HOME NURSING is much more than just performing technical task

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

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

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

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

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

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

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

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

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

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

To receive more information on mobilenursing or MOBILE DOCTOR contact:

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

nursing@hnp-mobilenursing.com

Tel: 06 03 78777202

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

HOME NURSING PROVIDERS Sdn Bhd (644078-M)

JOB SCOPE : WRITE UP – The Importance of Skin pH

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

With commentaries by:

Yakob Scholer, Nursing Programme Director, Home Nursing Providers

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

• Contact dermatitis

• Atopic dermatitis

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

• Diabetes

• Chronic renal failure

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

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


Products to Use to Maintain pH Levels

There are three main categories of cleansing agents:

• Soaps

• Synthetic detergents

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

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

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

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

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

Home Nursing needs a lot of human psychology

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

If you are looking for MOBILE NURSING OR MOBILE DOCTOR please contact: www.hnp-mobilenursing.com or nursing@hnp-mobilenursing.com or +6 03 78777202

Understanding the five point Blood Glucose measurement

Understanding the five point Blood Glucose measurements

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

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

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

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

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

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

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

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

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

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

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

-end-

ABOUT THE AUTHOR

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

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

Cultural sensitive (home) Nursing

Cultural sensitive

(home) nursing

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

What is culture?

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

What is culture sensible nursing?

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

What is the purpose of intercultural nursing?

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

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

New Sign of a Stroke
Stick out Your Tongue

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

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

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

Manual Lymphal Drainage at the comfort of your homes

Various parts of the body will receive soft stroking massage

Lymphatic drainage massage LDM

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

The Origin of Lymph

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

The Role of Lymph

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

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

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

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

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

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

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

Contraindications for MLD

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

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

Alert

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

HOME NURSING PROVIDERS, MOBILE NURSING or MOBILE DOCTOR

www.hnp-mobilenursing.com

or nursing@hnp-mobilenursing.com

Tel: 06 03 78777202