A force for change: Improving Health System's … force for change: Improving Health System's...

A force for change: Improving Health System's Resilience May 2016


Mission

To enhance the quality of life in our

community by providing high quality

and cost efficient healthcare services.

Vision

To be recognized as a leading private

healthcare provider in the Gulf region

offering secondary and tertiary care

medical services.

Mission

CEDARS Jebel Ali International Hospital - Nursing Department is

committed to providing the highest level of patient-centered care through

evidence-based practice, advancement in professional nursing practice

and continued pursuit of nursing quality.

Vision

CEDARS Jebel Ali International Hospital - Nursing Department Vision is to

be one of the Gulf region leaders in:

Nursing Practice

Nursing Quality

Nursing Professional Development

Service Excellence

Nursing Department

CEDARS Jebel Ali International Hospital


Executive Editors

Ms. Priya M George - Charge Nurse - ICU & ER - Head Nurse

Ms. Reena Samuel - Operating Room In-Charge & Assistant Head Nurse

Ms. Remya Tinu - Nurse In-Charge

Ms. Clamency Thomas - Inpatient Unit - Charge Nurse

Mr. Piljo P Paul - Infection Control Nurse

Editor in Chief - Dr. Ali Hassan

Consultant General & Laparoscopic

Surgeon

PREFACE

Nursing is a profession within the health care sector focused on the care of

individuals, families, and communities so they may attain, maintain, or recover

optimal health and quality of life .Nurses are different from other health care

providers by their approach to patient care, training, and scope of practice.

CEDARS nurses are committed to providing the highest level of patient-

centered care through evidence based practice, advancement in professional

nursing practice and continued the pursuit of nursing quality.

We, the nurses of CEDARS-Jebel Ali International Hospital present to you our

first nursing journal and the first in-house initiative of our hospital. We have selected

this nurse’s day to publish it as the theme itself a depicts- A force for change-

Improving the health system resilience. This journal consists of articles related to

nursing and a study conducted by our nurses on World Health Day. Though it is a

novice experience for many of us we feel that we have accomplished ourselves by

putting it together as the first journal of CEDARS.

We acknowledge Dr. Adnan, Prof. Dr. Gunther, Dr. Bassam, Dr. Ali Hassan

and Ms. Anne for their immense support shown to us throughout in creating and

publishing this journal.

Special Thanks to Ms. Abby for designing and arranging the online

publication. Let us mark this as the beginning towards our journey in improving the

health system resilience.

“Dedicating this journal to the Human Angels all over the world”

-Editorial Board


Dr. Adnan Kaddaha Chairman and Managing Director

CEDARS Jebel Ali International Hospital

Message from the Chairman of CEDARS Hospital

On your glorious Nursing day, I cannot but present to you at

CEDARS my heartfelt good wishes and through you to all nurses the

world over.

Nurses, right from the inception of suffering on earth were there as

the angels of mercy attending to the sick and alleviating the suffering of

the ailing. They were always there to heal the injuries of wars, cruelty of

men towards one another or the downturns of destiny.

In modern times, nurses have become the indispensable

backbone of hospitals. This is more than true for CEDARS Hospital

where our nurses have demonstrated a beautiful combination of

professionalism, compassion, and loyalty to CEDARS.

Best wishes and many happy returns of the great occasion!


Anne-Susann Becker Chief Operating Officer

COO’s message for International Nurses Day 2016

Nurses’ Day is a great opportunity for nurses, colleagues and patients to truly

celebrate their vocation and the huge difference they make to the lives of millions of

people worldwide.

Each year the invaluable role that nurses play in keeping people in Dubai,

across the UAE, and around the world as healthy and independent as possible is

recognized on International Nurses Day. The celebration has been held annually on

May 12 for more than 50 years, a date selected to coincide with the anniversary of

the birth of Florence Nightingale, a symbol of pioneering nursing. The Management

of CEDARS Hospital is delighted to recognize the expertise, dedication, and

compassion of our nurses. We are delighted to say that we have some absolutely

extraordinary nurses at our hospital. There are so many fantastic examples our

expert staff going the extra mile to deliver the very best care for our patients.

International Nurses Day gives us a chance to celebrate their dedication and the

difference they make to the lives of people.

We know that nurses lead very demanding lives. Working with doctors,

healing patients and educating the communities are just few of the responsibilities

nurses perform on a daily basis. In fact, nurses are the backbone of our healthcare

system, providing us with the attention and medical care that we need to live healthy

long-lasting lives. Being a nurse can be exhausting at times, but the knowledge and

power to help heal others is what keeps them going in challenging times. Nursing

has been a profession with high standards and a strong sense of public service and

nurses are amongst the most respected of all of our professions. There are only a

few people whose lives have not been touched by the care and reassurance that

nurses provide, every hour of the day, every day of the year.

The nursing profession has come a very long way

since the achievements of one of its greatest - Florence

Nightingale whose birthday is on International Nurses Day.

The future of your profession is very bright. Thank you

CEDARS nurses - thank you for everything you do.


Prof. Dr. Gunther Kieninger

Medical Director

& Head of Department of Surgery

Dear Nurses of our CEDARS Hospital,

International Nurses Day is celebrated all over the

world on May 12th, the anniversary of Florence

Nightingale's birth who lived from 1820-1910. This

English nurse became known as the founder of

professional nursing, especially due to her pioneering

work during the Crimean War of 1853-1856, a conflict between the Russian Empire

and an alliance of England, France, and the Ottoman Empire. The Russians lost the

bitterly fought war, 500,000 soldiers die, 250,00 on each side.

The Crimean War was notorious for the military and logistical immaturity of

the British army. However, it highlighted the work of women who served as army

nurses. War correspondents of the newspaper reported the scandalous treatment of

wounded soldiers in the desperate winter that followed and prompted the work of

Florence Nightingale and other nurses and led to the introduction of modern nursing

methods. Due to her habit of making rounds at night, Nightingale became known as

"The Lady with the Lamp".

International Nurses Day was first celebrated in 1954, the 100th anniversary

of Nightingale's mission to the Crimean Peninsula at the Black Sea. I took the liberty

to dig into history since I presume that you and we, doctors are not fully aware of the

historical details which gave birth to the celebration of Nurses day.

We celebrate the remarkable difference nursing makes from the moment a

new life begins to saying goodbye to a loved one, and at all stages in between.

Back to CEDARS Hospital, passing the past year in review, I may call it the

year of organizational and financial consolidation of our hospital. To reach that goal

was only possible with the help of the fantastic contribution of nurses.

http://www.cedars-jaih.com/doctors-specialists.php#inline2


The Nurses Day gives me the opportunity to declare that we have a wonderful

Nurses team on which we can be proud of. A team which is highly professional

combined with a great spirit of devotion and humanity. I call it the unique CEDARS

spirit! Let me mention that the nurses are always as good as their Head and so it

was a stroke of luck for our hospital that Sister Priya took over the helm. Thanks to

her wonderful personality, professionalism, and her competence which she has

gathered like-minded Department Nurses around her. This enables the hospital to

incorporate new nurses fast and successfully.

In the name of all the doctors and of the management, I would like to thank

the whole Nursing Department, and above all Sister Priya, Department Head Nurses,

Reena, Remya and Clamency sincerely for their great contribution.

Let me conclude that we are in the very comfortable situation to have a highly

motivated, well trained, human thinking and acting Nursing staff upon which our

hospital can rely on. Our nurses are our most precious capital. And what else could

demonstrate the extraordinary spirit of our nurses more than the wonderful idea of

the tree planting? That was a great message for CEDARS.

The Nurses Day gives me a once a year opportunity to thank you in an official

way for your professional, dedicated and highly human service to our patients.

We are all very proud of you!


