THEY CAME IN THROUGH THE WINDOW.

Shortly after my final qualifying examination in nursing school, I applied for a job in a private hospital. I was called for interview and was asked to start work the following day. It was an obstertric and gynaecology specialist hospital, so it was an opportunity for me to gather enough experience in that specialty. It was barely two weeks after resumption of duty that I started observing certain strange behaviours from two of the nursing staff. They were not familiar with the nursing process (a framework designed to provide systematic, individualized, client-centered and holistic care to patients), their communication skill (to patients and co-workers) was unprofessional, their nursing practice was obsolete and lacked scientific rationale. They were bold and fearless, damning the consequences for their actions. Their zeal was without knowledge. They looked more like apprentice. So I started some research to know who they really are. I later discovered they were not Registered Nurses (RN). I was shocked. So I have been working with quacks all these while? To cut the long story short, I resigned and got another job.

The whole essence of sharing the above piece is to clearly bring to light what the Nursing profession stands for. Nursing is both an art and a science. It is a full blown profession. It is not (and will never be) apprenticeship. Nursing cannot be taught by one doctor in his hospital or clinic. The best of medical doctors cannot impact Nursing knowledge, skills, ethics and values because they are not trained to do so. We don’t do “freedom” in Nursing. That term is alien to us. Anyone who wishes to be a nurse should go to a nursing school that is accredited by the Nursing and Midwifery council of the country, or better still go to any University offerring Nursing as a course and accredited by the University Commision of that country. Any other route is mere waste of time, money and effort.

Don’t be deceived, it is not everybody you see in the usual white nurses uniform or scrub that is a nurse. And that is why you must always ask, “Are you a registered nurse?”, and watch out for the reaction and response. Don’t be afraid to ask. It is your right. Some came in through the window; they do not have what it takes to enter through the door. They are thieves. Their mission is to STEAL, KILL AND DESTROY. Our dear country is still suffering from the havocs these folks have wrecked and still wrecking through their ignorance.

But is it fair to heap the whole blame on them? What about their trainers? I dare to say those who train them are like them. They (their trainers) are in a dire need of slaves who will run errands for them, wash their cloths, fetch water and carry out other hospital and domestic works. They could even shout on them and slap them when they misbehave. And after an agreed number of years, they gather family and friends together celebrating MEDIOCRITY disguised as “freedom”. They have even stepped up now; it is has been rebranded as “graduation”.

There is hardly any private hospital you go in this country that these QUACKS are not found. The hospital owners are their automatic employer. They also go from house to house, doing private practice. Quacks are toxic to the society, so they are not wanted. Some quacks have made several attempts to sneak into government hospitals but were detected and ejected. Some sneaked in successfully but the periodic verification of results exposed them.

Hospital owners, in a bid to minimize cost, employ these QUACKS and pay them peanuts and eventually turn them to their slaves, running all kinds of errands. This is the perspective of a nurse by an average nigerian. What a wrong misrepresentation! So what you watch in nollywood is a reflection of the ignorance of a large percentage of the populace. It is a big shame on a country like ours.

Please, if you have friends and families who are already into quackery or who planning to plung into it, discourage them from doing so because it is a disservice to humanity. They administer drugs without sound knowledge of pharmacology. They dress wounds without any knowledge of aseptic techniques. Their first line of management has always been copious and liberal intravenous fluid administration irrespective of the disease condition. We have lost counts of the number of lives their actions and inactions have claimed. Parents, stop sponsoring your children to kill. Stop supporting them to cut short precious lives. Encourage them to go to school to receive proper training so that they can be productive, serve humanity and save lives. By so doing, your own lives too will be secured. You never can tell if you will end up in their hands when in serious danger. You reap what you sow.

