ARISE Nursing in focus
Endometriosis: An Unrecognized Disorder Among Women
By: Rhea B. Uy, Emergency Department
While Endometriosis is a potentially fatal disorder affecting millions of women around the world, it receives limited attention and small funding for research into its cause and possible preventive management.
Some women feel shy to talk about the pain that they experience during their period. Factors like culture, race, religion, upbringing or simply their individual personality affect their perception about menstruation.
Endometriosis Awareness Week, which will be held between March 3 and 9, 2017, aims to promote a greater understanding about this hidden and often unrecognized condition as a true, incapacitating and disabling disorder. It will highlight the effect of living with endometriosis. Through this program, it will provide an opportunity to those suffering from endometriosis to play an active role in making a difference, thus creating a better awareness among those in the medical profession, educational sectors, employers, government officials as well as the society in general.
Endometriosis should not be left unrecognized. As part of the health care sector, we nurses can empower women and teenagers to talk about their period and break the taboo. Encourage them and make them realize that it is OK to talk and consult to reduce the delay in diagnosing the disease and be able to help themselves.
IMPORTANT FACTS ABOUT ENDOMETRIOSIS
Endometriosis is a condition that occurs when a tissue, similar with the lining of the womb (uterus), grows in other areas of the body, mainly in the abdominal cavity. The tissue is associated to the hormonal cycle of a woman. However, unlike menstruation, this tissue remains within the body and bleeds forming scar tissue, lesion and blood-filled cysts.
SYMPTOMS OF ENDOMETRIOSIS
Pain and infertility are the primary symptoms of endometriosis. It occurs about 75% among women with pelvic pain and occurs as many as 40% among women with infertility problems.
Other common symptoms include:
- Painful menstrual cramp which worsens over time.
- Pain during or after intercourse
- Lower abdominal pain
- Heavy bleeding during menstruation
- Painful urination and bowel movements during menstrual periods
- Bleeding or spotting in between periods
- Fatigue and
- Suppressed immune system
Pain related to endometriosis can be debilitating that it can interfere with one’s daily activities. Understanding this condition is vital in conducting further researches because it could lead to a more effective treatment for this certain type of pain.
TREATMENT OF ENDOMETRIOSIS
Treatment for endometriosis is determined on a case to case basis. Currently, there is no exact cure for this condition; rather it is more focused on dealing with the symptoms of pain and infertility. Several factors are considered to determine the best possible care for endometriosis, which includes age, severity of the disease and its symptoms and the decision of bearing a child.
However, not all treatment will work well for all women. Three general categories for the treatment of endometriosis include pain medications, hormone therapy and surgical treatment.
Nonsteroidal anti-inflammatory drugs, (NSAIDS), and opioids, a stronger painkiller that interacts directly with the nervous system, are the most common types of pain relievers.
Hormone therapy that is used to treat endometriosis-associated pain comes in the form of a pill, a shot or injection, or a nasal spray.
For severe cases of endometriosis, health care providers recommend surgical treatment, although it is a short-term pain relief option. A detailed discussion should be given to a woman about all available options as some procedures are irreversible which can affect their fertility.
Nurses play an important role in health promotion through infertility prevention and disease management by providing support and health education to the patients with endometriosis. Nurses must update their knowledge regarding the signs and symptoms of the disease so they can assist in timely diagnosis, offer appropriate referral and facilitate quality of care and effectively manage treatments to reduce pain, improve quality of life, and prevent further progression of the disease.
By: Silvia Samuel - Staff Nurse OPD
It’s a good opportunity to increase awareness about one of the most common and preventable heart disease. So, let’s have an idea about Coronary Heart Disease. Here we go..
Coronary heart disease (CHD) is a condition in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle. When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.
According to WHO (World Health Organization) and the CDC (Centers Disease Control and Prevention), heart disease is the leading cause of death in the United Kingdom, United States of America, Canada and Australia. The number of USA adults diagnosed with heart disease stands at 26.6 million (11.3% of adult population). 23.5% of all deaths in the USA today are caused by heart disease.
So what are the risk factors?
Most common subjective symptoms are chest pain radiating to arm, jaw, and back, feeling pressured pain at mid chest, nausea, vomiting, dizziness, palpitation, dyspnea, and excessive sweating. Although these are the most common symptoms but still some patients remains asymptomatic.
Management of CHD depends upon the severity of the disease condition. Below is the management according to severity of condition:
- Mild CHD - usually the patient is advised for life style modification along with medication such as anti-platelets, antihypertensive, and statins.
- Moderate CHD - Invasive procedure like CAG (Coronary angiography or angiogram) or PTCA (Percutaneous transluminal coronary angioplasty), along with life style modification and medications.
- Severe CHD - Patients with severe blocks advised for CABG (Coronary artery bypass grafting).
Prevention of Coronary Heart Disease
There are several ways to reduce the risk of coronary artery disease, such as…
- Eating Healthy and Balance Diet – Usually low fat and high fiber diet is recommended which includes fresh vegetables and fruits. Try to minimize the amount of salt, sugar, and saturated food items like cheese, hard creams, butter, sausage, and meat. Small frequent meal is always recommended.
- Regular Exercise and Maintaining Ideal Weight – Combining a healthy diet with regular exercise will keep you in ideal weight. Regular exercise like walking, jogging or even dancing will keep your heart to work harder, thus keeping you healthy.
