Tuesday, 9 October 2018

Mental Illnesses

Who Becomes Mentally Ill?
  • It can affect anyone, regardless of age, ethnic background, income or gender.
  • One in five Canadians has or will develop a mental illness.
  • Sometimes mental illness is complicated by drug and alcohol use

Refers to severe and prolonged feelings of discouragement, frustration and even a sense of despair. Multiple causes such as specific, distressing life events, a biochemical imbalance in the brain or persistent psychological factors such as a negative or pessimistic view of life. Common symptoms of depression:
  • Irritability.
  • Anxious mood.
  • Trouble sleeping or sleeping too much.
  • Loss of energy and excessive fatigue.
  • Physical aches and pains.
  • Diminished ability to think and concentrate.
  • Feeling bored and not interested in many aspects of your life.
  • Imagining you have an illness such as cancer when there are no physical indications.
  • Feelings of worthlessness, hopelessness
  • Possibility of suicidal thoughts
  • Changes in personal grooming
  • Isolation and withdrawal
  • Inability to experience joy or pleasure

Bi-Polar Disorder:
Refers to the two poles of the continuum of mood with alternating periods or cycles of mania highs and depression lows as described previously. Common symptoms of mania:
  • Persistently high or irritable
  • Decreased need for sleep.
  • Appetite disturbance.
  • Excessive spending.
  • Reckless and impulsive behaviour.
  • Inflated ideas about what you are capable of doing – grandiose thoughts.
  • Delusional and psychotic thinking.
  • Hyper sexuality
  • Heightened senses to colour, noise, and smell
  • Accelerated thoughts and speech.

The word psychosis is used to describe conditions that affects the mind, in which there has been some loss of contact with reality. When someone experiences the symptoms of psychosis, their condition is referred to as a psychotic episode. It affects an individual’s thoughts, feelings and behaviours. Some people experience psychosis as a part of their mental illness or because of using or withdrawing from drugs and alcohol. It is most likely to occur in young adults. About 3 out of every100 people experience a psychotic episode in their lifetime. It occurs equally in males and females and across all cultures and levels of socio-economic status. Most people make a full recovery from the experience. Common signs and symptoms of psychosis:
  • Disorganized or confused thinking.
  • Reduced concentration, attention
  • Reduced drive and motivation, lack of energy
  • Sleep disturbance
  • Anxiety
  • Social withdrawal
  • Behavioural changes, irritability
  • Hallucinations or delusions
  • Disorganized speech

Anxiety Disorders
  • A group of disorders which affect behaviour, thoughts, emotions and physical health. Caused by biological and situational circumstances. Heightened and continuing response to a perceived threat. Types of anxiety disorders:

General Anxiety Disorder
  • Repeated and excessive worries lasting at least six months pertaining to routine life events and activities like work, relationships, finances and family.

Panic Attacks
  • Fear of imminent death leading to heart palpitations, choking, nausea, faintness, dizziness, chest pain and sweating.

Panic Disorder
  • Fear of situations which may cause a panic attack.

  • Overwhelming feelings of terror in response to a specific object, situation or activity.

Obsessive-Compulsive Disorder (OCD)
  • Repetitive actions used to cope with recurring or unwanted thoughts.

Post-traumatic Stress Disorder (PTSD)
  • A sense of re-experiencing a traumatic event for months and sometimes years after the incident.

Treatment & Recovery
Treatment for any mental illness, whether or not it is complicated by drug and alcohol misuse, should occur as soon as symptoms appear. Recommended treatment involves a combination of approaches:
  1. EDUCATION – To help you and your family/support system understand the illness, its causes and effects and ways of dealing with symptoms.
  2. MEDICATION – New ones are now available with fewer unpleasant side effects than older medications.
  3. PSYCHOLOGICAL THERAPY OR COUNSELLING - To help you understand what is happening, change your lifestyle to optimize the chances for recovery and learn new skills such as problem solving and relaxation techniques.
  4. SOCIAL, EMPLOYMENT AND EDUCATION SUPPORT – You may need support to stay at your job, or in school. This is important, so you maintain skill development and continuation of income and do not become cut off from friends and workmates. Research has shown that people who experience mental illness have fewer relapses when their family or other support system is involved in their care and treatment. The same is true when substance misuse is involved. If friends and family are knowledgeable and informed, they are in a better position to support you.

