Sunday, 26 June 2022

WEIGHT, A DICEY AFFAIR


NB: This is work I had published previously on a different platform in 2021.

“Self-care is never a selfish act - it is simply good stewardship of the only gift I have, the gift I was put on earth to offer others. Anytime we can listen to true self and give the care it requires, we do it not only for ourselves but for the many others whose lives we touch.” Parker Palmer


 




Can you perform two minutes of effective CPR without feeling like you may need to be resuscitated too? Most of us dread it. We are so unfit that often it is the main indicator of our fitness level. We spend many hours taking care of others that we forget to care for ourselves. Two minutes of CPR have us breathless and on the verge of collapsing. If you don't believe me just steal a glance at your colleagues after they complete one cycle of CPR during a mega code.
Better still glance at your colleagues as you read this how many of them look fit? To correctly determine one's level of fitness we need to use quantitative measures and merely not visual inspection. After all, are we not the propagators of evidence-based practice? At this time, however,  just humour me and think about your colleagues. How many colleagues are complaining of fatigue yet it is just the start of the shift? How many are undergoing treatment for lifestyle-related conditions? Are you one of them? 




In a study done by Kyle et al. (2017) a quarter of nurses in England hospitals were considered obese. Comparatively, this was a lower figure than for nurses in Australia (28.5%), New Zealand (28.2%),15 the USA (27.0%), South Africa (51.6%) and Scotland (29.4%). What about Kenya? I think it is time we explore the figures.  




Often, the general population expects health workers to have lesser rates of obesity due to enhanced health awareness. However, from different studies such as the aforementioned one we realize that there isn't much statistical weight difference between the two cohorts.


The World Health Organization (2021) article on obesity states that most of the world's population lives in countries where overweight and obesity kill more people than being underweight. The article further details how the deaths related to being overweight and obese are a result of cardiovascular conditions, malignancies, and musculoskeletal disorders. This is quite concerning. So, what makes us be at risk?


Most studies link it to our uptake of longer shifts, notably nightshifts. However, it is not a clear-cut cause and effect due to the association of other confounding factors. Nonetheless, it would be a great area for further exploration. Below are links to some studies on this topic.

Shift work and abdominal obesity

Prevalence of overweight and obesity among nurses in Scotland

Obesity among the general population in South Africa

Prevalence of overweight and obesity among healthcare workers in Nigeria


 Some proposed reasons for the increased prevalence of overweight and obesity among health workers include.

  1. Adopting poor dietary habits is linked to frequent snacking and disproportionate caloric intake.
  2. Low recreational physical activity.
  3. Sleep deprivation- This leads to a decrease in leptin levels which is crucial in appetite suppression. When this occurs it leads to elevated ghrelin levels which enhances appetite causing weight gain. Often this is due to the need for increased caloric intake without adequate caloric expenditure.
  4. Night shifts lead to disruption of the circadian rhythm yet it is needed in controlling the sleep-wake cycle and this results in unplanned weight gain.

Due to the nature of our work, we cannot do without shift work but we can try to make some modifications to try to curb this problem. Some recommended solutions by Kelly and Wills (2018) include.

  1. Organizational level changes

  • Provision of staff meals. There should be an option for healthier food/snack.
  • Release staff for exercise sessions within the working days.
  • Generate in-house programs that encourage physical activity.
  • Conduct yearly staff wellness checks that include nutritional assessments and services.

    2. Personal behaviour changes

  • Seek to practise more self-care.
  • Be intentional about adopting healthier food options.
  • Due to the possibility of decreased physical activity, try increasing the number of steps taken each day.  For instance, take the stairs more instead of the workplace lifts. 



In summary, as we try changing the health patterns among our patients, we should remember that we can only create a permanent positive impact in their lives when we adopt the same because  "The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires." William Arthur Ward



                                                     References

Kelly, M., & Wills, J. (2018). Systematic review: What works to address obesity in nurses? Occupational Medicine, 68(4), 228-238. https://doi.org/10.1093/occmed/kqy038 

Kyle, R. G., Wills, J., Mahoney, C., Hoyle, L., Kelly, M., & Atherton, I. M. (2017). Obesity prevalence among healthcare professionals in England: a cross-sectional study using the Health Survey for England. BMJ Open, 7(12), e018498. https://doi.org/10.1136/bmjopen-2017-018498 

World Health Organization. (2021). Obesity and overweight.