Table of Contents

Title Page

A Force for Change: Improving Health System's

Resilience 1 - 6

Evidence - Based Practice / Nursing 7 - 12

Determinants and Drivers of Increased blood glucose level

in a selected population in Middle East 13 - 17

Effective Communication in Nursing 18 - 22

Angels on Earth 23 - 25

A Journey from Infection Control to Infection Prevention -

A Wake up Call 26 - 28

Post-Traumatic Stress Disorder 29 - 33

ECG- Nurse Perspective 34 - 37

Holistic Nursing 38 - 41

Nursing Theories 42 - 45

Vital Aspects of Nursing - Critical Thinking, Leadership

in Nursing 46 - 49

Nursing Specialties Nursing - A growing profession 50 - 52

Innovation of Technology Ensures Right Patient Care at

Right Time 53 - 55

Frame of Triumph 56 - 57


Page 1

A Force for Change:

Improving Health System's

Resilience “Resilience: the capacity to recover from difficulties”

“Health system resilience can be defined as the capacity of health actors,

institutions and populations to prepare for and effectively respond to crises; maintain

core functions when a crisis hits; and ,informed by lessons learned during the crisis,

reorganize if conditions require it.” Kruk et al (2015) p.1910

Is nursing only an Order taking Job?

Nursing is the largest profession in the healthcare industry. It’s the one among

the largest female profession in the world.

Nursing includes the promotion of health, prevention of illness, and the care of

ill, disabled and dying people. Advocacy, promotion of a safe environment, research,

participation in shaping health policy and in patient and health systems

management, and education are also key nursing roles. (ICN, 2002)

Nursing encompasses autonomous and collaborative care of individuals of all

ages, families, groups and communities, sick or well and in all settings. It includes

the promotion of health, the prevention of illness, and the care of ill, disabled and

dying people. (WHO)

Ms. Reena Samuel

Assistant Head Nurse &

Operating Room In-Charge


Page 2

Both ICN and WHO says that nursing is autonomous. Is it so? How many of

ours Nursing practice is autonomous. How many of our opinions are counted in our

daily patient care and treatment module? Resilience is needed for nursing from the

attitude and practice of considering nurses just as a helping hand of Physicians.

Nurses at the core of resilience

Nurses make a significant contribution to developing and maintaining

resilience in health systems. We contribute to service development; supervise and

develop other members of the team; work with and advocate for patients, their

carers, and communities; and collect data and inform the development of evidence.

The importance of nursing at all levels of the health system, including

governmental and policy levels, is recognized in health systems strengthening.

Ventura et al (2015) reviewed the evolution of WHO’s initiatives for strengthening

nursing and midwifery and found clear documentation of the increasing importance

of nurses as multidisciplinary health team members and their role in the

improvement of health systems. Nurse leaders involved in health systems capacity

building bring knowledge of population needs and can ensure that strategies are in

line with these needs.

There is also a clear link between the vital role nurses play and the availability

of evidence. Nurse leaders should be present at all levels of the health system in

order to participate in health systems capacity building that are based on population

needs (Ventura et al 2015).

Nurses and nursing can:

1. Lead and support interprofessional education (IPE) and interprofessional

collaborative practice (IPCP). Interprofessional collaboration is an innovative

solution to health systems’ strengthening. IPE prepares health workers for

interprofessional collaboration and is an essential precursor to collaborative

practice. IPCP creates a strong and flexible health workforce with health

professionals sharing best practices in the face of opportunity and challenge. The


Page 3

collaborative practice represents an opportunity for nurses to maximize their skills

and practice at their highest capacity and capability (WHO 2010b).

2. Advocate for a paradigm and operational shift in health care that balances illness

focused care with population health.

3. Identify and champion global and national strategies to address health workforce

misdistribution and migration.

4. Strengthen and diversify primary health care. Primary health care (PHC) creates

resilience, efficiency and equity in health systems.

5. Ensure a strong nursing voice in all health and social system policy development

and planning dialogues.

6. Consider the influence of regulation and legislation on the health system and HRH

planning issues.

7. Design and improve information infrastructures and data collection to support

health system redesign and planning.

8. Participate in research related to HRH and in health systems research and

evaluation in order to create and synthesize the best evidence.

9. Consider the influence of complex, ubiquitous social and gender issues such as

the determinants of health, and inequality and inequity.

So how can Nursing achieve Autonomy & Control over Nursing practice

(CONP)?

Autonomy refers to the ability to act according to one’s knowledge and

judgment, providing nursing care within the full scope of practice as defined by

existing professional, regulatory, and organizational rules (Weston, 2008).

CONP refers to the nurses’ ability to shape departmental and organizational

policies and practices related to nursing care (Weston, 2008).

http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No1Jan2010/Enhancing-Autonomy-and-Control-and-Practice.html#Weston08

http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No1Jan2010/Enhancing-Autonomy-and-Control-and-Practice.html#Weston08


Page 4

Strategies for Enhancing Autonomy and Control over Nursing Practice

1. Strategies for Enhancing Autonomy

a. Clarify expectations about clinical autonomy

1. Describe expected behaviors

2. Embed nursing knowledge into clinical practice processes

3. Recognize and reward autonomous practice

4. Role model expected behaviors

5. Coach nurses not demonstrating expected behaviors

6. Provide manager support for autonomous practice

b. Enhance competence in practice

1. Create a learning environment

2. Enable formal and informal educational opportunities

2. Strategies for Enhancing Control Over Nursing Practice

Establish participative decision making

1. Use an organized structure for nurse participation in decision making

2. Ensure authority for clinical decision making resides with direct care nurses

3. Include nurses on organizational committees

4. Minimize bureaucracy

5. Support involvement by nurses on committees and workgroups

c. Enhance competence in decision making

1. Teach nurses about the decision-making process

2. Coach and support nurses through early decisions

3. Teach facilitation skills to leaders

3.Strategies for both autonomy and CONP

d. Ensure strong nurse leaders

1. Create strong, visible, nurse leaders

2. Ensure that nurses in supervisory positions are encouraging autonomy

and CONP


Page 5

3. Have executives advocate for influential nursing practice

4. Encourage new and innovative ideas

e. Work upstream

1. Influence social, political, and economic factors

2. Publicly describe nursing’s unique expertise and contribution

3. Acknowledge nurses’ contributions in all roles and practice settings

4. Use political clout of professional organizations and nurses in leadership

roles

These strategies can be applied and it helps a nurse who is efficient and

competent to achieve autonomy. Being a nurse who started the career in 1998, I

have seen that there have been changes in the attitude towards nursing profession

and nurses practice autonomy though partially as years are passing by. This varies

with different regions of the world. There are some places in which still the nurses

are considered as a helping hand only. I started my career as a junior registered

nurse and had to just follow the orders of the doctors or to follow the set rules by the

hospital. So the chances of incorporating new practices and ideas were very less for

the nurses, however, knowledgeable they were .

After few years of nursing practice in my home country, I migrated abroad and

started my career as a registered nurse and soon got the opportunity to be at the

leadership level to manage the nursing department and to involve in the setting up of

the Operation Theater. Throughout my career I have been fortunate enough to

participate in mentorship, administration, decision making, implementing innovative

ideas, committees. This has all been possible because of the support from the

authorities and management .My institution has given me the opportunity to handle a

responsible part in the licensing and accreditations like ISO & JCIA.

In Conclusion, Nurses today have the opportunity, even the obligation, to

ensure and enhance both autonomy and CONP by influencing social, political, and

economic factors related to their practice. Nurses can promote and expand their

autonomy and CONP by publicly identifying their unique expertise in health and


Page 6

patient care in easily understandable terms in a way that shows the value of their

nursing expertise. Nurses need to communicate that their work involves an exclusive

knowledge base and skill set that is different from and even unknown by physicians.