Top 10 places to visit in Dubai

Burj Khalifa: Among the various places to visit in Dubai, Burj Khalifa is a highly exotic one. It has been the tallest structure and building in the world
Dubai Aquarium: It is one of the world’s largest suspended aquariums in Dubai. The underwater zoo has a huge collection of sand tiger sharks and many other endangered species which are being conserved in their natural habitat. 
Desert Safari with BBQ Dinner: Desert Safari is undoubtedly one of the most exclusive activities to try in Dubai. Exploring the endless deserts while on your Dubai trip is an adventure you must not miss.
Wild Wadi Water Park: It is an outdoor water park in Dubai which is being operated by the Jumeirah International. It is a place which will quench the thirst for all your water sports adventures. 
Dubai Marina: Dubai Marina contains ten regions each created as an unmistakable group. The Dubai Marina Walk, which lines the waterfront, has a choice of cosmopolitan eateries.
Ferrari World: Ferrari World is Abu Dhabi’s largest theme park, founded back in 2010. The park’s indoor activities are centered around everything you can do with a Ferrari. At Ferrari World, there’s something for everyone to do, whether you go with your kids or by yourself.
Dubai Creek: Dubai Creek zone that associates the ocean exchanging port to the leave as it goes through the heart of Dubai. This Dubai attraction is a saltwater brook situated in Dubai, United Arab Emirates and it closes at Ras Al Khor Wildlife Sanctuary.
Dubai Dolphinarium: Located within the picturesque Creekside Park in Dubai at Umm Hurair, Dubai Dolphinarium has become one of the city’s greatest amusement venues including Coral Reef Aquarium, Fish Farm, Gatorville and a research therapy center.
Ski Dubai: Ski Dubai, a 22,500 square meter indoor resort dedicated to snow and skiing. The resort is covered in snow where you can enjoy all types of indoor snow activities and be in the winter wonderland you could only dream of in the Alps.

Dubai Miracle Garden: The lush gardens are a treat to your senses and will leave you with a pleasant and happy feeling throughout. This Dubai attraction is the worlds’ largest natural flower garden and what makes it more miraculous is that it happens to be put up in the city of deserts.

Thursday, 4 October 2018

Nursing Education 2019 Conference : Workshop

ICU, acquired pneumonia and ventilator: Is Ventilaor-associated Pneumonia an Independent Risk Factor for Death? By Fatma Slem, RN, New Mwasat Hospital, Kuwait 
Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs 48-72 hours or thereafter following endotracheal intubation, characterized by the presence of a new or progressive infiltrate, signs of systemic infection (fever, altered white blood cell count), changes in sputum characteristics, and detection of a causative agent. VAP contributes to approximately half of all cases of hospital-acquired pneumonia. VAP is estimated to occur in 9-27 % of all mechanically ventilated patients, with the highest risk being early during hospitalization. It is the second most common nosocomial infection in the intensive care unit (ICU) and the most common in mechanically ventilated patients. VAP rates range from 1.2 to 8.5 per 1,000 ventilator days and are reliant on the definition used for diagnosis. Risk for VAP is greatest during the first 5 days of mechanical ventilation (3 %) with the mean duration between intubation and development of VAP being 3.3 days. This risk declines to 2 %/day between days 5 to 10 of ventilation, and 1 %/day thereafter. Earlier studies placed the attributable mortality for VAP at between 33-50 %, but this rate is variable and relies heavily on the underlying medical illness. Over the years, the attributable risk of death has decreased and is more recently estimated at 9-13 % largely because of implementation of preventive strategies. Approximately 50 % of all antibiotics administered in ICUs are for treatment of VAP. Early onset VAP is defined as pneumonia that occurs within 4 days and this is usually attributed to antibiotic sensitive pathogens whereas late onset VAP is more likely caused by multidrug resistant (MDR) bacteria and emerges after 4 days of intubation. Thus, VAP poses grave implications in endotracheally intubated adult patients in ICUs worldwide and leads to increased adverse outcomes and healthcare costs.

