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

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

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

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

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

Nursing AIDS patient not a special risk to the nurse

By Yakob Abdul Rahman W. Scholer

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

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

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

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

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

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

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

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

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

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

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Mobile nursing of babies and young people

Mobile nursing of babies and young people

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

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

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

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

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

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

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Feeding tube, a life saver or human abuse

The controversy around the Ryle’s tube feeding

By: Yakob Abdul Rahman.W.Scholer

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

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

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

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

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

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

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

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

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Not just verbal warning, actions need to follow!

By Mona Hassan

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

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

A Taboo that may cost the male his life

The Taboo Subject - Prostate Gland cancer

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

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

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

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

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

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

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

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

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

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

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

Preventive measures

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

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

Here some general points one should observe.

Well balanced diet

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

Smoking

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

Alcohol

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

Liquid

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

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

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The various benefit of the Banana! One should know.

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

Energize Yourself

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

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

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

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

Healthy Banana

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

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

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

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

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

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

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

Banana Dishes

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

So, Go (for) "Banana"!!

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