book is very informative for anyone who wants to do homecare for their sick, elderly and disabled family members. The content and method is written in a manner that is simple and easy to understand. It also serves as an eye opener and motivation for healthcare personnel and anyone who wish to pursue a career or passion in home and mobile nursing.
Raja Rajeswary Veeramani, R.N., R.M., Dip. Ophthamology,
Assistant Manager, Masterskill University College of Health Sciences
©2009
ISBN : 9789814253987
Price : US$29.95
Pub Date : March 2009
Size : 229 x 153 mm
Subject Major : Health Science
Subject Minor : Nursing
Rights : World
Edition : First
Binding : Paperback
Pages : 100 pp
For orders/enquiries, please contact
Cengage Learning Asia Pte Ltd
5 Shenton Way #01-01 UIC Building
Singapore 068808
Tel : (65) 6410 1200
Fax : (65) 6410 1208
Email : asia.info@cengage.com
Website: www.cengageasia.com

If you are looking for MOBILE NURSING OR A MOBILE DOCTOR please contact:

www.hnp-mobilenursing.com or nursing@hnp-mobilenursing.com

or +6 03 78777202

ENSURING ALZHEIMER PATIENTS GET THE NUTRIENTS that THEY NEED

2009-03-11T07:58:00.006+01:00

left picture: Normal brain right picture: Alzheimer brain

INVITATION TO EAT :

By : Yakob Scholer, Nursing Consultant, Home Nursing Providers

Alzheimer Dementia Patient are often overtaxed with eating and drinking. This is how we can help them.
Family members and nursing personnel of persons suffering from Alzheimer Dementia (dementia) know the problems related to food and drinks consumption by these patients. Often, the person may sit in front of a plate of food yet does not make any move or effort to start eating. At times, the person may even have forgotten what he was doing at the table in the first place.
For a normal and healthy person, eating and drinking are not only acts of sustenance but also pleasure. For a person with dementia on the other hand, these two basic acts are at times deemed a major problem with serious consequences. As a result, statistics have shown that more than 90% of dementia patients suffer continued weight loss. Drastic and continued weight loss can also lead to other severe health problems for dementia patients. Therefore, relatives and caregivers are often faced with multiple dilemmas, from coping with the dementia, ensuring proper diet and nutrition for the patients to managing other physical health problems associated with dementia.
Nevertheless, coping with dementia patients need not be a chore or a difficult ordeal. By learning to understand their needs at a deeper level, caregivers and family members can create a stress-free environment that can contribute to better dietary health and supervision of dementia patients.

For example, patients with dementia cannot recognise the feeling of hunger and thirst. Therefore, they will hardly ask for food and drinks on their own accord. This is because, at the on-set of dementia, the patient’s sense of smell and taste will start to diminish, resulting in their inability to recognise the smell and taste of food that is a prerequisite to desire food in an ordinary person. It is therefore important to stimulate the patient’s other senses such as sound, sight and touch through the preparation and serving of food in order to invoke their interest to eat and drink. This could be done from bringing to their attention the mere sounds of cooking and the utensils used, to encouraging the patient to observe as his meal is being prepared. Watching his meal prepared will help to remind the patient that the time for food intake is imminent. In addition, the way in which a table is set for a meal will also influence dementia patients to eat. For example, it is helpful to have transparent glasses and coloured plates to emphasise the colour of the food and beverages, thereby not only enticing the patient but also triggering his memory to eat and drink.
For a patient with dementia, his favourite dishes will remain a favourite even when he may no longer be able to express his wishes for them. Repetitive serving of the patient’s favourite dishes will not only ensure that his dietary needs are met through food consumption but also provide the patient with a sense of security.
Many dementia patients have also lost their motor skills to use fork and spoons. Therefore food for dementia patients should be prepared to ensure easy handling by hand or cutlery and utensils. The caretaker should also eat with the patient so that the patient can observe the caretaker and be stimulated to follow his movements in handling food and cutlery. In doing this, it is important for caretakers and family members to remember that pressure on the patient to eat and drink should be avoided, as it will reinforce his incompetence and make him lose interest in trying.
Families are at times embarrassed when the patient does not adhere to proper "table manners" and may use his hands to eat in a way deemed inappropriate. It should be remembered however
that it is OK to allow the patient to eat the way he feels most comfortable. In fact, patients should be encouraged to do so as this will improve his appetite and self-esteem.
Another great way to remind and entice patients to eat is to place titbits and drinks at various strategic places around the house, particularly in areas frequented by the patient. This will remind the patient to eat although proper supervision and control is needed to ensure that the patient is eating healthy and not just consuming junk food that could cause further damage to his health.
For other patients, regular weight control or management is usually taken to mean that patients should be prevented from becoming overweight. It is the complete opposite however, with dementia patients. Regular weight control is needed to ensure that the patient’s weight does not dip to dangerous levels. This is because, in addition to losing his appetite and not remembering how to ask for food when he is hungry, dementia patients will burn a lot of calories and use up a lot of energy from his restlessness and constantly moving around. Should the patient lose more than 10% of his original weight in one year, the feeding of energy rich nutrients and supplement is strongly recommended. This can be in the form of energy drinks or integration of health supplements into regular food. Caregivers and family members may seek the counsel of the patient’s physician or nurse. Alternatively we at Home Nursing Providers Sdn Bhd (HNP) can also provide such advice and guidance.