Reference:

The 2016 International Nurses Day Kit

MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No1Jan2010/Enhan

cing-Autonomy-and-Control-and-Practice.html#Autonomy –The online Journal of Issues in Nursing by ANA

http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No1Jan2010/Enhancing-Autonomy-and-Control-and-Practice.html#Autonomy

http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No1Jan2010/Enhancing-Autonomy-and-Control-and-Practice.html#Autonomy


Page 7

Evidence - Based Practice

/ Nursing

Evidence- based practice (EBP) involves

complex and conscientious decision- making

which is based not only on the available evidence

but also on patient characteristics, situations, and

preferences. It recognizes that care is

individualized and ever changing and involves

uncertainties and probabilities.

Evidence- based Nursing (EBN) is the process

by which nurses make clinical decisions using

the best available research evidence, their clinical expertise, and patient

preferences. Three areas of research competence are :interpreting and using

research, evaluating practice, and conducting research. These three competencies

are important to EBN.

Why is best evidence and evidence based nursing important?

Ensures patient/ clients receive the care that fits their needs.

Facilitates sound decision making and makes it more explicit.

Minimizes risk to the patient/client so that benefits outweigh harm.

Provides the nurse with the skills and knowledge to evaluate healthcare

literature and practice.

Exposes gaps in knowledge and conflicts in evidence.

Ms. Priya M George

Head Nurse &

In - Charge - ICU & ER


Page 8

Key Components of EBP

Decisions about care are based on:

A. Research Evidence

Randomized controlled trials

• Laboratory experiments

• Clinical trials

• Epidemiological research

B. Clinical Expertise

Knowledge gained from practice

over time

Inductive reasoning


Page 9

Why is research Important for Evidence - Based Practice?

Develops empirical knowledge base

Identifies best practices that are based on clinical practices

Improves outcomes for:

- Patient and Family

- Nurse

- Health Care System

The Six Steps of Evidence-Based Practice

1.Assess the need for change: Formulate the research question based on the

inadequacies of current practice.

2. Locate the best evidence: Obtain sources and assess their credibility and

relevancy to the research question.

3. Synthesize evidence: Compare and contrast the available sources to find

similarities and differences in the various approaches taken.

4. Design the change: Apply the synthesized evidence to create a change in

practice that reflects the new understanding.

C. Patient Values, Circumstance

• Unique preferences, Expectations ,

Financial resources, Concerns,

Social Support


Page 10

5. Implement and evaluate: Apply the necessary changes and assess the changes

to acquire new evidence.

6. Integrate and maintain changes: Reassess based on new evidence to continue

improvement.

The steps of EPN

1. Cultivate Spirit of Inquiry

2. Ask Clinical Question (PICOT.

3. Search for and Collect Relevant Evidence.

4. Critically Appraise the Evidence.

5. Integrate the Evidence

6. Evaluate Outcomes.

7. Disseminate Outcomes.


Page 11

Conclusion

All nurses should be skilled in reviewing and evaluating current findings to

determine if they are applicable to their practice setting.

Evaluation is important for determining whether or not a theory is

pragmatically adequate.

Advanced practice nurses should be leaders in evaluating, translating, and

helping others utilize theories.

"

In Nursing, best research evidence refers to methodologically sound, clinically

relevant research about the effectiveness and safety of nursing assessment

measures, the power of prognostic markers, the strength of causal relationships, the

cost - effectiveness of nursing interventions, and the meaning of illness or patient

experiences".


Page 12

"With Evidence-based practice the nurses can provide quality health care

services to all people in need are the ethical and professional responsibility of

nurses. As committed, innovative and solution-oriented professionals, nurses

continue to provide care with resilience and versatility even with little or no resources

or organizational support. However, improving health systems’ resilience requires

intersectoral efforts by all actors at all levels. Nurses, who deliver the majority of

health care services in collaboration with colleagues in both health and non-health

sectors, have an important role in this process".


Page 13

Determinants and Drivers of

Increased blood glucose level

in a selected population

in Middle East

BACKGROUND

About 29 million people or 9% of all US adults had Type-2 diabetes in

the year 2012. A strong correlation has been established between a high BMI and

development of Type-2 diabetes, a study of more than 7000 British Man. The results

which are published in the Journal Circulation found that cutting back on sugar will

reduce blood pressure.

This is news even for people without diabetes since blood glucose levels tend

to rise as we grow older. The findings suggest that exercising to improve blood sugar

levels could be a way for some people to slave off the normal cognitive decline that

comes with age. Obesity, a global health problem, has been identified as the most

important risk factor for hypertension and diabetes. Obese persons have a

significantly higher risk of hypertension and type 2 diabetes.

In the Hong Kong Cardiovascular Risk Factor Prevalence Study, only 42% of

people with diabetes had normal blood pressure and only 56% of people with

hypertension had normal glucose tolerance. In the US population, hypertension

occurs in approximately 30% of patients with type 1 diabetes and in 50% to 80% of

patients with type 2 diabetes. A prospective cohort study in the United States

reported that type 2 diabetes mellitus was almost 2.5 times as likely to develop in

subjects with hypertension as in subjects with normal blood pressure .An increase in

body fat is generally associated with increased risk of metabolic diseases such as

Ms. Clamency Thomas

Inpatient In-Charge


Page 14

type 2 diabetes mellitus, hypertension. However, not all overweight or obese

patients have metabolic diseases, and vice versa.

BMI is calculated from height and weight, measured using standardized

examination protocol, above 25 is considered as overweight. The high blood

pressure over 140/90 milliliters of mercury is linked to an increased risk of Type-2

diabetes. The normal plasma glucose level is considered as 140 mg/dl above that is

considered as high.

STUDY

The population of interest of this study is adults those who are working in free

zone, Jebel Ali, Dubai, data were randomly obtained from 100 individuals on World

heath day 2016 .The personal heath records were prepared for all samples

consisting of needed variables .The BMI, blood pressure, and random blood glucose

were measured by registered nurses using standard devices. We compared

demographic, clinical and baseline BMI of these individuals. Study participants were

between the age group of 23 years and 63 years meanwhile most of them are males.

Picture -1Depicts among 100 samples, 18 of them are having increased blood glucose level

between the age group of 23 years and 59 years.

Normal blood glucos level

Increased blood glucosel


Page 15

Picture - 2. Out of 100 people, 56 are maintaining normal blood pressure but 44 person's

reading shows increased levels (pic-2).

Picture - 3. The age of selected population categorized in to two groups, that is above and

below 40 years. The 46 participants were above 40years, remaining persons are below 40

years, represented in Pic-3.

Age above 40 years

Age below 40 years

Normal blood pressure

Increased blood pressure


Page 16

RESULTS

We compared the data obtained during this study and it reflects the

relationships among the variables. Our findings potentially mirror there is an

enormous connection between increased blood glucose level and high BMI. About

83% of the population with increased blood glucose level is having BMI above 25

(Pic-4a). At the same time, more than half of the participants with increased blood

glucose level have increased blood pressure (Pic-4b). Most of the population (60 %)

with increased blood glucose is above 40 years (Pic-4c).

We found a positive association between BMI and the risk of being diagnosed

with Type 2 DM. Similarly, the prevalence of increased blood glucose levels also was

high in patients with increased blood pressure. The occurrence of increased blood

glucose level is more evident in people, those who are above 40 years.

Pic-4

Pic-4a Pic-4b Pic-4c

BLOOD SUGAR LEVEL BLOOD SUGAR LEVEL BLOOD SUGAR LEVEL

BMI Increased blood pressure level Age

0

2

4

6

8

10

12

14

16

18

2018 18 18

15

1011


Page 17

ACKNOWLEDGEMENT

“I am indebted to chiefs of JAFZA, Dubai for allowing us to work in their area.

This study would not have been possible without the assistance of Dr. Ali Hassan

and Piljo. P Paul RN – Infection Control Nurse. I thank my superiors Ms. Priya

George and Ms. Reena Samuel for their great support .With great pleasure, my grant

deal of thanks to my colleagues in CEDARS Jebel Ali International Hospital. This is

just an attempt to study the determinants factors leading to Diabetes and its

association with BMI and blood pressure.”