- Smoking Cessation and Reduce Alcohol Intake - Smoking is one among the major risk factor for CHD. So, as a nurse you can counsel your patients regarding the ill effects of smoking and excessive alcohol intake.
- Regular Check-Up – Regular monitoring of Blood pressure, Blood sugar, and cholesterol level is highly recommended. Therefore any variance in these parameters will help in early detection and treatment as well.
- Regular Medication Intake – For patients known to have Diabetes, High Blood Pressure or Elevated cholesterol levels – Emphasizing the importance of medication compliance is very important to ensure that the patient is getting maximum health benefit.
Nurses Roles and Responsibilities
Patient with this condition, nurse has to be the following:
- Decision Maker - To use critical thinking in decision making, set goals, and promote outcomes for patient. Nurse has to assess the patient to identify the problem; therefore she can set an appropriate intervention and evaluate the outcomes.
- Educator - Nurse has to educate the patients regarding the importance of healthy lifestyle practices, balance diet, ill effects of smoking, medication regimen, avoid obesity, regular health checkup, and also to teach them regarding the early signs of the disease and its prevention.
- Counselor - To train and advise the patient regarding lifestyle modification as well as stress management.
- Motivator – To enhance the importance of daily physical activities and regular health checkup.
Heart disease can often be prevented when people make healthy choices and manage their health conditions. Health professionals and patients can work as a team to fight against preventable diseases.
Nurses to Walk the Talk on National Influenza Vaccination during the winter season
By: Rhea Uy, Emergency Department
As UAE starts to feel the cold breeze of the winter air, a high incidence of Influenza has been reported in the country during this change of season. Emiratis and expats, adult and children alike catch this dreaded disease with no escape.
The public are encouraged to receive their flu shots. This winter season is intended for all susceptible population especially the healthcare workers. Nurses, being the frontline of health care, are the most vulnerable in getting this contagious disease. To be able to lead by example is to walk the talk. Nurses can only expect their patients to follow their medical advices when they themselves implement it.
The role of the nurses is not only to administer the vaccinations; they too need to get vaccinated. These vaccinations which are approved by the Centre for Disease Control (CDC) can be availed at all hospitals, private clinics and government Primary Health Centers.
Aside from getting vaccinated, there are a number of ways on how to keep Influenza away:
- Observe proper hand hygiene; Use your PPE’s (Personal Protective Equipment) when handling patients; observe the five moments of hand washing.
- Eat food rich in Vitamin C or take Vitamin C supplement to keep ones immune system strong
- Keep oneself warm and take steam inhalation
- Practice the cough technique; cover the mouth when coughing or sneezing as droplet infection can travel from six feet across.
- Avoid crowded places
- Refrain from smoking
- Visit your GP for a preventive check if you are suffering from any respiratory disease.
According to the American Public Health Association, "Influenza vaccination of health care workers is the single most important measure for preventing occupation-acquired and nosocomial influenza from both known and unexpected sources. Other measures, such as hand hygiene and barrier precautions, are additional protective steps, not alternatives. Masks or respirators, whether worn by people with influenza-like illness (ILI) symptoms or those who are in proximity to them, are not as protective as preexposure immunization, especially given the high proportion of asymptomatic infectious people."
Nurses who receive their flu shots or get vaccinated are those nurses and health care workers who care about themselves, their patients and the community.
Back to the Bedside Nursing Campaign
Due to time constraints and changes within the healthcare industry and nursing education, nursing departments have reported a gradual decline of bedside nursing activities, with nurses spending more time away from the patients, with increased time spent on non-nursing activities (Lippincott 2015).
This change has brought about a large amount of research into the effects that this has had upon delivery of patient care, with no great revelations in the findings – increase in patient complaints, increase in incidents related to safety and lack of team work and support. One particular study aimed to look at how nurses distribute their time, focusing on patient care time, MDT time and individual task time. This study was conducted over a two year period in order for the breadth of the study to include if there had been any changes with work patterns over this time (Westbrook et al, 2011). Westbrook et al, (2011) concluded that over two years nurses spent only 37% of their time with the patient, this combined with an average of two interruptions every hour (with 27% of those interruptions occurring during medication rounds) the chance for error is relatively high.
Healthcare facilities across the globe are now recognizing the importance of focusing the nurse back to the bedside. Facilities are introducing new systems to enable less disruptions and non-nursing related tasks. Subsequent research has been undertaken on the return to the patient bedside demonstrating dramatic results.
The results from this subsequent research highlight a reduction in infection rates, reduction in falls, and reduction in medication errors, with an increase in patient satisfaction feedback.
The concept of being back at the bedside is not new, it is a concept that originated from the very basics of nursing care and its roots can be found in the ethos of Patient Centered Care. However it has become a concept that has been over looked as other demands and advances take centre stage.
The nursing department of UHS advocates patient centered care, it is this belief in patient centered care that motivates the nursing department to launch the “Back to the bedside” campaign. This campaign aims to provide a unified approach to nursing care within UHS, ensuring all patients receive the highest standard of care possible.