Monday, 1 October 2018

Keynote Talk : Nursing Education 2019

Understanding and implementing EBP to foster and maintain safe and competent care by Dr.Rabie’e Al Rashdi, Oman Academic Accreditation Authority, Oman

Abstract: Several definitions exist for the ‘Evidence Based Practice’ (EBP) concept, but the most commonly cited definition, according to Boyce et al (2018), comes from Dr. David Sackett in his 1996 letter in BMJ on what evidence-based medicine is and is not. In the letter, he described EBP as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients (Sackett, et al, 1996). According to Mackey and Bassendowski (2017), Evidence Based Practice evolved from Florence Nightingale in the 1800s to medical physicians in the 1970s and the nursing profession in the late 1990s. It began as an idea to provide better outcomes for patients who experienced deplorable, unsanitary, conditions and developed from this foundation to a widely communicated and critically needed practice for fostering and maintaining safe and competent care. The critical need of Evidence Based Practice stems from the fact that, despite its development and wide interest to adapt it in nursing and other healthcare professions, there is still a wide variation in health care practices that ultimately lead to unnecessary wastage of resources, wasted care delivery time and efforts, as well as poor treatments and nursing care outcome (Youngblut and Brooten, 2001). In response to the aforementioned status quo of Evidence-Based Practice, commissioners and providers of health care were encouraged to implement it in order to utilize resources, improve the outcome of treatment and care delivery and meet public demands for cost-effective and high standards of care. In this keynote presentation, the author aims to answer the following key questions: what is Evidence Based Practice and what is it not?; why is Evidence Based Practice needed in healthcare?; what is the best way of implementing Evidence Based Practice?; what are the hindering factors in the implementation of Evidence Based Practice?; and how to overcome the hindering factors and enhance the implementation of Evidence Based Practice?.

Tuesday, 25 September 2018

How to choose a Nursing Home : An Insider View

Cleanliness: When you visit, cleanliness will be one of the very first things that you notice. If the residency does not appear to be taken care of, this could indicate the residents are being neglected as well.
The appearance of residents: Are the people who live there dressed and groomed or do they look as though no one cares if they are reasonably neat and clean? Are their rooms tidy and clean? Is their clothing fresh and clean or dirty and foul? Did you notice an overall stench at the home?
Pain management: As you walk through the home pay attention to the conversations between residents or between residents and caregivers. Note if you hear anyone say he/she is hurting, as it is pertinent that nursing home residents are receiving prompt and accurate care.
Medication: While it is important for nursing home residents to receive proper medication and treatment, it is equally important that they are not being overmedicated. See if the facility has an antipsychotic medication policy for residents who suffer from schizophrenia and bipolar disorder, as these are just a few of the issues faced in nursing homes today. These medications should not be used to subdue patients, however. They are only used when medically necessary.

Nutrition: To determine if your loved one will receive nutritious food and beverages, request a meal during your visit (at your expense). Also look at residents’ plates after they have been served, observing their expressions as they eat and notice if they did not finish their meal. If you did not enjoy your meal, think of the residents who dine at the facility every day, as they do not have access to alternative options. Also, ask if snacks are served between meal times and if residents have choices in times to eat and foods that they prefer.