Tuesday, 3 May 2022

A MOMENTS INSIGHT



"No one can whistle a symphony. It takes a whole orchestra to play it."  H.E. Luccock






Globally, there has been increasing emphasis on effective teamwork in healthcare.  von Knorring et al. (2020) documented how quality teamwork has been linked to improved patient safety. Some of the examples include;



  1. Reducing patient complications - Effective communication is a component of teamwork and it allows for discussions on personal, system or equipment errors identified. This, therefore, aids to mitigate or prevent adverse events by formulating solutions. 
  2. Decreasing the length of hospital stay- Rendering optimal services by competent teams allows for early diagnosis hence early treatment or initiation of early rehabilitative measures.
  3. Improving patient and employee satisfaction - Great relationships in our workstations foster productive environments improving the quality of services rendered to patients.
  4. Decreasing costs of care  - prolonged hospital stays lead to increasing financial burdens to patients and their families.

So what is teamwork? 

"Teamwork is the ability to work together toward a common vision. The ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results."  Andrew Carnegie

Are you part of an effective team? 

Bisbey and Salas (2019), state that effective teams are characterized by the following six Cs. These are  

  • Cooperation - Diverse groups of people willing to work together for a common goal.
  • Communication - Passing clear and correct information to other people and comprehending what is being said to us.
  • Coordination - Ensuring synchrony of different roles.
  • Conflict management -  Diverse mindsets create friction hence the need for early identification of problems and seeking solutions before an issue escalates.
  • Coaching - A process of equipping employees with the knowledge, tools, and opportunities necessary for them to be effective.
  • Shared cognition among team members- Involves having a competent team that understands the task at hand.


Teamwork is affected by many things some within our locus of control and others beyond. This understanding is cardinal in formulating an effective team. The literature describes several internal and external factors that influence teams. Some of these are; 



  • Organizational characteristics- does it have a clear purpose, clear job roles among the members, appropriate culture eg support culture of safety, specified task, appropriate choice of leadership, hiring competent personnel, adequate resources
  • Individual contributions - Professional self-image,  ability to confer/receive trust, commitment to the task, flexibility to different opinions.
Among the different types of health workers, the bulk is formed by both nurses and doctors, therefore, a lot of literature exists on their interesting team dynamics. Just perform a random search on HINARI, PUBMED etc there is a lot. So how then do we identify if we are part of an effective team? The answer lies in us evaluating our performance measures (Agency of Health Care Research and Quality, 2015)

According to the Agency of Health Care Research and Quality, 2015 & Schmutz et al., 2019 these include; 
  • Process-related outcomes( adequate behaviours during processes) - eg Adhering to formulated guidelines, attitudes expressed at work, 
  • Outcome related aspects of performance - eg Infection rates postoperatively, patient survival rates etc
In summary; as we look at improving our  output (job satisfaction, patient outcomes let's remember "Individual commitment to a group effort that is what makes a team work, a company work, a society work, a civilization work." Vince Lombardi

References
Agency of Health Care Research and Quality. (2015). Types of Health Care Quality Measures. https://www.ahrq.gov/talkingquality/measures/types.html

 Bisbey, T., & Salas, E. (2019). Team dynamics and processes in the workplace. In Oxford research encyclopedia of psychology.

Schmutz, J. B., Meier, L. L., & Manser, T. (2019). How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open, 9(9), e028280.

von Knorring, M., Griffiths, P., Ball, J., Runesdotter, S., & Lindqvist, R. (2020). Patient experience of communication consistency amongst staff is related to nurse-physician teamwork in hospitals. Nursing Open, 7(2), 613-617.