Special attention must also be given by family members to the problem of as dementia patients have the tendency to suffer from aspiration, a condition in which the food goes through the oesophagus into the bronchial system and lung instead of the stomach. In this case a visit to a neurologist is strongly recommended as he will be able to determine the correct diagnosis and proper management of such a condition.
Nevertheless, should this happen, the family and caregiver should be prepared to adjust the patient’s diet plan accordingly. For example, patients should avoid food where solids and liquid are served or prepared together. Instead, it is recommended to mix rice or potatoes with minced meat and vegetables so as to ensure proper swallowing and provide variety in taste and nutritional value. Sometimes it is also helpful to use gelatine (or its equivalent) to bind the liquid and yet keep the food soft. This may be used with fruits juices, thereby creating a fruit jelly that is not only healthy and appetising but also easy and safe for the patient to swallow.
Dementia patients are often very restless and may have the constant urge to move and use their hands. If they wish to assist in clearing the table after a meal, they should be allowed and encouraged to do so. However family members and caregivers can ensure their safety and avoid further mess and stress in the house by only allowing them to handle plastic plates
and none breakable utensils. This will help the patient feel useful and improve his otherwise depleted self-esteem.
It is important to understand that Alzheimer Dementia is a unique condition that requires not only physical support, but also the patience, emotional support and psychological encouragement by family members. Unlike most other medical conditions, there is no ultimate cure for Alzheimer Dementia although it is a highly manageable disease. To do so, it is important for family members to first accept the condition and proceed to gaining more knowledge and understanding of the problem. The constant support and assistance by family members will enable patients with dementia to live healthy and fulfilling lives.
For further Information and guidance in mobile nursing/MOBILE DOCTOR you may consult:

HOME NURSING PROVIDERS SDN. BHD (HNP) at : 06 03 7877 7202

or visit http://www.hnp-mobilenursing.com/ nursing@hnp-mobilenursing.com

Mobile HOME Nursing as A WAY of cutting hospitalization cost

2009-02-19T17:07:00.004+01:00

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

2009-02-10T10:55:00.010+01:00

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

2009-02-02T17:37:00.006+01:00

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 -

Home Nursing needs a lot of human psychology

2009-01-28T02:03:00.004+01:00

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

Understanding the five point Blood Glucose measurement

2009-01-19T09:45:00.012+01:00

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

Cultural sensitive (home) Nursing

2009-01-08T00:08:00.006+01:00

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.

In case you are looking for MOBILE NURSING or MOBILE DOCTOR please contact:

www.hnp-mobilenursing.com or nursin@hnp-mobilenursing.com or call

+6 03 78777202

Identification of a stroke

2008-12-23T23:24:00.008+01:00

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

2008-12-19T09:29:00.012+01:00

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

2008-11-03T16:40:00.007+01:00

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

2008-11-03T08:16:00.009+01:00

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"

2008-10-29T09:53:00.005+01:00

"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

2008-10-29T09:40:00.005+01:00

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

2008-10-29T09:37:00.004+01:00

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

2008-10-24T09:27:00.005+02:00

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

2008-10-19T10:27:00.008+02:00

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

2008-10-14T17:04:00.010+02:00

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.

2008-09-14T12:43:00.007+02:00

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

2008-09-14T12:39:00.008+02:00

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

2008-08-11T02:28:00.006+02:00

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