REFERENCES:

1; Adam TC and Epel ES: Stress, eating and the reward system. Physiol Behav 2007, 91:449-58. |

Article | PubMed.

2; Bakari AG, Onyemelukwe GC, Sani BG, Aliyu IS, Sani SH and Aliyi TM: Relationship between

Random Blood Sugar and Body Mass Index in an Africa Population. Int’L J Diabetes Metab. 2006,

14:144-145. |

3; Flegal KM. Excess deaths associated with underweight, overweight, and obesity. JAMA.

2005;293:1861–7. [PubMed].

4; Stamler J. Epidemiologic findings on body mass and blood pressure in adults. Ann Epidemiol.

1991;1:347–362. 5;http://www.hoajonline.com/hoajbiology/2050-0874/2/4

http://dx.doi.org/10.1016/j.physbeh.2007.04.011

http://www.ncbi.nlm.nih.gov/pubmed/17543357?dopt=Citation

http://www.ncbi.nlm.nih.gov/pubmed/15840860

http://www.hoajonline.com/hoajbiology/2050-0874/2/4


Page 18

Effective Communication

in Nursing

Good communication between nurses and patients is essential for the

successful outcome of individualized nursing care of each patient. To achieve this,

however, nurses must understand and help their patients, demonstrating courtesy,

kindness, and sincerity. Also, they should devote time to the patient to communicate

with the necessary confidentiality, and must not forget that this communication

includes persons who surround the sick person, which is why the language of

communication should be understood by all those involved in it. Good

communication also is not only based on the physical abilities of nurses, but also on

education and experience.

Ms. Remya Tinu

OPD Coordinator


Page 19

There are two types of communication that are verbal and nonverbal. Verbal

means Face-to-face, telephone, radio or television and other media. Non-Verbal

means our body language, gestures, how we dress or act.

Honesty is your best bet. Whether you are talking to patients or your co-

workers, it is always best to communicate with honestly. Of course, there may be

times you would be overstepping your role to discuss everything with your patients.

Some information is up to the physician to discuss. But instead of giving a false

answer, let the patient know whatever they are asking will have to be answered by

their doctor.

The Communication Process

The term communication process refers to the exchange of information

between two or more people. These are different models of the interpersonal

communication process, but here are some of the key elements:

The sender or communicator (the person who initiates a message)

The receiver or interpreter (the person to whom a message is directed)

http://grammar.about.com/od/rs/g/Sender.htm

http://grammar.about.com/od/rs/g/Receiver.htm


Page 20

The message (the verbal or non verbal content that must be encoded by the

sender and decoded by the receiver)

The channel (the medium by which the message is delivered and received)

The context (the setting and situation in which communication takes place)

Noise (anything that interferes with the accurate expression or reception of a

message)

Feedback (a response from the receiver indicating whether a message has

been received in its intended form)

Use SBAR to Improve Communication

SBAR technique provides a standardized framework for communication between

members of the health care team about the patient condition.

Appropriate SBAR Situation

Effective communication and teamwork have been identified in the literature

as key enablers of patient safety. The SBAR (Situation-Background-Assessment-

Recommendation) process has proven to be an effective communication tool in

acute care settings to structure high-urgency communications, particularly between

physicians and nurses; however, little is known about its effectiveness in other

settings.

http://grammar.about.com/od/fh/g/Feedback.htm


Page 21

SBAR Communication Template in CEDARS Jebel Ali International Hospital

Tools for Improvement

How to improve

How to use extra net

A guide to mortality measurement

How to use trigger tools

Reducing patient identification errors

Effective Communication skills

Looking and listening for cues

Asking open questions, for example'' How are you?”

Asking open questions about feelings

Asking open direct questions

Using pauses and silences

Clarifying

Barriers to effective communication

Environment – high workload, lack of time, lack of support, staff conflict.

Fear and Anxiety – related to making patient more distressed by talking or

asking difficult questions.

Other barriers- not having the skill to cope with difficult reactions, thinking “it is

not my role” and the patient is bound to be upset.


Page 22

CONCLUSION:

Effective communication is a core skill for all healthcare professionals and

nursing staff in particular since nurses spend more time with patients and relatives

than any other health profession. Developing rapport is integral to promoting good

patient care. Supportive relationships with patients and carers grow from contact with

warm, genuine and caring healthcare professionals. When nurses communicate

effectively with interest, listen actively and demonstrate compassion, patients may be

more likely to report their experiences as positive, even at times of distress and ill

health. Nurses have an important role in the care of patients and their loved ones in

a variety of healthcare settings. Therefore, every point of contact can be an

opportunity to improve patient care and relationships using effective communication.

REFERENCES

http://journals.rcni.com/doi/pdfplus/10.7748/ns.29.14.53.e9355 & CEDARS Hospital Document

http://journals.rcni.com/doi/pdfplus/10.7748/ns.29.14.53.e9355


Page 23

Angels on Earth

Nurses are the angels on earth. God sent the angels to earth to care for the others

and that's why angels are born. The life cycle of the human being is going through

the angels hands, at the time of birth nurses are receiving the baby first and the end

of the life angels are closing the eyes of the human.

Being an angel we have certain roles in our life. The meaning of NURSE is

N- Nourishes

U- Usefulness

R- Resourcefulness

S- Simplicity

E- Empathy

Nourishes / nourishing

A nurse is a person who is trained and skilled to take good care the sick or ill

persons. The word says nourishes, the nurse who always nourishes other with her

caring ability. She or He is always encouraging, nourishing, and motivating others.

Nurse’s character and behavior can influence patient’s life especially on who were

Ms. Blessymol Cherian

Outpatient Unit - RN


Page 24

on a long stay or were in ICU. As a nurse, we have the opportunity to heal the heart,

mind, soul and body of our patients, their families and ourselves. They may not

remember your name but they will never forget the way you made them feel.

Usefulness

The angels were born to help others in their sad & bad situations, so are the

nurses; to help the people those who are in need. They are spending most of their

time to care for others even if they are complete strangers. Only medical

professionals can consider others as a family member and can make them feel that

they are a part of the family. Even though these angels are facing so many problems

in their own life; before starting their duty some supernatural power fills them and

they forget their personal problems and make others life colorful and seeing that

we bring joy to our life and content.

Resourcefulness

The nurse always has resources what they learned or skilled from. So that

even if in their own home setting also they are handling all emergency and

managing injuries .They are using their resources to care others, neighbors and

those who are in need.

Simplicity

The nurse’s life is always simple; even our white uniform represents peace

and simplicity. Nurses are always leading the simple life and show simplicity in their

character and attitudes. They are a good listener, slow to anger, solving problems in

an efficient manner and the important character is even though they were hurt by

others, they will forgive them easily and will always be there for them in helping or

caring them according to their needs. Angel’s hands are specially created by God

and this is the reason our therapeutic touch makes the patient sudden relief from

their anxiety and depression. Therapeutic touch says that “We are always with you

when you need.


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Empathy

Nurses dispense comfort, compassion, and caring without even a

prescription. This is the character which makes us different from other professionals.

If we look in the outside world, so many emergencies or accidents happen, nobody

will be bothered about it or will be ready to give immediate attention .Being a nurse,

those who are ill or sick even though we don’t know they don’t belong to our family or

friends, and then also we are caring them all impartially. This same occurs during our

off-duty hours and throughout our life. Empathy is always reflecting in our life and we

go an extra mile to keep people comfortable both in professional and personal life.

"I am proud to be a nurse and of all others those who have chosen such a

noble profession. As a nurse, we can make a difference in our world. We can change

the world into a beautiful place. Without doctors and nurses, the hospital won’t run.