 



Wednesday, 9 March 2022

MEN'S PRECONCEPTION HEALTH




"The piece of the puzzle that is missing is the role of the paternal germline in the aetiology of genetic( and possibly epigenetic) mutations in the offspring. Most spontaneous genetic mutations arise in our species via the fathers' germline (not the mothers) and are powerfully influenced by age and environmental/lifestyle factors such as smoking and obesity." Aitken, 2017




I recently nursed a neonate with bradycardia as low as 50bpm. What was of great interest to us was him being in no form of distress or experiencing any other abnormal finding. He was under our care for some time as clinicians worked round the clock to establish the cause and monitor for any cardiopulmonary arrest. This was our greatest concern because for this age group this is absurd. Fortunately, the stay was uneventful and he was stepped down to continue with prescribed antiarrhythmics pending placement of a defibrillator at a later date.
Within the short stay, extensive testing was done to determine the root cause for the bradycardia. Among the ordered tests it was established via an Echo study that he had a congenital heart block. A review of maternal records led to a tentative conclusion that it is closely linked as an outcome of a pre-existing maternal autoimmune condition. No paternal preconception record existed and this drew my attention. Had we missed something more? Or was this conclusion enough?

So what is preconception care?


The
World Health Organization (2013), defines preconception care as the provision of “biomedical, behavioural and social health interventions to women and couples before conception occurs. 

It aims to;

1. Improve maternally and child health status by encouraging behaviour modification in both the short and long term (Frey et al., 2012).

2. Allows early detection and diagnosis of certain conditions in the preconception stage allowing for better decision making and planning among the partners. Conditions that may be detected include HIV, genetic disorders, infertility/subfertility, STIs, mental health concerns etc, (World Health Organization, 2013).

This is helpful for it allows for increased preparedness among the couples. For instance, planning may involve considering setting finances aside for frequent future hospital visits, a need for modification of home environment setups if a child is likely to develop congenital abnormalities, adjusting one's career trajectory, discussions on consideration of other alternatives to having children etc.

A review of existing literature reveals inadequate attention to men's preconception health (O'Brien et al., 2018). According to Frey et al. (2012), despite many men being aware of the need for optimal health as prospective fathers, this does not translate to knowledge on the specificities involved in the same which meant that health providers were missing out on this critical information. Within the African continent, it is unfortunate that there exists so much data on preconceptions efforts directed towards the female gender and paucity of data on the same for men. With that being said, it is, important to be cognizant of the fact that healthcare utilization is complex and somewhat inconsistent (Rosu et al., 2017).


Preconception health among men

Garfield (2018), summarizes preconception health for men as a reproductive health plan, health assessment, health promotion, and clinical and psychological interventions to improve adolescent and young men's health.

This is essential as other researchers such as Misra et al. (2010); van der Zee et al. (2013) have identified that, paternal involvement results in better health outcomes  of a nation by;


·       Increasing rates of prenatal care.

·       Decreasing maternal rates of alcohol consumption.

·       Encouraging fathers to actively participate in their children’s lives.

·       Promote good relationships with their partners.

·       Prevents direct and indirect harm to his future child.


How can we enhance preconception health among men?

   Prompt men to develop a procreative consciousness through 

  •  Encouraging visualization of their future kids' health by appealing to the concept of the greater good.
  • Have lengthy discussions on different health practitioner visits on the impact of age and the ability to promote the conception of a healthy foetus. ( To be aimed for during health screening visits). 
  • Address gendered perceptions of men in society and this will most likely encourage a positive outlook towards increasing their screening risks.
  • Have more female practitioners provide men sexual health service
  • Use creative tools to assess their sexual health issues at different age groups for example use of the HEADSS tool among adolescents and use of SNAP tool among men greater than 40years (Addison et al., 2021, Noble et al., 2015).
  • Encourage men to openly discuss their problems with no judgement.
  • Providing the services among already existing screening models(O'Brien et al., 2018).