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COMPASSION FATIGUE (Part 1)

We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our clients. We experience their fears. We dream their dreams. Eventually, we lose a certain spark of optimism, humor and hope. We tire. We aren’t sick, but we aren’t ourselves.”
– C. Figley, 1995

There are usually two sides to the nurse-client relationship: it can be very satisfying/fulfiling and at the same time, extremely distressful. The fulfilment one gets when a patient who used to be deeply unconscious, gradually regains consciousness; the joy of seeing our patients smile following a significant improvement in health status; the inner tranquility of giving one’s best to patients after each shift; the privilege to help patients go through devastating experience and come out strong: these and many others culminate into satisfaction, which is key to the well being of the nurse. It boosts self esteem, rejuvenates energy reserves and encourages better performance. Other factors that bring satisfaction include: a healthy and friendly work environment, good and fair supervision, good leadership, professional competence, regular promotion at work, adequate staffing and availability of equipment and work tools.

However, being constantly exposed to several traumatizing events in the course of caring for the patient can cause a distressing emotional response by the nurse. This results from her empathy (compassion), thereby sharing/bearing patient’s suffering and feeling their feelings. This weighs her down and drains her energy reserves, thus lacking the capacity to care and show compassion. The cumulative effect of these events results in compassion fatigue (CF). It is also referred to as secondary traumatic stress(STS) because it results from the patient’s distress (primary stress). It is also called, “the cost of caring”.

Considering the strategic roles nurses play in patient care, the intimacy, the trust, the good rapport established with the client and the empathy; our emotions get so involved that we begin to feel their pains and bear their hurts and sufferings, though subtly. The nurse working in the emergency unit gets exposed to a lot of traumatizing and life threatening events. The palliative nurse who gives end-of-life care to her patients cannot help but sympathize with these dying patients. The nurse who takes the delivery of a still birth is touched deeply and tries to give comfort to the parents even though she is also in need of help. The shock of suddenly losing a patient and the pain of breaking the news to the relatives of the client. These experiences have the capacity to cause a shift in the world view of the nurse. This concept is termed “vicarious traumatization”.

.….to be continued.

Ogunlabi David (RN).

LOADING DOSE ALONE IS NOT ENOUGH.

Training and development, though often used together, are not the same. Training is short term, development is long term. Training is the foundation, development is building on the foundation that was laid. Training is time bound, development is for a lifetime. Training is usually aimed at a group, development is about an individual (it is personal).

We get trained in our nursing schools and universities to become certified as PROFESSIONAL NURSES. This training impacts us with the basic and fundamental knowledge and skills, which equips us for service. We can liken training to the loading dose of a medication; and development will be the maintenance dose. Truth is, what keeps us potent, sharp, competent, proficient and vibrant in nursing practice is not just what we are trained to do, but much more, what enhances them. So development is an enhancer, a sharpner, a fan (fanning our skills to flame).

Our motive for studying and reading very hard in school must be checked. Examination has been identified as the key reason why students read. Take away examination factor, a lot of students will naturally loose interest for books. This is posing a threat to the glorious emergence of nurses and nursing. The minds of our nursing students have been conditioned to read just to pass examination. Alas, when such students later become nursing staff, they lack the drive for self-development. Ideally, as one climbs up the rungs of professional ladder, one’s level of knowledge ought to increase proportionately. But reverse seem to be the case as you hear older nurses asking the younger ones to remind them of the current trend of practice, claiming they left school a long time ago (a sign that the axe is blunt). This fits perfectly into the frame of training void of development.

The older and more experienced nurses should be looked up to by the younger ones for knowledge, insights and clarifications. This will remain a mirage if we do not deliberately and proactively embrace DEVELOPMENT in our career. Development should be a part of the routine activities and responsibilty of the employer. But it is unfortunate that many health facilities rarely have a structure that motivates knowledge-seeking behaviours of its employees. Nurses are therefore encouraged to take the initiative by doing the needful: organize teachings, attend seminars and workshops (of course, not without a cost), conduct research, take advantage of every opportunity to learn new things. Clinical handover and ward rounds are good period to impact knowledge and learn new things.