Doctors are the God on earth and Nurses are the angels on earth. In our CEDARS

family we, nurses start our work with praying together every day and we believe that

spiritual healing is always flowing from our hands which can make the life colorful of

the people whom we come in contact daily. "


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A Journey from

Infection Control to Infection

Prevention - A Wake up Call

Mr. Piljo P Paul

Infection Control Nurse

A tribute to a Lady with the Lamp founder of modern

nursing

Florence Nightingale

12 May 1820 – 13 August 1910

History – Infection Control Concept

The scientific study of a hospital or nosocomial cross-infection began during

the first half of the 18th century, and from that time until the start of the

'Bacteriological Era' many of the most notable contributions originated in Scotland.

However it was only 100 years later in 1858 that Florence Nightingale promoted the

case for hospital reform. The real understanding of hospital infection followed upon

the discoveries of Pasteur, Koch and Lister and the beginning of the 'Bacteriological

Era'. The close of the 19th century saw the triumphs of hospital reform and asepsis

and seemed to herald the final victory over hospital cross-infection. However, the

victory was short-lived. It was soon realized that infections occurred not only in

obstetric and surgical patients but in medical patients as well and that air could also

be a source of infection. Streptococcal, staphylococcal and then Gram-negative

bacilli as a cause of hospital infection became a focus of attention, as did antibiotic-

resistant organisms.

This paper looks briefly at the establishment of the control of infection doctor,

infection control committee and infection control nurse as well as summarizing the

changes, problems and advances in infection control up to the present time.

https://en.wikipedia.org/wiki/Nursing


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Present - Infection Control Concept

Future - Infection Control Concept

It's undeniable that the role and responsibilities of today's infection prevention

(IP) bear little resemblance to the infection control practitioner of the past. While the

core tenets of infection prevention and control carry over as the foundation of the

profession, the expectations for the position itself have evolved such that a new

framework is needed to help professionals respond to these demands. With many

months of tireless work behind it, the Association for Professionals in Infection

Control and Epidemiology (APIC) is unveiling not only an updated strategic plan that

articulates the association's vision for the future through 2020 but a set of

professional competencies that will help IPs chart a corresponding course for their

professional development.

1. Patient safety goal

2. Implementation science goal

3. IP competencies and certification goal


Page 28

4. Advocacy goal

5. Data standardization goal

6. Improvisations (Ex: Merging of Housekeeping Department to Infection Control

Department in hospital settings., there after housekeeping staff will be named as

Infection controllers which is already implemented in CEDARS Jebel Ali

International Hospital - Dubai)

Conclusion – Resilience in Infection Control

Hand washing Compliance rate is 40 % (Globally)

Influence of Conventional Practices

Lack of Researches

Lack of Improvisation

Resources

Knowledge

Communication Barriers

Infection Control is the responsibilities of everyone, who are responsible for a

patient care even in direct or indirectly. Speciality nursing departments are booming

up to enhance the quality of nursing care. Infection control Nursing is the most

indelible and backbone of Nursing.

All health care professionals who have a clinical responsibility for patients

must include infection prevention and control as part of their everyday practice. All

health care staff should receive mandatory infection control training as part of their

induction and on an ongoing annual basis. It is particularly important that knowledge

and skills are continually updated.


Page 29

Mr. Arun Almeida

Inpatient Unit - RN

Post-Traumatic

Stress Disorder

Introduction

PTSD can occur after experiencing or witnessing traumatic events such as

military combat, natural disasters, serious accidents, terrorist attacks, violent deaths

and personal assaults, including rape and other situations in which the person felt

extreme fear, horror or helplessness.

PTSD can affect anyone. It's common and affects around 5% of men and 10%

of women sometime in their life. It can happen at any age, including in childhood.

Symptoms usually develop immediately or within three months of a traumatic

event, although, occasionally, they do not begin until years later.

PTSD has been called shell shock or battle fatigue syndrome because it first

came to prominence in the First World War, with soldiers' memories of the trenches.

The term post-traumatic stress disorder was first used after the Vietnam War.

It was formalized in 1980 when it was included in the Diagnostic and Statistical

Manual of Mental Disorders, which was developed by the American Psychiatric

Association.


Page 30

Symptoms of PTSD can include:

flashbacks, nightmares or frightening thoughts, especially when exposed to

anything reminiscent of the traumatic event,

avoidance of reminders of the event and a refusal to discuss the experience,

numbness and feelings of estrangement or detachment from others,

inability to remember aspects of the traumatic event,

decreased interest in life,

increased consciousness of one's own mortality,

problems with concentration,

problems with sleeping,

irritability or outbursts of anger,

hyper-vigilance and alertness to possible danger,

re-experiencing the traumatic event,

feelings of guilt,

long-term behavioral effects,

alcohol abuse, drug dependency,

failed relationships/divorce,

severe depression, anxiety disorders or phobias,

chronic illness headaches, stomach upsets, dizziness, chest pain and general

aches and pains, together with a weakened immune system, and

Employment problems.

Causes of post-traumatic stress disorder

It is not yet completely understood why certain people develop PTSD after a

traumatic experience, and others do not. However, there are some risk factors which

seem to make PTSD more likely to happen to some people. For example, if you

have already had depression or anxiety, or you have not had a lot of support from

family or friends, you are more susceptible to the condition.

Having a parent who had a mental health problem or experiencing abuse as a

child can also be risk factors.


Page 31

There may also be a genetic factor involved, so some people will be more

likely to develop PTSD. The hippocampus (part of the brain that is important to

memory and emotions) appears different in MRI scans in those with PTSD.

Researchers believe that changes in the hippocampus are related to memory

problems and flashbacks.

Studies have also shown that in people with PTSD, there are abnormal levels

of hormones involved in their response to stress. People in danger normally produce

natural opiates. These chemicals trigger a reaction in the body when put under

extreme stress or into a fight or flight situation. They deaden the senses and dull the

pain. It has been found that people with PTSD continue to produce high levels when

there is no danger. This may cause them to have feelings of detachment and blunted

emotions.

Diagnosis

Diagnosing post-traumatic stress disorder

Psychiatrists / psychologists can diagnose PTSD by discussing all your

symptoms with you. They will need to know various things, such as your feelings,

your overall health, and how you are sleeping.

Often they will use a specially-designed questionnaire to help them diagnose

PTSD. It can include questions such as; have you had difficulty remembering the

event? Or have you felt distant or cut off from other people.

Treating post-traumatic stress disorder

Treatment for PTSD usually begins with a detailed evaluation, and a

treatment plan is then tailored to your individual needs. It is never too late to ask for

help - PTSD is still treatable years after the traumatic event.

Psychiatrists/psychologists you see should always treat you with sensitivity

and understanding, and should explain your treatment plan to you clearly. For

treatment to be effective, it is important that you and your family understand that


Page 32

PTSD is a medically recognized anxiety disorder that happens to some people after

an extremely traumatic experience.

PTSD is often treated with psychotherapy, medication, or a combination of the two.

• Cognitive-behavioral therapy (CBT) - includes learning skills that help you

to change negative thought processes. It also includes the use of mental imagery of

the traumatic event to help you work through the trauma, and to gain control of the

fear and distress.

• Eye movement desensitization and reprocessing (EMDR) - this involves

making several sets of side-to-side eye movements while recalling a traumatic

incident. This appears to help reduce distress for many with PTSD. EMDR helps you

to have more positive emotions, behavior, and thoughts.

• Medications - the most widely used drug treatments for PTSD are the

selective serotonin reuptake inhibitor (SSRI) such as paroxetine. These medications

may also be prescribed to help reduce associated symptoms of depression and

anxiety and help ease sleep. Benzodiazepines are effective against anxiety,

insomnia, and irritability, but are now used with great caution because of the high

incidence of substance dependence in people with PTSD. These medicines can,

however, rapidly relieve any feelings of anxiety triggered by PTSD.

How Nurses can help?

An effective treatment plan is crucial to helping PTSD patients. Since most

patients with PTSD report sleep disturbances, leaving them tired the next day, a

treatment plan should focus on helping the patient regain their restorative sleep.