In conclusion, we have learnt that it is important for preconception services to also be provided to men and that we need to be creative while at it. Remember, "Parenting begins the moment you make any conscious effort to care for your own health in preparation for enhancing your child's conception." Carista Luminare-Rosen




References

  1. Addison, J., Herrera, N., Tuchman, L., & Bokor, B. (2021). HEADSS Up! Missed Opportunity for Psychosocial Screening in Hospitalized Adolescents. Hospital Pediatrics, 11(4), 417-421. https://doi.org/10.1542/hpeds.2020-000216
  2. Frey, K., Richard, E., & Brie, N. (2012). Preconception healthcare: what do men know and believe? Journal of Men's Health, 9(1), 25-35. https://doi.org/10.1016/j.jomh.2011.11.001
  3. Garfield, C. F. (2018, Jan). Toward Better Understanding of How Fathers Contribute to Their Offspring's Health. Paediatrics, 141(1). https://doi.org/10.1542/peds.2017-3461
  4. Misra, D. P., Caldwell, C., Young, A. A., Jr., & Abelson, S. (2010, Feb). Do fathers matter? Paternal contributions to birth outcomes and racial disparities. Am J Obstet Gynecol, 202(2), 99-100. https://doi.org/10.1016/j.ajog.2009.11.031
  5. Noble, N., Paul, C., Turon, H., & Oldmeadow, C. (2015). Which modifiable health risk behaviours are related? A systematic review of the clustering of Smoking, Nutrition, Alcohol and Physical activity (‘SNAP’) health risk factors. Preventive medicine, 81, 16-41.
  6. O'Brien, A. P., Hurley, J., Linsley, P., McNeil, K. A., Fletcher, R., & Aitken, J. R. (2018). Men's Preconception Health: A Primary Health-Care Viewpoint. American journal of men's health, 12(5), 1575-1581. https://doi.org/10.1177/1557988318776513
  7. Rosu, M. B., Oliffe, J. L., & Kelly, M. T. (2017). Nurse Practitioners and Men’s Primary Health Care. American journal of men's health, 11(5), 1501-1511. https://doi.org/10.1177/1557988315617721  
  8. van der Zee, B., de Wert, G., Steegers, E. A., & de Beaufort, I. D. (2013). Ethical aspects of paternal preconception lifestyle modification. American Journal of Obstetrics & Gynecology, 209(1), 11-16. https://doi.org/10.1016/j.ajog.2013.01.009
  9. World Health Organization. (2013). Preconception care to reduce maternal and childhood mortality and morbidity: policy brief.


Wednesday, 12 January 2022

AMYGDALA HIJACK

 


Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring; all of which have the potential to turn a life around." Leo Buscaglia




According to the World Health Organization, more than 700,000 people commit successful suicides each year. That is approximately the total population for some countries. One such country is Bhutan it is located in the Eastern Himalayas and has a population of 771,612 by end of the year 2020. (Just google it).  In 2019, suicide was considered the fourth leading cause of death among 15-29-year-olds. Despite the majority of existing studies showcasing increased risk among higher-income countries, the World Health Organization still considers suicide as a global phenomenon. Data from their website show that  77% of global suicide deaths emerge from low and middle-income countries. More on suicides



For most of us, our work environment is quite stressful and, unfortunately, despite being health workers we often underplay its impact. When counselling is provided few if any personnel take it up. In addition, very few healthcare organizations actually budget for out of work activities to aid staff to de-stress. What is worse is that being away due to any form of illness especially ongoing mental health challenges is frowned upon, more especially when one is placed on sick leave. In some instances, these warranted sick leaves are later used as opportunities to victimize personnel.

Depression often seems like a foreign concept to most people and that when our loved ones get diagnosed it is so unfathomable.  I was recently reminded of this and thought I should share for it may help someone else too. Recently, a friend reached out, his phone call actually woke me up from deep slumber. He was crying frantically repeatedly stating that he wanted the world to go quiet. He kept reiterating how he had had enough of everything and wanted the pain to stop. "I can not do this anymore." It is too much". I was so taken aback and so confused for a minute I thought I was experiencing a nightmare. It could not be real, was it? Like how was this happening? Being that as humans we are selfish  my first actual brief thought was, "of all days I decide to pick a phone call it had to be this." ( You can judge all you want but it is true) I quickly got over it and tried to figure out what to do. I was more than 200kms  away. I wondered how could I help? After a quick prayer and the help of other great friends, we managed to neutralize the situation. However, the battle still continues and we are presently working on developing long term solutions to the events that led to that scary phone call and honestly it has not been easy.