This campaign aims to achieve the following:
- Enhanced communication (nurses to patients, families and the MDT)
- Improved teamwork
- Increase in patient satisfaction feedback, decrease in patient complaints
- Improved safety (IPSG)
- Compliance with JCIA standards
- Improved working routines for nursing teams across the department
- An increased sense of pride and ownership of the nursing department
UHS Nursing department originally launched this initiative back in 2015, with significant changes already realized and improvements to patient care noted. These changes have included (but not limited to) introduction of Ward Clerks in the busy patient care areas (reallocation of some non-nursing related duties), re-design of patient flow, ward layout and nurses routines including bedside handover, increased numbers of COWs (Computers on Wheels), installation of white boards in all patient rooms (for the nurse assigned to the patient to write their name and the physician name on the board for the patient and family) and revision of the nursing team, with designated Team Leaders in majority of all inpatient care areas and the ER, as well as an increased number of HCAs (Health Care Assistants) allowing the RN (Registered Nurse) to focus more on patient care delivery as well as creating a more team nursing approach to the patient care.
It has been decided that after a busy year in nursing (2016) with increased patient volumes and large scale recruitment, to re-launch the campaign at the beginning of 2017, fitting with the strategic vision of the nursing department in lifting the standards and ensuring consistency in standards across the department.
The senior nursing team will commence thorough training for all nurses on the principles of the campaign, daily changes to routine, expectations etc…
Specific Team Leader training will be provided where required.
There will be continuous monitoring of the campaign to ensure standards are being maintained.
The senior nursing team will be responsible for reviewing all action plans and suggestions for improvements with recommendations made to the Front Committee as required.
The senior nursing team recognizes this campaign is a combined team effort, with continuation of the reward programme for those nurses who excel with the principles. This reward programme is to acknowledge the efforts of our nursing staff, recognizing their commitment to the patients, and UHS.
The nursing department believes this campaign combined with ongoing nursing quality initiatives will ensure the nursing department maintains acceptable and agreed levels of patient care and interaction.
The nursing department looks forward to sharing their findings and results with all of UHS once the campaign is up and running.
Lippincott Solutions (2015) Four Strategies to get Nurses Back to the Bedside. Lippincott Solutions. Available from:
Westbrook, J. Duffield, C. and Creswick, N. (2011). How much time do nurses have for patients? a longitudinal study quantifying hospital nurses’ patterns of task time distribution and interactions with health professionals. BMC Health Services Research, 11, 319.
Radiology Nurses: Who We Are and What We Do
By: Ellaine Bajet
In celebration of the International Day of Radiology on November 8, 2016, the University Hospital Sharjah highlighted the role of medical diagnostic imaging in breast cancer awareness—one of the many breakthroughs of medical technology that encourages early illness detection and reduces the percentage of mortality. While it is very evident that technological advancements in radiology are overwhelming, what most of us don’t realize are healthcare practice progresses, too, specifically the introduction of the relatively new term “radiology nursing.”
Gone are the days when nurses are only perceived as those who take care of the sick. Likewise, patient care is depicted by the close relations between patient and a nurse. Nowadays, especially in the diagnostic imaging field, radiology nurses are also required to have an advanced knowledge of different imaging techniques. We do not simply look after the patient as he or she goes through the procedure, but most importantly, and undeniably useful to patients, we talk to them all throughout the process to keep them informed and calm.
A woman patient in her late 30s, who was lying on a gurney, was endorsed to me as soon as I started my shift. Inpatient nurse introduced me to her as we led her to the MRI room, but she did not utter a word. Instead, she showed her faint smile, which could tell a mixed of emotions and a plethora of worries about what was going to happen in the next few minutes in that cold bright room. She did not have to say she was nervous, I already knew. I held her hand comfortingly while I asked how she was feeling and what her fears were. My objective was to engage her in a small talk to distract her from anxiety and gain her trust, and this technique actually worked. It does all the time.
You see, these state-of-the-art imaging machines can get very intimidating. Our patients simply need reassurance that they are being taken care of and that everything will be alright. We are our patients’ security blanket. What we do for our patient is not limited to patient care but is more of a compassionate care because we treat him or her with dignity and respect, like someone who is dear to us with life history and medical needs. We have the duty to provide full emotional and physical support to our patients and ensure that they cooperate in the examination instructions so that the radiology technicians can acquire accurate and functional images.
Aside from performing general nursing duties, we also administer medications or assisting intravenous sedation or contrast and we assess infusaports and suctions, etc. Consequently, what differentiates us from the general nurses is our specialized additional knowledge about radiation safety, infection control, and occupational health and safety because we are more exposed to radiation risks and we safeguard our patients from being exposed to more radiation than necessary. We are also well-experienced in identifying the precise positioning or postoperative mobility of the patient’s body for examination based on their medical history, such as if one has a chronic obstructive pulmonary disease or one is newly operated.
As the medical world continues to evolve, with the emergence of innovative imaging techniques and equipment and healthcare practices, we desire not to limit these far-reaching developments within medical communities but rather advocate and educate the public, starting from the patients to their families and friends, and significantly, we, as radiology nurses, aspire to be well-recognized as an essential part of this inclusive progress.
"Think Pink": A Breast Cancer Awareness Month
October is Breast Cancer Awareness Month, an annual campaign that not only increases awareness of breast cancer but also highlights its importance, education and research.