Some patients fall asleep easily and then wake up in the middle of the night, while

others have nightmares making it nearly impossible for them to get any rest.

Nursing Priorities

1. Provide safety for client/others.

2. Assist client to enhance self-esteem and regain sense of control over feelings /


Page 33

actions.

3. Encourage development of assertive, not aggressive, behaviors.

4. Promote understanding that the outcome of the present situation can be

significantly affected by own actions.

5. Assist client/family to learn healthy ways to deal with/realistically adapt to

changes and events that have occurred.

6. Assess degree of anxiety/fear present, associated behaviors, and reality of

threat perceived by client.

7. Maintain and respect client’s personal space boundaries (approximately 4-foot

circle around client).

8. Develop trusting relationship with the client.

9. Identify whether incident has reactivated preexisting or coexisting situations

(physical/psychological).

If you've been diagnosed with PTSD:

Remember that emotional distress after a trauma is perfectly normal.

Give yourself time to get over it.

Let family and friends help take care of you.

If you're struggling, don’t be afraid to speak to your doctor.

Because

PTSD is not about what is wrong with you.

It is about what happen to you.


Page 34

ECG- NURSE PERSPECTIVE

Here there is an attempt to focus the perspective of

nurse to do ECG effectively. ECG interprets the electrical

activity of heart muscles, which will determine the conduction

system of heart.

Here we have 10 leads to be attached to patient (6 chest

leads and 4 Limb leads).

How its turn to 12 lead ECG ?

This was a quiet confusing question for me during my

curriculum.

Willem Einthoven was a Dutch Doctor and

Physiologist. He invented the first practical

electrocardiogram (ECG or EKG) in 1903 and received

the Nobel Prize in Medicine in 1924. Willem Einthoven

21 May 1860 – 29 September 1927

Mr. Sumesh Mohanan

Emergency Dept. - RN


Page 35

The triangle is composed of Leads 1 2 and 3 forming the shape .Leads aVR,

aVL and aVF perpendicularly intersect each side to the triangle .These six leads can

point a large picture of patients overall cardiac health. The limb leads are bipolar

meaning they have positive pole and negative pole.

Lead I extends horizontally from the Right arm to Left arm.

Lead II forms one of the vertical arms of the triangle and stretches from the Right

hand to Left Leg.

Finally Leads III forms the other vertical arm to Left Leg.


Page 36

Always remember three aspects while taking ECG

D E P

D- Dislodgement of Leads

E- Equipment Failure

P- Patients problems

BEFORE TAKING ECG

Verify the Instruction for ECG, it prevents potential error.

Confirm by ID band, it Ensures client safety.

Wash hands ,it reduce the transfer of micro organism

Explained the procedure to patient and provide privacy.

Ensure the machine is working

Check the paper speed is set 25mm/second

Place the patient in supine position

Ask the patient to Relax and breath normally

Select the fleshy areas to place the limb leads, avoid bony areas, tissue

conducts more effectively than bone.

Excess hair should be removed, we can take Verbal consent.

DURING THE PROCEDURE

Tell the client to lie still and not to talk When record ECG.

Patient is trembling or shivering make sure feet are not touching the bed

board.

Check the quality of ECG, if any muscle tremor or respiratory swing, repeat

ECG.


Page 37

AFTER THE PROCEDURE

Ensure date and time, patients name clearly visible on the ECG.

If patient needs repeat ECG, leave the electrodes in place.

Remove the electrodes

Clean the hands after use.

Check any allergic reaction on the skin.

SPECIAL CONSIDERATION

When recording an ECG from females, chest leads (v4, v5 and v6) are placed

beneath left breast.

If the client has pacemaker we can perform ECG with or without magnet, be

sure to note the presence of pacemaker and the use of magnet on the strip.

When obtaining ECG in older adults, remove the electrodes carefully to

prevent tearing of skin.


Page 38

HOLISTIC

NURSING

Development of Holistic

Nursing by Florence

Nightingale

History is one of the most important aspects of any profession. Modern

nursing has a proud heritage through its founder, Florence Nightingale, who lived

from 1820 to 1910.Nightingale was a mystic, visionary, healer, reformer,

environmentalist, feminist, practitioner, scientist, politician and global citizen. Her

achievements are astounding when viewed against the backdrop of the Victorian

era, and her contributions to nursing theory, research, statistics, public health, and

health care reform are invaluable and inspirational as a brave risk-taker, Nightingale

possessed uncommon vision, focus, dedication, and commitment. Her tenets of

healing, leadership, and global action provide us with her vision for a healthy world.

Holistic nursing is generally defined as all nursing practice that has healing

the whole person as its goal. A holistic nurse is a licensed nurse who takes a “mind-

body-spirit-emotion-environment” approach to the practice of traditional nursing.

Ms. Jency Justus

Inpatient Unit - RN


Page 39

The practice of holistic

nursing requires nurses to integrate

self-care, self-responsibility,

spirituality, and reflection in their

lives. This may lead the nurse to

greater awareness of the

interconnectedness with self, others,

nature, and spirit. This awareness

may further enhance the nurses

understanding of all individuals and

their relationships to the human and

global community, and permits

nurses to use this awareness to facilitate the healing process.

STANDARDS OF HOLISTIC NURSING PRACTICE

The standard of nursing

practice reflects the five core values

of holistic nursing.

Engage in activities that

respect, nurture, and enhance the

integral relationship with the earth

and advocate for the well being of

the global community economy,

education, and social justice.

Advocate for the rights of

patients to have educated care of

plan.


Page 40

“HOLISTIC NURSING is not just a Career, It’s an Adventure”

HOLISTIC NURSING isinaprime

positiontomovefurtherforwardwith

analreadyevolvedinnovativeand

creative holisticnursecoachmodelof

careonethatisdesignedtofully

engageclientsinselfcareandthe

managementofindividualhealthcare

practicesandoutcomes.

Holistic nursing is not necessarily something that you do: it is an attitude, a

philosophy, and a way of being. These and other influences, such as research

linking the mind and body and an emphasis on patient-centered care, have affected

the development of holistic nursing.

American Holistic Nurses Association (AHNA) was founded in 1980 to serve

as a voice for holistic nurses and to promote the education of nurses and others in

the philosophy, practice, and research of holistic caring and healing.

The American Holistic Nurses Certification Corporation (AHNCC) was

founded in 1997 to credential holistic nurses. AHNCC has a collaborative

relationship with AHNA to advance the role of holistic nursing and to provide

educational opportunities in holistic nursing.

We are at a time in history where we must transform the health care structure

from a disease management industry to a healing system. As nurses, our role today

is key to the future of health care. How do you want to actively contribute to these

dynamic changes that will impact the practice and the image of professional nursing,

and the healing of society?

Can holistic nursing can be delivered in today’s health care environment?

Yes! But nurses must understand what holistic nursing is and what is involved in


Page 41

holistic care. Although the face of modern health care has changed, the essence of

Florence Nightingale’s message for holistic nursing and holistic care remains the

same.

“A part of Nightingale's wisdom resides within each of us.”


Page 42

NURSING THEORIES

INTRODUCTION

Nursing theory provides a perspective from which to define the what of

nursing, to describe the who of nursing (who is the client) and when nursing is

needed, and to identify the boundaries and goals of nursing’s therapeutic activities.

Theory is fundamental to effective nursing practice and research. The

professionalization of nursing has been and is being brought about through the

development and use of nursing theory. The basic elements that structure a nursing

theory are concepts and propositions.

IMPORTANCE OF NURSING THEORIES; In Clinical Practice

Nursing theories provide a framework for thought in which to examine

situations. As new situations are encountered, this framework provides a structure

for organization, analysis, and decision making. In addition, nursing theories provide

a structure for communicating with other nurses and with other members of the

health care team. Nursing theories assist the discipline of nursing in clarifying beliefs,

values, and goals, and they help to define the unique contribution of nursing in the

care of clients.