Take some time off work to advance in your career development. Career progression can be very fulfiling and it boosts self esteem. A lot of nurses are bitter for this same reason, so be wise. After your Masters degree, please go for your phD. Keep moving, don’t be discouraged. Take courses from other fields that are related to nursing. Don’t be too rigid. Take courses on management and leadership, research, psychology, to mention a few. Mandatory courses should be attended with a good and ready heart.

Remember, the loading dose alone isn’t enough to get rid of micro-organisms, you need the maintenance dose also.

#davidthenurse

LOADING DOSE ALONE IS NOT ENOUGH.

Training and development, though often used together, are not the same. Training is short term, development is long term. Training is the foundation, development is building on the foundation that was laid. Training is time bound, development is for a lifetime. Training is usually aimed at a group, development is about an individual (it is personal).

We get trained in our nursing schools and universities to become certified as PROFESSIONAL NURSES. This training impacts us with the basic and fundamental knowledge and skills, which equips us for service. We can liken training to the loading dose of a medication; and development will be the maintenance dose. Truth is, what keeps us potent, sharp, competent, proficient and vibrant in nursing practice is not just what we are trained to do, but much more, what enhances them. So development is an enhancer, a sharpner, a fan (fanning our skills to flame).

Our motive for studying and reading very hard in school must be checked. Examination has been identified as the key reason why students read. Take away examination factor, a lot of students will naturally loose interest for books. This is posing a threat to the glorious emergence of nurses and nursing. The minds of our nursing students have been conditioned to read just to pass examination. Alas, when such students later become nursing staff, they lack the drive for self-development. Ideally, as one climbs up the rungs of professional ladder, one’s level of knowledge ought to increase proportionately. But reverse seem to be the case as you hear older nurses asking the younger ones to remind them of the current trend of practice, claiming they left school a long time ago (a sign that the axe is blunt). This fits perfectly into the frame of training void of development.

The older and more experienced nurses should be looked up to by the younger ones for knowledge, insights and clarifications. This will remain a mirage if we do not deliberately and proactively embrace DEVELOPMENT in our career. Development should be a part of the routine activities and responsibilty of the employer. But it is unfortunate that many health facilities rarely have a structure that motivates knowledge-seeking behaviours of its employees. Nurses are therefore encouraged to take the initiative by doing the needful: organize teachings, attend seminars and workshops (of course, not without a cost), conduct research, take advantage of every opportunity to learn new things. Clinical handover and ward rounds are good period to impact knowledge and learn new things.

Take some time off work to advance in your career development. Career progression can be very fulfiling and it boosts self esteem. A lot of nurses are bitter for this same reason, so be wise. After your Masters degree, please go for your phD. Keep moving, don’t be discouraged. Take courses from other fields that are related to nursing. Don’t be too rigid. Take courses on management and leadership, research, psychology, to mention a few. Mandatory courses should be attended with a good and ready heart.

Remember, the loading dose alone isn’t enough to get rid of micro-organisms, you need the maintenance dose also.

#davidthenurse

SODIUM BICARBONATE AND ARTIFICIAL AIRWAYS.

imagesq=tbnANd9GcT9UmpzRvYwbcFW3d0qK92mkqSM0IseLXYwj_9GyKTTQu8ZWuB5VQ.jpg Instilling small and diluted sodium bicarbonate into artificial airways (ETT or tracheotomy) has been said to be an outdated practice. Some research findings revealed that it predisposes patients to ventilator acquired pneumonia (VAP). Therefore, some settings no longer use it while some others find it useful, as it helps to loosen thick and stubborn secretions in the artificial airway, with good patient outcome.

However, let’s look into the scientific rationale behind the use and effectiveness of sodium bicarbonate in decreasing the viscosity of mucus.

One of the causes of thick secretions is dehydration. It can also be as a result of increased ionic calcium in the mucus. Calcium ions help to condense, package and cross-link mucus granules into goblet cells.
Bicarbonate is a chelating agent that helps to chelate calcium thus reducing the calcium in the secretion. This causes the thick secretions to become loosened, uncondensed and less viscous. Also, the chelated calcium is replaced by extracellular sodium ions which further loosens the secretion and makes it swell and watery (due to its affinity for water).