While most people are aware of breast cancer, many forget to take steps to have a plan to detect the disease in its early stages and encourage others to do the same. Breast Awareness and screening can help increase survival rate.
Let’s Talk about Breast Cancer
1 in 8 women will be diagnosed with breast cancer in their lifetime. Breast cancer is the most commonly diagnosed cancer in women. Breast cancer is the second leading cause of death among women. Although breast cancer in men is rare, an estimated 2,150 men will be diagnosed with breast cancer and approximately 410 will die each year. Breast cancer is not contagious and you can't contract cancer from a person who has the disease.
Breast cancer is the most common cancer that women may face in their lifetime (except for skin cancer). It is the second leading cause of cancer death in women. Breast Cancer can occur at any age, but the risk goes up as you get older. Because of certain factors, some women may have a greater chance of having breast cancer than others. But every woman should know about breast cancer and what can be done about it.
What is Breast Cancer?
Breast cancer starts when cells in the breast begin to grow out of control. Breast cancer is a malignant tumor that starts from cells of the breast. A malignant tumor is a group of cancer cells that may grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. Breast cancer occurs mainly in women, but men can get it, too. Many people do not realize that men have breast tissue and that they can develop breast cancer.
Know the symptoms of breast cancer
Early breast cancer usually doesn’t cause symptoms. But as the tumor grows, it can change how the breast looks or feels.
- A lump or thickening in or near the breast or in the underarm area
- A change in the size or shape of the breast
- Dimpling or puckering in the skin of the breast
- A nipple turned inward into the breast
- Discharge (fluid) from the nipple, especially if it’s bloody
- Scaly, red, or swollen skin on the breast or nipple
- The skin may have pitting so that it looks like an orange
These symptoms do not automatically indicate breast cancer. But, if you have any of these conditions, you should tell your health care provider so that the problems can be diagnosed and treated.
Early Detection and Breast Screening:
Screening refers to tests and exams used to find a disease in people who don’t have any symptoms. Early detection means finding and diagnosing a disease earlier than might have happened if you’d waited for symptoms to start.
Breast cancers found during screening exams are more likely to be smaller and still confined to the breast. The size of a breast cancer and how far it has spread are some of the most important factors in predicting the prognosis (outlook) of a woman with this disease.
Most doctors feel that early detection tests for breast cancer help save thousands of lives each year, and that many more lives could be saved if even more women and their health care providers took advantage of these tests.
What you can do?
The best defense is to find breast cancer early – when it's small, has not spread, and is easier to treat. Finding breast cancer early is called "early detection." The American Cancer Society recommends the following for breast cancer early detection:
Women ages 40 to 50 should get mammograms every 1-2 years and should check with their health care provider.
Women 50 and older should get mammograms every year, and can continue yearly screening.
All women should be familiar with the known benefits, limitations, and potential harms linked to breast cancer screening. They should also be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.
Some women at high risk for breast cancer – because of their family history, a genetic tendency, or certain other factors – should be screened with MRIs along with mammograms. (The number of women who fall into this category is very small.) Talk with a health care provider about your risk for breast cancer and the best screening plan for you.
The Pillars of Breast Cancer Screening
- Regular Breast Self Examination (BSE).
- Regular Clinical Breast Examination (CBE) by physician.
- Regular Mammogram After the age of 40.
- Reduce your risk of developing Breast Cancer by keeping a healthy weight, eating healthily, stop smoking and exercise.
Regular Breast Self Examination(BSE):
The importance of Breast Self Examination is it enables women to detect any changes or lumps that might occur. For pre menopausal women you have to choose a day between the 6th-10th day after the start of your monthly period and for post menopausal women you have to choose any day of the month to perform the Breast Self Examination.
Even though, Research does not show a clear benefit of physical breast exams done by either a health professional or by you for breast cancer screening, still, all women should be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.
Before you get started, pick one motion you will use every time you perform your monthly breast self-examination. This makes it easier for you to detect any changes in your breast.
Place a pillow under your right shoulder. Place your right hand behind your head. Use the inner pads of the three middle fingers of your left hand (see red circle in the diagram). Feel for any changes in your breast, above and below your collarbone and your armpit area (like a lump or a hard node or skin thinking). Now repeat the same procedure for the left breast.
Place your right hand behind your head. Use the three middle fingers of your left hand while feeling your right breast. Inspect all the areas of your breast, chest and collarbone just like you did when lying down (see the red outlined box). Repeat the same procedure for the left breast using your right hand.
Arms held over your head. Check your breast for any change in size, shape and color.
Arms pressed against the hips and bending forward check your breasts for puckering, dimpling, rash, nipple discharge or retraction or any other change that does not look and feel normal.
Breast Self-Examination for men is easy and simple. Although Breast Cancer in men is rare, it is advisable to perform breast self-examination regularly. Pick one motion to use every time you conduct your BSE, it makes it easier for you to detect any changes in your breast.
Stand in front of the mirror and look at the skin for any changes including lump, swelling, dimpling or puckering. Look straight ahead; move to the right and to the left and back to the center.
Slowly raise your arms above your head, again looking for skin changes dimpling or puckering. Move to the right and to the left. Bring your hands on your hips. Flex your pectoral muscle again looking for dimpling or puckering or skin changes. Move to right and to the left.