COMMON CONCEPTS OF NURSING

Four concepts common in nursing theory that influence and determine nursing

practice are: 1-The person (patient) 2-Environment 3- Health and 4- Nursing each

of these concepts is usually defined and described by a nursing theorist, and

although these concepts are common to all nursing theories, both the definition and

the relations among them may differ from one theory to another. Of the four

Ms. Jiji George

Inpatient Unit - RN


Page 43

concepts, the most important is that of the person .The focus of nursing, regardless

of definition or Theory, is the person.

METAPARADIGM CONCEPTS

USES OF NURSING THEORY

Theory guides and improves nursing practice.Theory proides goals for nursing

care and with goals; nursing practice is rendered more effective and efficient.

Primary use of theory is to guide research. Theory enhances communication; theory

contributes to the development of desciplines body of knowledge.

TYPES OF NURSING THEORIES

Grand Theories

Middle Range TheorieS

Descriptive Theories

Prescriptive Theories


Page 44

THE CHARACTERSTICS OF THEORIES

Theories are;

Interrelating concepts such a way as to create different way of looking at a

particular phenomenon

Logical in nature

Generalizable

Bases for hypotheses that can be tested

Increasing the general body of knowledge within the discipline through the

research implimented to validate them.

used by the practitioners to guide and improve their practice

Consistent with other validated theories, laws, and principles but will leave

open unanswered questions that need to be investigated.


Page 45

Defined Nursing: The act of utilizing the environment of the patient to assist him in

his recovery.'

Focuses on changing and manipulating the environment in order to put the

patient in the best possible conditions for nature to act.

Identified 5 environmental factors: fresh air, pure water, efficient drainage,

cleanliness/sanitation and light /direct sunlight.

Considered a clean, well-ventilated, quiet environment essential for recovery.

Deficiencies in these 5 factors produce illness or lack of health, but with a

nurturing environment, the body could repair itself.

CONCLUSION

We have seen that these models continue to use the nursing process as the

core for decision making in determining if nursing care to clients is meeting the

expected outcomes as estabilished by the clinical pathways.Applying these theorists

views is a challenge and it provides opportunity for meaning ful nursing practice.

Common concept in nursing Theories:

Four concepts common in nursing theory that influence and determine nursing

practice are:

1-The person (patient) 2- Environment 3- Health and 4- Nursing. Each of

these concepts is usually defined and described by a nursing theorist, and although

these concepts are common to all nursing theories, both the definition and the

relations among them may differ from one theory to another of the four concepts.

The most important is that of the person. The focus of nursing, regardless of

definition or Theory, is the person.


Page 46

VITAL ASPECTS OF NURSING -

CRITICAL THINKING, LEADERSHIP IN

NURSING

“The Nurses need more than the ability to be better observers,We must know

how to apply everything we already know and feel,to evaluate our own thinking and

especially to change our behaviour as a result of thinking critically”

Critical thinking is an active, organized, cognitive process used to carefully

examine one’s thinking and the thinking of others.

The critical aspects of caring is the essence of nursing,promoting client

health,enhancing individual growth and stimulating coping.A process for identifying

underlying assumptions and variables in order to draw conclusions and make

decisions.

Critical thinking involves the use of several concepts, including: exploring,

analyzing, prioritizing, explaining, deciding, and evaluating to identify solutions

and determine a course of action to solve patient care problems.

Exploring encourages you to identify all the variables within a situation.

Analyzing is the process of studying each variable to understand its meaning and its

relationship to the other variables.

Ms. Josily Jacko

ICU & ER - RN


Page 47

Prioritizing requires you to weigh the relative importance of each variable to the

others.

Explaining the variables involves make an idea regarding each variable to

understand its meaning in the situation.

Deciding means to choose a specific course of action.

Evaluating requires the thinker to assess how correct the thinking process was, and

if further action is needed.

CRITICAL SPIRIT IS AS IMPORTANT AS SKILL IN CRITICAL THINKING

The critical spirit requires one to think critically about all aspects of life,to think

critically about one's own thinking and to act on the basis of what one has

considered when using critical thinking skills.

Critical thinking cannot occur in a vaccum, it requires individuals to apply what

they know about the subject matter as well as their common sense and experience.

Managing Time

Effective leaders use successful strategies for time management.

Effective leaders use self dicipline to organise these task and assign priority to

projects that produce results.There is a time management matrix that provides a

guide for understanding the relationship between important,not important,urgent and

non urgent activities

A Leader can use this matrix to priortise task and responsibilities,therby

reducing time wasted on non urgent activities.


Page 48

Delegation Skills are critical to a leader’s ability to manage time.

MANAGING CHANGE

Critical care leaders must respond to new regulations changing economic conditions

and consolidations. Implementing and responding to change requires that leaders be

able to evaluate the change process.

Deming’s model of change:

Plan- Do- Study- Act is prevalent in health care organisations;

1. Plan- Identify and clearly define the problems

2. Do- Develops and implements a solutions


Page 49

3. Study- Analyse a problem, identify the root cause, and map the process

and what affects it

4. Act -Evaluate the result

CONCLUSION

As a nurse, we are expected to think more effectively in workplace

overcoming the unique obstacles.So we are expected to take responsibilities and

direct our thinking towards our most important goals and purposes.


Page 50

Nursing Specialties

Nursing - A growing

profession

Abstract. In the modern world there are number of nursing specialities.

Professional organisations or certifying boards issues voluntary certifications in many

of these specialities .After finishing nursing school choosing right nursing speciality

becomes their chief focus with so many specialities to choose from.

The beginning was with health and healing belief of ancient civilization,

superstitions and black magic. Injuries from wars and other triagic event were

treated. Biblical records show Jesus healing the wounded and infected. Health care

is beginning at 19th century from that general nursing developed; any body could

freely describe themselves as nurses and call what they did as nursing until general

nursing council register became operational

Florence nightingale – LADY WITH THE LAMP in 1860 laid the foundation of

professional nursing when the first school of nursing was established. Now a days

we have so many specialities in nursing .All specialities have its own importance for

example ambulatory care in community, Burns care nurse, cardiac nurse, cath lab

nurse, paediatric nurse, critical care nurse, oncology nursing etc. By choosing one of

these specialities the nurse can focus on their own field of interest .This

specialization will help to learn more detail about the area and earn more knowledge.

A clear description of the specialty nursing practice assists the larger community of

nurses, healthcare consumers, and others to gain familiarity and understanding of

the nursing specialty. There are many courses to learn speciality, after taking the

bachelor degree, nurses can choose the speciality and do the master degree

Ms. Lekshmi S G

Pediatric RN


Page 51

courses .On other hand there are so many diploma courses also like diploma in

neonatal care, neurology, cardiac care, diploma in emergency care etc.

The nursing field has seen explosive growth in recent years, and this should

continue for the foreseeable future. In reality, there is actually nursing shortage in

many specialties. In future we can see so many specialities like an informatics nurse

who collects, interprets and analyzes important medical data that comes into a

health facility every day. An informatics nurse also often trains other nurses in the

hospital on any new technology that is being introduced. Informatics nurse often

work for hospitals, pharmaceutical companies and government agencies. The

demand in this field is still growing, but the few nurses who have these specialized

skills will find themselves in strong demand.

Nurse anesthetists belong to one of the most prestigious and well-paid fields

in nursing. This field is in high demand and requires a high level of education,

training and experience. Nurse anaesthetists provide anaesthesia to patients who

are going into surgery. They also do patient care in the OR, and they provide follow

up care for many procedures that are done on an outpatient basis.

A pain management nurse is a type of advanced nursing profession that will

give you a great deal more responsibility, more skills and higher salary. Pain

management is such a vital part of the medical field, because alleviating chronic pain

is so important to improving the quality of life of patients. It also is very important to

help the patient to not become addicted to narcotics. A pain management nurse

works with the patient to determine what is causing the pain, and then works with

other medical professionals to determine the best course of treatment.