So you may wonder who is at risk of committing suicide?

Well, suicide has been linked greatly to anyone experiencing challenges managing daily stressors for example:



1. People living with some mental disorders such as depression, substance use dependence etc.

2. People experiencing any form of abuse (sexual, verbal. physical, emotional).

3. Vulnerable populations such as the LGBTQI, refugees, immigrants etc.

4. People who experience impulsive episodes of crisis such as financial crisis, relationship conflicts and episodes of severe pain in chronic illness among others.

So what little things can you do to help as a health care provider or as a layman? 


It all begins with the basics. 






1. If anyone you know belongs to the populations at risk please keep checking on them despite your busy schedule. You may be the only one who does.

2. While spending time with them physically or via the different digital forums learn to improve your listening. Talk less and listen to them more. Learn their non-verbal cues.

3. Use social media as a tool For instance go to Youtube and learn about conducting a basic mental screening assessment and ways to establish the red flags.

4. If a friend, family member or colleague has a history of a previous suicide attempt or threat limit access to potential items that may be used to commit suicide.

5. For parents with children try to foster socioeconomic skills from a tender age.

6. Eliminate archaic rules to encourage self-reporting of suicidal thoughts. When identified please refer for professional help unless, of course, you can offer it.

7. Keep a list of resources around you of counselling service providers, treatment facilities etc.


As I conclude, in a world most people are marred with dark thoughts be the light that keeps someone going and if you are the one experiencing suicidal thoughts I leave you with  these words by Winston Churchill " Never, never, never, give up."




Resources

1. http://www.befrienderskenya.org/

2. https://www.enableme.ke/en/article/suicide-emergency-numbers-and-free-counselling-centers-in-kenya-3770



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Wednesday, 4 August 2021

SALT OR PEPPER




 

"Life is not a collection of unrelated events." Jay Shetty




How big are your personal dreams? Come on, you know the ones you never disclose. The unrelenting dream you daydream about often. It can be one, it can be many, there is no limit. The ones that are so immense you doubt your personal capability to achieving them. Well,  don't be scared as Nelson Mandela said, "It always seems impossible until it is done."  For anyone who has read a few of my blogs, you may realize that am a firm believer in evolving and developing into our best version. This can take many forms, it can be going to the highest level within the nursing profession, re-routing to other nursing related fields or it can be a total shift from nursing and pursuing your other interests. This article is directed to the nurse who feels their calling or their desire is present elsewhere but is afraid to let go. I hope by reading this post you will become comfortable with your hidden dream and begin pursuing it. Do not be afraid, it is a good move.




The nursing profession has come a long way and we can see its ever-changing face in our daily life. Last year was the year of the nurse and well our voices were heard, probably not as we would have wanted but more people came to appreciate our role. This pandemic season prompted many of us to ask ourselves, "Is this really what I want with my life? "Once this season is over, is there more that I can do? These are very sobering questions and for most people, it was long overdue. It is unnerving but  necessary  Louis E Bonne once said "The saddest summary of a life contains three descriptions: could have, might have, and should have." 



It is scary but it is worth a try

There is comfort in acceptance. There is unexpected growth of seedlings of life if we take the risk of opening ourselves up. Jan Warner

Develop mantras that act as your positive affirmation. Search for a few quotes that reinforce your beliefs. For instance:

  • “There are no wrong turnings. Only paths we had not known we were meant to walk.”Guy Gavriel Kay

Sticking to the tried and tested route doesn't guarantee you a great result. It just gives us reassurance that at least I know it may work out. It means we are using someone's life as a reference yet, no two peoples journey is similar. Changing from one profession to another does not mean that you hate your current one. It may be an opportunity to discover hidden talents. You may discover your purpose. Be excellent at the place you are now then grow toward being excellent in your next path.