Lie on your back (or stand still). Use your right hand to examine your left breast and vice versa. Place your left hand under your head and bring your right hand to the armpit area to examine your left breast.
Use three pressures: light, medium and deep dime sized circles. Continue to move down the chest in light, medium and deep circular moves. Repeat the moves till you cover the whole breast. Squeeze the nipple to observe the discharge of any fluid.
Regular Clinical Breast Examination (CBE)
It is done as part of the annual health check up or when you feel something wrong. It should be done every 3 years starting from the age of 20 and it should be done every year after the age of 40.
Regular Mammogram After the age of 40
A Mammogram can detect the smallest abnormalities and changes in the breast even before being detectable by the women herself or by the doctor. A mammogram is performed at the age of 40 years and older and repeated every 1-2 years. Earlier screening is advisable if a strong family history of breast or ovarian cancer is present.
Treatments: There are several ways to treat breast cancer, depending on its type and stage.
Local treatments: Some treatments are called local therapies, meaning they treat the tumor without affecting the rest of the body. Types of local therapy used for breast cancer include:
The first step and most common form of treatment for breast cancer is surgery. Surgery involves removing the tumor and nearby safe margins. The margin is the surrounding tissue that might be cancerous. The goal of surgery is to remove not only the tumor, but also enough of the margin to be able to test for the spread of the cancer. Once the removed tissue is checked, your post-operative report should tell you if you had "clear margins," (meaning the tissue farthest away from the breast was free of any cancer cells.)
Some people with Stage 2 or Stage 3 cancer may receive chemotherapy first, which is known as "pre-operative “or "neo-adjuvant*" chemotherapy. The goal is to shrink the tumor. By making it smaller first, you may have the option of a breast-conserving surgery or lumpectomy instead of a mastectomy.
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated with the radiation. Breast cancer radiation therapy may be used to destroy any remaining mutated cells that remain in the breast or armpit area after surgery.
These treatments are more likely to be useful for earlier stage (less advanced) cancers, although they might also be used in some other situations.
Systemic treatments: Breast cancer can also be treated using drugs, which can be given by mouth or directly into the bloodstream. These are called systemic therapies because they can reach cancer cells anywhere in the body. Depending on the type of breast cancer, several different types of drugs might be used, including Hormone therapy, Targeted therapy and Chemotherapy.
Chemotherapy is a treatment method that uses a combination of drugs to either destroy cancer cells or slow down the growth of cancer cells.
Cytotoxic drugs (meaning "toxic to cells") are usually given orally or through a vein (intravenously or "through the bloodstream"). Chemotherapy is a systemic therapy, meaning that the drugs travel in the bloodstream throughout the entire body.
American Cancer Society. Detailed Guide: Breast Cancer. 2014. Accessed at www.cancer.org/Cancer/BreastCancer/DetailedGuide/index on September 3, 2015.
Centers for Disease Control and Prevention. National Breast and Cervical Cancer Early Detection Program. Accessed at www.cdc.gov/cancer/nbccedp/about.htm on September 3, 2015.
By: Mary Grace M. Jimenez
Breast Care Centre - Nurse
By: Rhea Uy;
At some point in our lives, we experience pain in one form or another. Pain is an unpleasant sensation with physical, emotional and cognitive components. It can range from mild to severe pain that it interferes with our ability to function at our optimal level.
As pain is considered a universal element of human experience, its management becomes an integral part of nursing. The adoption of Pain as the "fifth vital sign," made it not just a symptom but a serious detriment to quality of life that requires appropriate medical attention. Effective management of our patient’s pain does not end on administering analgesia alone, hence, we need to fully understand and take a holistic approach in dealing with their condition.
This September, we too can help raise awareness by getting involved. This month is dedicated in undertaking various activities and initiatives to achieve the goal of promoting education, advocacy and awareness about chronic pain and eventually remove the barriers to effective pain management.
Help promote The Pain Awareness Month and let’s CONQUER PAIN TOGETHER.
The Pain Awareness Month serves not merely for clinicians to develop their pain management skills but a powerful approach to convey the message that a number of people continue to suffer from chronic pain, which deserves proper management. It is actually an opportunity for those who suffer from pain to finally have their voices be heard and stimulate a much- needed change.
Patients should not go through depression and frustration, feel anxious, and fear for their condition. As nurses, we can educate our patients on several coping strategies to divert and alleviate their pain.
Specific imagery and chronic pain control techniques that are effective for pain control include:
- Altered focus
This is a favorite technique for demonstrating how powerfully the mind can alter sensations in the body. Ask your patient to focus their attention on any specific non-painful part of the body (hand, foot, etc.) and alter sensation in that part of the body.
As the name implies, this chronic pain technique involves mentally separating the painful body part from the rest of the body, or imagining the body and mind as separate, with the chronic pain distant from one’s mind.
- Sensory splitting
This technique involves dividing the sensation (pain, burning, pins and needles) into separate parts. For example, if the leg pain or back pain feels hot to you, focus just on the sensation of the heat and not on the hurting.
- Mental anesthesia
This involves imagining an injection of numbing anesthetic (like Novocain) into the painful area, such as imagining a numbing solution being injected into your lower back. Similarly, you may then wish to imagine a soothing and cooling ice pack being placed onto the area of pain.