A travel nurse They are in general, relievers whenever a shortage of nurses

happens in a specific facility usually works for a nursing or health care agency.

These types of healthcare organizations provide nursing services to hospitals and

medical facilities to fill a short term need. A hospital might, for instance, have a few

nurses that are out on maternity leave and they need you to fill in for a couple of

months. A typical assignment is two months, but you might get assigned to one

facility for one or two years.


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Nurse Practitioner The state laws have different abiding rules for this

particular field, but nevertheless, all NP’s function with the same variety of duties as

that of a physician. A nurse is giving minor procedures without any physician around,

or giving medication orders in a hospital. Some are still governed by a licensed

physician though; while some are allowed to practice independently, but it really

depends on what state you are in. as much as that of. NP’s are like a nurse and a

physician all rolled into one, meaning, they give primary care, continuity of care, and

they work closely with the patient from admission to discharge. Plus they can

diagnose medical conditions and perform minor procedures as a physician would.

Clinical Nurse Specialist (CNS) Sometimes called an Advanced Practice

Nurse (APN), a CNS is more focused on one particular medical specialty, to name a

few, oncology, orthopaedics, paediatrics, etc. The scope of the CNS is wide, varying

from educating their department staffs and patient, participating in research,

maintaining and improving the quality of care provided by the staff, investigating

clinical errors, formulating an action plan to encourage efficiency and hospital

protocol implementation, go out on an outreach program in the community to

improve the health of the population by providing health education and evaluation of

the patient’s health, and function as a nurse manager.

CONCLUSION

The profession of nursing is continually evolving in conjunction with

healthcare consumer needs and desires, expanding healthcare and nursing

knowledge, and the evolution of healthcare delivery systems, and technologies. As

nurses focus their practice in new and different areas of health care, clear

statements of the scope of specialty nursing practice and standards of specialty

practice and professional performance help to assure continued understanding and

recognition of nursing’s diverse professional contributions.


Page 53

“ INNOVATION OF TECHNOLOGY

ENSURES RIGHT PATIENT

CARE AT RIGHT TIME ”

Around the globe, in every setting, technology has advanced at a rapid rate

and brought a tremendous change even in the health care sector.The nurses

introduce modern technology and skills to provide complete and comprehent care to

patients to keep them safe,help them heal and return to the highest possible level of

functioning.At a glance, we feel modern nursing is similar to what has been done for

years but there is also much advancement in modern nursing care as a

whole,allowing nurses to more efficiently and effectively do their job.

ENABLING THE ORDINARY: MORE TIME FOR PATIENT CARE

The modern equipments are not completely replace the workload of nurses,

but rather enhanced and expanded its capabilities.Today's nurses are at the centre

of health care delivery.It is very hard to know that nurses can spend only 31% of

their time on direct patient care.The rest?Paperwork.So the affordability and

accessibility of technology has brought many benefits,including less paparwork,

better treatment ,improved quality of life and higher life expectancy.The transition to

a paperless health care system is the chance for the nurses to shape the technology.

SAFE AND EFFICIENT CARE WITH TECHNOLOGY

Clinical Information Systems: These systems bring together an

organization's patient records, lab results, pharmaceutical data, medical research

resources and other information, providing nurses and other caregivers with

Naissy Philip

Inpatient Unit - RN


Page 54

integrated, PC-based tools to help them input and retrieve information.Clinical

Information Systems provide a common source of information about a patient’s

health history. These systems enhance the ability of nursing professionals to

coordinate care by providing a patient’s health information and visit history at the

place and time that it is needed

Electronic Health Records: Patient records in this format provide instant

access to a patient's medical history, improve communication between caregivers

and offer flags and alerts to prevent conflicts over prescriptions and tests.These

records can be shared across different health care settings.Electronic health records

may include a range of data, including medical history, medication and allergies,

immunization status, laboratory test results, radiology images, vital signs, personal

statistics like age and weight, and billing information.

Sphygmomanometer: Having an electronic blood pressure cuff that also

records the patient's heart beat is probably one of the greatest times saving tools

that technology has brought to nursing.We can get an accurate result quickly from

most electronic blood pressure monitors. We use different sizes of cuffs which help

to find a proper fit to ensure accuracy.

Vein Finders: Venipuncture procedures are too often takes too much poking

and prodding to find that elusive vein. Now, new technology and portable vein

viewers are making veins more visible, saving a lot of pain and problems for both

patients and nurses.Vein finder devices use special forms of light to find the veins

and it also displays veins beneath the surface.

IV monitor: Before the development of electronic IV monitors and IV pump

infusions, IV was administered under the watchful eye of a nurse. Because manual

Intravenous infusions were susceptible to stop or flow too rapidly so, a nurse

remained by the patient's side every time when they received an IV. When you

consider how common IVs are, it is easy to see how much time is saved with the

electronic IV monitor.

https://en.wikipedia.org/wiki/Immunization


Page 55

Medical Devices: Devices such as infusion delivery systems and ventilators,

often we feel that have "brains built into them,"These electronic brains assist nurses

by flagging problems and helping to avoid errors.

Robotic nursse: It is introduced in the health care delivery as a way to

address the shortage of health care worker.Nursing robots will be able to assist

caregivers with a number of tasks such as lifting, supporting elderly patients and

assist in surgeries.

Telenursing: Is the use of telecommunications and information technology on

delivary, management and coordination of health care and services within the domain

of nursing whenever there is a large physical distance exists between the nurse and

the patient or between the nurses.

Travel nursing: This nursing concept developed in response to shortage of

professionals. In this field nurse’s travel to different places especially in hospitals as

a temporory post in short term contract periodes.Travel nurses are expected to be

very experienced and knwoledgeable in the given speciality.

Digitalized world: Patient behaviors are also evolving in a digitalized world.

Patients are using online resources to research and treat their symptoms. Health and

wellness are consistently among the most searched-for topics on Google. Nurses will

need to double as health technology librarians, directing patients to trustworthy

websites and useful applications.

Today’s nurses aren’t just caring for the sick; they’re changing our very notion

of modern medicine and health care delivery. Nurses are giving information by

conducting conferences, publishing scientific research, developing mobile medical

applications, and actively addressing health care policy. They are collaborating the

technology, information and care inorder to provide the highest standard and quality

of care to the patient .Introduction of robost and sophisticated clinical information

system has prompted significant transformation in health care and focused greater

attention on patient safety and outcome.


Page 56

Frame of Triumph World Health Day 2016


Page 57

Frame of Triumph International Nurses Day -

Journal Inauguration

Frame of Triumph International Nurses Day - Debate

Frame of Triumph International Nurses Day - Tree

Sampling

Frame of Triumph International Nurses Day 2016


Established in 1999, CEDARS – Jebel Ali International Hospital is a full-fledged multi-specialty

hospital offering services ranging from Pediatrics to Occupational Health, Laparoscopic Surgery to

Internal Medicine. The Hospital is equipped with ICU for medical and surgical emergencies, with

two major and one minor operation theatres as well as with fully equipped Laboratory and

Radiology departments.

The CEDARS Training Center is a registered training provider with qualified and dedicated

instructors offering a wide range of courses for both individuals and companies. The training

center is committed to improving health and safety at home, at any public place or in the

workplace providing classes in Basic First Aid and Basic Life Support through an alignment with the

American Hospital Dubai, an American Heart Association (AHA) International Training Center.

Further attached to the hospital are the 24-hour-pharmacy, the CEDARS Clinic and Dr. Adnan

Kaddaha Clinic, opening soon in Dubai Motor City. Projects to expand the hospital structure and

add more services that enable CEDARS Jebel Ali International Hospital to become a comprehensive

healthcare provider are under way.

About CEDARS - Jebel Ali International Hospital

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