The above mechanism is such an interesting one to know. Isn’t it?

I am not making any attempt to answer the question that was raised in the beginning of this write up. I just want to ignite some passion for further study in you. Come up with your own conclusion through diligent research on this subject matter. Be scientific. Be knowledgeable. Be a good and effective nurse.

Thank you.

Feel free to share your view on this matter.

 

 

GUTHRIE TEST

imagesq=tbnANd9GcRtBe8be13f9CuwKHugNltMCuAMymVN5gauhSLGVJ2VU-Sc9dISegGUTHRIE TEST.
Guthrie test (also known as heel prick test) is a test that helps in early detection of phenylketonuria (PKU) in neonates. It was first discovered by Dr. Robert Guthrie, a microbiologist and a physician. It is called heel prick test because blood samples for the test are usually taken from the heels of the newborn.

Phenylketonuria (PKU) is rare genetic disorder and an inborn error of metabolism of the amino acid – phenylalanine. This is as a result of deficiency of phenylalanine hydroxylase (enzyme that metabolizes the amino acid, phenylalanine), thereby leading to an increase/rise in the level of phenylalanine in the blood. The high concentration of phenylalanine in the blood can cause mental disability, brain damage or seizures at early age of the neonate or later in life. Hence, early detection of this condition is very important as it gives a better prognosis.

Phenylalanine occurs naturally in many protein-rich foods, such as milk, eggs and meat. Phenylalanine also is sold as a dietary supplement. The artificial sweetener, aspartame, which is added to many medications, diet foods and diet sodas, contains phenylalanine. Such foods and medications containing phenylalanine must be severely restricted or avoided in PKU patients.

NOTE: Guthrie test is usually done within few days (5-8 days) of neonatal life. It’s a routine test for all neonates before leaving the hospital.

 

TRIPHASIC RESPONSE FOLLOWING PITUITARY SURGERY

imagesq=tbnANd9GcRynMnYg2dc7MNI9fCSvt37d1J1x9zFC5hUfWsk8wPxBYkE5vD-uA.jpgVasopressin (also known as anti diuretic hormone, ADH) is synthesized in the supraoptic and paraventricular nuclei of the hypothalamus, and often released into the posterior pituitary gland or neurohypophysis through the vasopressin-releasing neurons.
A TRIPHASIC response usually follows pituitary surgeries; they are:

PHASE ONE: CENTRAL DIABETES INSIPIDUS/HYPERNATREMIA.
There’s decreased release of vasopressin following pituitary surgery due to trauma or ischemia/shock of the vasopressin-releasing neurons in the hypothalamus. This results in the passage of large amount of diluted urine (polyuria) and increased thirst (polydypsia). In response to the polyuria in this phase, extracellular sodium level rises (a condition known as HYPERNATREMIA) in a bid to compensate for the water loss.

NURSING INTERVENTIONS:
Monitor urinary output every hour.
Ensure strict intake and output monitoring.
Measure urine specific gravity.
Give fluid replacement with 5% dextrose water (free water).
Administer IV Desmopressin (DDAVP).

PHASE TWO: OLIGURIA/HYPONATREMIA
In this phase, there’s leakage of vasopressin from the posterior pituitary gland, leading to the excessive release of pre-synthetic vasopressin – a condition known as syndrome of inappropriate anti diuretic hormone (SIADH). This condition potentiates fluid retention; which is further complicated by the interventions given in phase one. Hyponatremia is the expected response to fluid retention. Therefore, urinary output is reduced and patient becomes oliguria.

PHASE THREE: CHRONIC DIABETES INSIPIDIS/HYPERNATREMIA.
Individuals may or may not enter this phase. It takes the death of 80-90% of vasopressin-releasing neurons to develop a chronic diabetes insipidus. The normal, uncomplicated pituitary surgery should resolve in phase two.

DDAVP means 1-Desamino 8-D Arginine Vasopressin.