• New Book Information • Guide to Home Nursing

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

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

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

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

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

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

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

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

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

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

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

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

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

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

or nursing@hnp-mobilenursing.com

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

HOME NURSING is much more than just performing technical task

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

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

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

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

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

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

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

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

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

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

To receive more information on mobilenursing or MOBILE DOCTOR contact:

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

nursing@hnp-mobilenursing.com

Tel: 06 03 78777202

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

HOME NURSING PROVIDERS Sdn Bhd (644078-M)

JOB SCOPE : WRITE UP – The Importance of Skin pH

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

With commentaries by:

Yakob Scholer, Nursing Programme Director, Home Nursing Providers

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

• Contact dermatitis

• Atopic dermatitis

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

• Diabetes

• Chronic renal failure

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

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


Products to Use to Maintain pH Levels

There are three main categories of cleansing agents:

• Soaps

• Synthetic detergents

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

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

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

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

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

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