- Mental analgesia
Building on the mental anesthesia concept, this technique involves imagining an injection of a strong pain killer, such as morphine, into the painful area.
- Age progression/regression
Ask your patient to use their imagination to project themselves forward or backward in time to when they are pain-free or experiencing much less pain. Then encourage them to act "as if" this image were true.
- Symbolic imagery
Let your patient envision a symbol that represents their chronic pain, such as a loud, irritating noise or a painfully bright light bulb. Gradually reduce the irritating qualities of this symbol, for example dim the light or reduce the volume of the noise, thereby reducing the pain.
- Positive imagery
this coping strategy works by focusing the attention on a pleasant place like going to the beach, mountains, etc. - where one can feel carefree, safe and relaxed.
Silent counting is a good way to deal with painful episodes. You might count breaths, count holes in an acoustic ceiling, count floor tiles, or simply conjure up mental images and count them.
August - is Children's Eye Health and Safety Month
Summer vacation is almost over. Parents and children are preparing physically and mentally for a new school year. But what about our children’s eyes? According to friends for sight, the inability to see clearly affects not only academic performance but also athletic and self-esteem. In UHS eye center, our goal is to ensure that children has the visual skills required for school and sports so that they can perform better.
We may take it for granted but majority of what we learn is through our eyes. To appreciate the beauty of this world, our eyes perform a very complex functions; it requires the cooperation of many small and complex parts. A healthy human eye can distinguish millions of different colors and one of the few organs that cannot be transplanted (Yet). Once detached, the nerve fibers that connect our eyes to our brain do not regenerate. By far, the cornea or the clear front part of the eye is the only part that can be transplanted. To emphasize the importance of having healthy eyes and to avoid eye diseases and injury, this August, we celebrate Children’s Eye Health and Safety Month.
- Lazy eye or Amblyopia - It occurs when a child sees much better in one eye than the other. Lazy eye can be a result of misaligned eyes (strabismus) where one eye may look straight ahead while the other turns in, out, up or down. If the child’s vision is significantly better or poorer than the other, the child needs to be examine in the clinic.
- Encourage the patient to verbalize feelings of anxiety, as this condition can be frustrating to your patient.
- Teach the patient how to apply eye patch, as ordered. By covering the good eye with an eye patch, the lazy eye is forced to work harder and strengthen the eye muscles.
- Help the patient and parents adjust to the use of refractive lenses, if indicated.
- Institute safety measures to prevent falls and injuries related to occlusion therapy.
- Pink eye or Conjunctivitis - Can refer to either viral, bacterial infection, or allergic reaction. The eye appears red or pink due to inflammation of the conjunctiva, the thin, filmy membrane that covers the inside of eyelids and white part of eye. Not all pink eye are infectious such as an allergic reaction, however we emphasize the importance of proper diagnosis through slit-lamp to provide appropriate treatment.
- Teach proper hand hygiene technique and instruct the patient to avoid touching the eyes.
- Sanitize all objects that are regularly touched such as door knob, phone, toys, and tables
- Teach the patient to install eye drops and ointments correctly without touching tip of container with eye or lashes.
- Instruct the patient to avoid sharing towels or hankies.
- Instruct the patient to throw away tissue after use.
- Blocked tear duct – It occurs when the eye’s drainage system for tears is obstructed, either partially or completely. As a result, tears cannot drain normally, causing a watery, irritated or infected eye. Some babies are born with a blocked tear duct, but the condition usually resolves on its own within the first year of life. If the baby’s tear duct does not unblock by itself, it may be necessary to professionally ‘pop’ the membrane. This is a small operation that requires anesthesia.
- Teach the parent how to perform deep massage of the nasolacrimal duct. To help open up the membrane covering the lower opening into the baby's nose.
- Administer eye drops or ointment to treat any bacterial infections, as ordered.
- Encourage the parent to apply hot compresses frequently.
- Refractive error - A potential cause of blurred vision. Generally, corrective lenses restore clear vision. The most common refractive errors in children are:
- Nearsightedness or Myopia - close objects look clear, but distant objects appear blurred.
- Farsightedness or Hyperopia- difficult to see or read at close distance.
- Distorted vision or Astigmatism - distorts or blurs vision for both near and far objects
- Educated the patient and parents on the importance of wearing eyeglasses. To improve vision and help the child to function better in his/her environment.
- Encourage parents to allow their child to choose whatever frame color they want.
- Recommend parents to buy eyeglasses with plastic frame.
Eye injuries – Eye damage results from accidents at home, school, or at play. To prevent injuries, children should wear protective eyewear when playing football, soccer, or any contact sports. Teach children to practice safe use of common items that can cause serious eye injury, such as paper clips, pencils, scissors, bungee cords, wire coat hangers and rubber bands.
If the child gets eye injuries, regardless of its severity, examine the eye as soon as possible. Delaying medical attention can cause the damaged areas to worsen and could result in permanent vision loss or blindness. In the eye clinic, the doctor and nurse inspect the eye for any foreign body or ulcer.Nursing Interventions:
- Instruct the patient not to touch, rub or apply pressure to the eye.
- Apply eye drops or ointment, as ordered
- Cover the affected eye with eye patch and eye shield
- In the event of chemical exposure, flush the eyes with plenty of water.
- Instruct the patient and parent the importance of attending follow-up treatment.