"It is the mark of an educated mind to be able to entertain a thought without accepting it." Aristotle



If you always listen to the negative your achievements are limited. Often people are ready to project their fears on your path. Be very discerning of this stay away from anyone quick to create doubt without understanding why. Limited mindsets reveal ignorance or arrogance. Ignorance in that we have no intellectual capacity to understand the dreams of others or arrogance in that we secretly don't wish for our colleagues to evolve as they risk achieving more than us.

Maintain objectivity


“A goal without a plan is just a wish.” Antoine de Saint-ExupĂ©ry




Get your dream out of your mind and onto paper. How do you plan on attaining it? Create SMART goals, do your research on the desired area and put down all you gather and organise this information. If you can not do it on your own, research how best to do this. Break down all information into daily achievable targets and start working. Slowly you will see it come to pass. Stop expecting things to be handed to you or to be done for you. You are more than capable.


As I conclude, may we all continue creating our  unique paths remember,

All of us need to grow continuously in our lives. If you are the same person now that you were a year ago or even a day ago, then you are not growing. Les Brown







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Tuesday, 12 January 2021

A PENNY FOR YOUR THOUGHTS



 “Financial freedom can only be achieved by a conscious choice. It's not an accident. It's not just merely by thinking, it's through grinding and doing what is necessary to get to that goal.” David Angway“






It is officially 2021. How do you feel about it? Are you excited? I am having mixed emotions. Last year was quite an emotional rollercoaster so this year I am choosing to be optimistically cautious. During the initial lockdown mid last year I found myself thinking of my retirement. The thought caught me by surprise for often this is a conversation reserved for when one is more advanced in the profession. Nonetheless, it got ingrained. I started having so many thoughts around it. How well am I preparing myself for it? What will I have to show for the long hours? During this time I finally came to the realization that for every day worked I get closer to my retirement. I, therefore, pose the questions. How is your financial situation? Have you been quite keen on it? In nursing, we explore many things but unfortunately, retirement planning is something that we do not discuss enough.



Currently, some of our colleagues are on strike and one of the main reasons is due to lack of remuneration. We have been hearing horrifying accounts of people being uncompensated for several months. This has resulted in them lacking access to health services when they fall ill. It is sad, but out of pocket, we cannot afford the same services we provide. It is not sustainable. This then builds a great foundation as to why we need to be smarter with our life choices. I am speaking to you young nurse. You who is assuming thirty years or more is such a long time. Do not wait till it is too late. Start now and thank me later.

Due to the changing dynamics of our career, we now have more opportunities for transitioning to non-hospital settings. These particular setups call for nurses with vast experience as often the roles are of a senior cadre. These opportunities then look to increase the longevity of one's career but if one is ill-prepared even this will be of no use. By having this in mind we then need to be financially awakened and one simple way is adopting a proper retirement savings plan. In my quest, I have discovered a few things that I wish to share. I hope that it ignites a desire to generate these conversations in our circles.


Get a good pension plan

Pension refers to a retirement plan that is paid by the employer, employee or both. In Kenya we currently have the government-affiliated plan; NSSF and private company owned schemes. The advantage of monthly NSSF deductions ensures that they are consistent and the limit has been set low enough for the majority of Kenyans to afford. However, will that be enough to meet your future needs? Calculate what you will have accrued then conduct a simplified projection of the probable future inflation rates. Ask yourself. Will it be enough? Secondly, is it reliable? Once you retire how soon will you access your finances? With such questions in mind, it brings up the question. What is a good pension plan? I have highlighted below information obtained in an article attached along with a few pieces of sage counsel from financial experts. Find more information here A guide to a personal pension and here Kenya new laws on retirement.

A good plan should be;

1. Personalized- The amount you contribute should be sustainable to ensure consistency. 

2. Flexible-  It should ease the process of funds transfer. For instance, due to switching to a new plan when changing employers or adopting a new pension plan. Percentage of money contributed should be revised when remuneration increases. This translates to greater savings.

3. Ensure maximum returns-  Among the available options within the plan. A good plan ensures that one achieves the best option among the list. 