Monday, 24 September 2018

Assure patient safety in the heat

There is good evidence that dehydration in the summer months causes a significant increase in the incidence of urinary tract infection (UTI) and other severe infections associated with it. Jennie Wilson, the member of the Infection Prevention Society, provides these key facts to help you prevent your patients from becoming dehydrated.
Keep drinking
Adults need to take in a minimum of 1.5 liters of fluid every day. This is equivalent to at least 8 large cups or mugs of fluid.  Make sure that drinks are offered to patients enough times during the day to enable them to drink this amount of fluids
Older people are more vulnerable to dehydration
The loss of thirst reflex decreases in muscle mass in which to store fluids, and reduced kidney function combine to make older people at much greater risk of dehydration. They need to be reminded to drink and advised of the importance of drinking enough to keep them healthy
Any fluid is good fluid
The most important thing is to consume sufficient fluids; it does not matter what form this takes. Use fluid-rich foods such as jelly, ice cream, yogurt to supplement fluids in drinks
Assistance to drink
Think about the design of cups or mugs used to serve drinks. Are these appropriate and pleasant for patients to hold and drink from?  Remember that some older patients may need someone to help them drink and a member of staff will need to be allocated to support them
Support people worried about incontinence
One reason older people do not drink enough is that they are worried about being able to get to the toilet in time or about getting up in the night to use the toilet. Make sure that they know how important it is that they drink enough during the day. If they are in hospital or care, ensure they are reassured that they can ask for help to get to the toilet
Look out for signs of dehydration
Some of the more obvious signs are a dry skin or mouth, dark-colored urine, or complaining of a headache.  Also look out for confusion or drowsiness as these can also be important indicators that a patient is becoming dehydrated
Choice and drinks preferences
Exploring preferences of your residents and extending the choice of drink to include theirs can make a big difference. Introduce an anonymous form to help residents select what they enjoy drinking the most
Introduce protected drinks time
A structured approach to ensuring all residents are offered drinks means no confusion as to who has or hasn’t had a drink most recently
Provide additional drinks before and after meals
Some people may not manage to drink with their meal or may not want to. Building in extra time for hydration around the meal means that the need for drinking won’t get lost when the focus is on food
These principles are not only important for patients in the hospital, but also for the frail elderly in their own home or in residential care

Wednesday, 12 September 2018

Cerebral Palsy

What is Cerebral palsy?

Cerebral palsy is primarily a disorder of movement and posture. It is defined as an umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of its development. It may be stated as a static encephalopathy in which, even though the primary lesion, anomaly or injury is static, the clinical pattern of presentation may change with time due to growth and developmental plasticity and maturation of the central nervous system.

What are the Various types of Cerebral palsy?

There are several different types of cerebral palsy:

Spastic cerebral palsy

This is the most common type of cerebral palsy. Spasticity means stiffness or tightness of muscles. The muscles are stiff because the messages to the muscles are relayed incorrectly from the damaged parts of the brain. When people without cerebral palsy perform a movement, groups of muscles contract whilst the opposite groups of muscles relax or shorten in order to perform the movement. In children with spastic cerebral palsy, both groups of muscles may contract together, making the movement difficult.

Dyskinetic cerebral palsy

This refers to the type of cerebral palsy with abnormal involuntary movements. It is divided into two types of movement problems, called dystonia and athetosis.
• Dystonia – this is the term used for sustained muscle contractions that frequently cause twisting or repetitive movements, or abnormal postures.
• Athetosis – this is the word used for the uncontrolled extra movements that occur particularly in the arms, hands and feet, and around the mouth. The lack of control is often most noticeable when the child starts to move – for example, when the child attempts to grasp a toy or a spoon. In addition, children with athetoid cerebral palsy often feel floppy when carried.

Ataxic cerebral palsy

This is the least common type of cerebral palsy. Ataxic (or ataxia) is the word used for unsteady shaky movements or tremor. Children with ataxia also have problems with balance.

Mixed types

Many children do not have just one type, but a mixture of several of these movement patterns. Some of these concepts are difficult to understand. Please discuss them further with your therapist or doctor.

Which part of the body is affected?

Again, this varies greatly from one child to another. Certain words are used to describe the parts affected:
Hemiplegia – the leg and arm on one side of the body are affected (also described as hemiparesis). Diplegia – both legs are predominantly affected. Children with diplegia usually also have some difficulties with their arm and hand movements.
Quadriplegia – both arms and both legs, and the trunk are affected (also described as quadriparesis). The muscles of the face, mouth, and throat can also be involved.

What are the causes of cerebral palsy?

Cerebral palsy occurs in about two in every thousand children. There are many different causes. A problem with the brain can occur:
1. If the brain does not grow or form properly. The result is that children may have brain malformations.
2. In the early months of pregnancy – for example, if the mother is exposed to certain infections such as Rubella (German Measles), or Cytomegalovirus (CMV).
3. During labor or at birth – for example, if the baby does not receive enough oxygen.
4. In the period shortly after birth – for example, when an infant develops a severe infection, such as meningitis, in the first few days or weeks of life.
5. In children having accidents in the early years of life, causing permanent brain injury. These children are also considered to have cerebral palsy.

Mental Illnesses

Who Becomes Mentally Ill? It can affect anyone, regardless of age, ethnic background, income or gender. One in five Canadians has...