Nurses play an important role in promotion of healthy eyes and prevention of eye diseases and disorders. Here are some simple eye educations that you can share to your patients and to their parents as well.
- Eyes and Sunlight - Looking directly at the sun or any bright light can damage the eyes. Encourage the patient to wear sunglasses and hats on bright days for both protection and fashion.
- Eyes and Chemicals – Educate parents that all chemicals and sprays must be kept out of reach of small children.
- Eyes and Eye Glasses - Use a cleaning solution specially made to clean glasses and use a microfiber cloth to shine up those lenses. Instruct the patient to keep a protective case for their glasses in their backpack, desk, or other convenient place for use during the day.
- Eyes and Food – Instruct the patient to eat foods rich in Vitamin A. Vitamin A helps protect the surface of the eye (cornea), it is essential for good vision. Vitamin A is especially important for seeing in the dark or in poorly lit areas. Without vitamin A, we would not be able to establish a wide array of colors because it helps your eyes distinguish colors such as bright orange or dark purple. Vitamin A is typically found in colorful foods such as cantaloupe, watermelon, yellow and red peppers, carrots, spinach and sweet potatoes.
- Eyes and Computer/TV Screen – Educate the patient that the eyes can get sore if he/she use computer or watch TV for too long. If the child spends a lot of time at the computer or focusing on any one thing, he/she sometimes forget to blink and the eyes can get fatigued. Teach the patient to try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds. This can help reduce eyestrain.
- Eyes and Sports/Play – Encourage the patient to wear protective eyewear when participating in sports or recreation. Unsafe toys are the most common cause of eye injury among children. Instruct the parents to keep small parts and sharp edges away from their younger children and to buy age-appropriate toys.
- Eyes and Hands – Instruct the patients not to rub their eye if it gets irritated and proper hand washing helps prevent eye infection.
According to the American Optometric Association, children should have an eye exam by no later than 6 months old, then again by age 3 years, and just before starting school. School-age children need an exam every two years after that if they have no visual problems. However, if the child requires eyeglasses or contact lenses, schedule visits every 12 months. Regular eye exams are important because during the school years your child's eyeglasses prescription can change frequently.
When a child visits an eye clinic, the nurse should note the following in the patient assessment form: history of prematurity, delayed motor development, frequent eye rubbing, excessive blinking, failure to maintain eye contact, inability to maintain a gaze (fixation) while looking at objects, and poor eye tracking skills. Early eye examination is crucial to make sure children have normal and healthy vision.
By: Cham Rodriguez
OPD Staff Nurse
July - World Hepatitis Day 2016
By: Rhea Uy
ELIMINATION is the theme for this year’s World Hepatitis Day. It will be held on 28 July 2016. The World Health Organization adopts the first ever Elimination Strategy for Viral Hepatitis which includes fundamental measures to achieve greater awareness and increased diagnosis. These include universal vaccination, safe handling of blood and injection, harm reduction and proper management. All these activities address the main goal of eliminating viral hepatitis as a public health threat by the year 2030.
World Hepatitis Day is an important global platform celebrated each year to raise awareness and influence real change to prevent, diagnose and treat the disease.
As part of health care team, we too can participate in the elimination campaign on hepatitis by initiating some guidelines to achieve a safe working condition:
- Hospital and health care providers must be trained on hepatitis precaution and modes of transmission.
- Strict observance of universal or standard precaution and use of personal protective equipment.
- Contaminated linens must be discarded or bagged with label before sending for laundry.
- Infected food service workers must be prohibited from handling, preparing and serving food.
- Staffs or any employees who have had direct exposure must be screened and should be given immunoglobulin (IG) vaccination when needed.
- Practice proper needle or sharp disposal precaution. Used needles must not be recapped.
- In case of needle stick injury, University Hospital Sharjah adapts the strategy of being COOL.
- C-clear the area; wash the injured site with soap and water. Never squeeze out the blood;
- O- Occurrence or incident report.
- O- Occupational health notification;
- L-let your supervisor, nurse manager and infection control coordinator know.
- Basic features of safe sharp disposal container described below:
- Made of durable plastic
- Able to close with tight-fitting, puncture- resistant lid
- Upright and stable during use
- Leak-proof; and
- Properly labelled to warn of hazardous waste inside
- Discard sharp disposal containers when it is about ¾ full and follow the guidelines for proper disposal methods.
"Hepatitis. Know it. Confront it." Let's all help make the elimination strategy of viral hepatitis as our next greatest achievement.
June is National Safety Month
By: Rhea UY, Emergency Department
Shiny Abraham, Emergency department
Safety is everyone’s responsibility. It is a choice that everybody has to make throughout their entire lives. Whether you are inside your work, driving along the road, or even inside your home, we are all empowered to make safe decisions and practice safe behaviors 24/7, anywhere, everywhere.
The National Safety Month is observed annually in the month of June. It focuses on reducing the leading causes of preventable deaths and injuries in the workplace, on the roads as well as inside the home and community through education, leadership, research and advocacy.
In the Hospital
Always remember to be S.A.F.E.
Safety first: Make sure you and your family know your allergies and medications.
Ask, ask, and ask: Know all the who, what, when, where and why about the care and treatment you are to receive. Expect everyone involved in your care to introduce them by name, and to wear an identification badge. Make sure to tell your healthcare professional if you think he or she has you confused with another patient. Tell the nurse or doctor if you think you are about to receive the wrong medication or if something doesn’t seem right. Don’t assume anything.
Feel respected: You and your family have a right to be treated with respect, dignity and confidentiality. Never forget that your opinion matters.
Educate: Educate yourself and your family in partnership with your healthcare provider. Learn all you can about your illness and treatment options. Good sources include your doctor, your library, respected websites and support groups. Ask your doctor about the specialized training and experience that qualify him or her to treat your illness. Medical terminology can be confusing; make sure you understand the words used by your caregivers. And be sure to ask any questions you may have before signing any forms. Write down important facts your doctor tells you. Ask a trusted friend or family member to be your advocate.
Patient Safety Tips
Identification: While in the hospital, wear your wrist ID bracelet (provided to you on admission). This bracelet gives the staff information that is critical to your safety and verifies that you are the patient that they should be caring for. Make sure your nurse or doctor checks your wristband or asks your name before he or she administers any medication or treatment.
Call lights: Your hospital bed and bathroom are equipped with call devices. Your nurse will show you how to use the call device. Always keep this device within your reach to call your nurse when you need help.
Smoke-free facility: To ensure everyone’s safety, UHS Health facilities are smoke-free. This means no smoking is allowed inside the building.
Prevention of fall
Some patients may be at risk for falling. If the staff believes you may be at risk, they will take steps to try to prevent a fall. One of the steps is putting a blue star outside the door to your hospital room to let the staff know you are at risk, or a red star if you already have had a fall. If sleeping medication is needed, it will be given early enough in the evening so that you will be less drowsy the next morning.
Here is what you and your loved ones can do to prevent a fall:
Keep the telephone, call device and bedpan or urinal within your reach at the bedside. If walkers, canes or other assistive devices need to be kept close by, let the staff know.
Remove clutter in the area where you will be walking. Send home any items that are not necessary. If equipment is in the way, tell the staff and it will be moved.
Call for assistance when you need to go from the bed to the chair or bathroom. Move slowly. If oxygen or other equipment is in use, ask for assistance before getting out of bed.
Let the staff know if you are going to be left alone in the room.
The staff takes measures to reduce the risk of patients developing an infection during the hospital stay. They include hand-washing, proper cleaning of equipment and sterile techniques. Hand washing is important for everyone to practice, including patients, physicians and visitors. You and your loved ones should feel comfortable asking your caregivers, including your doctors, if they washed their hands before having direct contact with you. Most patient rooms have soap dispensers at the sink, as well as an alcohol-based hand rinse that cleans hands without water.
Make sure to ask questions about your medications, such as what the medication does and the possible side effects. If you have any concerns about the medications, ask your nurse about them. To help you in take a more active role, fill out this Health Passport and bring with you when seeing the doctor. Some helpful tips for safe medication use are as follows:
Report all medications you are taking. Include prescription drugs, birth control pills and hormones, as well as over-the-counter medications such as aspirin, antacids, laxatives, eye drops and cough medicine; and herbal supplements, vitamins, minerals, diet pills and dietary supplements.
Let us know how you take these medications, such as with food or milk, or half a pill, especially if this is different from what was prescribed.
Take all of your medications as prescribed.
Keep a written record of your prescription medications, including the name, the dose and when you take it.
When you go for a follow-up visit to your physician, take a record of the medications prescribed to you when you left the hospital.
Speak up when you have any concerns or questions about your medication.
Report any allergies or adverse reactions you are having or have had.
While in the hospital, don’t take medications from home, including vitamins, herbs Invasive Lines and Tubes Patients are sometimes confused because of illness, injury, unfamiliar settings, effects of medication or other reasons. This confusion may lead you to try to pull out intravenous (IV) lines or other tubes. For your safety and comfort, the nursing staff will:
Work with the family to make you more comfortable.
Assist with visits to the bathroom.
Explain what is happening.
Cover tubes and bandages.
Patient Pain Tips
Managing your pain is an important part of treatment. Pain makes it hard for the body to heal. Also, pain interferes with your ability to participate in activities. You have a right to adequate pain management. Your opinion about how to manage your pain is important. In order for your nurses and doctors to help you control your pain, they should know the following information:
Where your pain is located.
Whether you have pain all the time or just some of the time.
What it feels like.
How bad it feels on a 0-10 scale (0 – no pain, 10 – worst possible pain).
When the pain started.
What makes you feel better and what makes you feel worse.
What you think is the reason for your pain.
What effect the pain has on your life (e.g., sleep, appetite, work).
Anything else you think the nurses should know about your pain.
Although medications are frequently used to treat pain, there are other pain reducing methods, such as massage, relaxation techniques and application of heat or cold. Check with your doctor, nurse for suggestions that may help your pain.
Surgery and Procedures
When coming for surgery or other procedures, be sure to ask questions before signing consent forms. You and/or your family will be asked to verify what type of surgery is planned for you. Mark the surgical site, which the doctor will do as well, so that there’s no confusion in the operating room.
As nurses, we can also safeguard the health of the public through the health teachings we give before discharging our patients. It is important to educate them about healthy diet, medication compliance, smoking cessation, avoidance of alcohol, as well as topics regarding fitness and exercise.