4. Transparent- The plan adopted should be concise and not have any hidden costs.

5. Bonus benefits- Due to life's eventualities the plan should allow for the nomination of a new beneficiary.


In a nutshell, as we continue with our personal journey of self-improvement let us remember that all aspects of our lives are important and none should be dismissed. "Your economic security does not lie in your job; it lies in your own power to produce, to think, to learn, to create, to adapt. That’s true financial independence. It’s not having wealth; it’s having the power to produce wealth.” Stephen Covey

Sunday, 27 December 2020

RETROSPECT




“The greatest people are ‘great’ because they’re willing to admit their greatest faults.”Craig D. Lounsbrough






Here comes the end of a very peculiar year. One that had so many unprecedented events. A year that almost brought humanity to its knees. A year where we moved from a state of denial when  Covid 19 began transversing the globe. To quickly escalating to panic-driven reactionary measures. To now being more accepting of our current realities and realizing we ought to adapt. This was also the year of the nurse and midwife. A year where we were to make bold moves as we reinforced our key roles within the healthcare provision teams. We had begun great till we forgot what our aim was but who can blame us we were dealing with something that for most of us, as long as I am ending the year alive and in good health,  it is the greatest blessing and accomplishment.

We have had to learn and unlearn a lot of things during this time and if we are keen enough this will then better our profession. Personally, it offered a great opportunity to examine what I can learn from other professionals. This has been through candid conversations and through observation of their day to day practice and behaviour patterns. What I got, out of it is that we need to work on our basics first so that we can generate one voice and only then can we all move forward.


1. Maintaining professionalism in digital media

In the current era where the internet is among our basic resources, there is now an emerging trend of developing professionalism in digital media. Read this,  Nurses and digital media Different platforms provide us with vast opportunities in supporting clinical decisions, learning new skills, documenting care, engaging patients and each other through support groups etc. Despite this, we have also witnessed several posts of inappropriate images or comments about patients, colleagues or our workplaces on social media.  Yes, the lines can be quite blurry but conversely, it doesn't excuse us from proper practice Before clicking the send button always think of this “What you post online speaks VOLUME about who you really are. POST with intention. REPOST with caution.” Germany Kent


2. Accept correction and correct lovingly

Think of a time where you made a grave error in your line of work? What was the result of it? Did learning take place? Were you made to feel inadequate by your colleagues or did they embrace you and have a good discussion with you on how to avoid repetition? Has it happened that you were on the other side of things? What was your response to things? Did you offer a solution or did you end up maligning the person? We have created such poor relationships among us that if we are honest enough we can admit that often it is easier to do the latter. Unfortunately, this helps no one. This tends to be a personal struggle and I am trying to unlearn bad habits and so should you. “Remember we are all human and can make mistakes that we should correct. However, no one should ever imagine that other people’s mistakes justify or lessen theirs.” C.A.A. Savastano



3.Team work

"We are all something, but none of us is everything." Blaise Pascal

Being a nurse in this decade is quite interesting. In the clinical areas, we are having very many cadres of nurses. We have certificate nurses, diploma nurses, undergraduate nurses, graduate nurses, general nurses to specialized nurses and also very young nurses to older generation nurses. Read this, Nurse's teamwork Honestly, you would think this matters but what is of more value is the quality of care provided to our patients and how best each member plays their part in making our workplaces more hospitable. For instance, do you seem to work better with some colleagues than others? In a clinical setup, it is often evidenced by having the same workload on different days but feeling more frustrated and fatigued on one day and feeling vibrant and ready to work on another. Of course, we are assuming other factors are constant. Teamwork is often a struggle but if we actively work on it we can derive a lot of pleasure in our workplaces and maybe just maybe our levels of burnout can be more manageable.



In summary, we have had a rough year but we should not allow ourselves to come out empty we should seek to grow into identifying our personal strengths individually and together. For "Though no one can go back and make a brand new start, anyone can start from now and make a brand new ending." - Carl Bard 





Tuesday, 15 September 2020

DIE KINDER


“There can be no keener revelation of a society’s soul than the way in which it treats its children.” Nelson Mandela, Former President of South Africa


A few years ago while working in the outpatient department I attended to a four-year-old who had presented for a surgical review. He had been discharged about a week prior to having undergone surgery to create a temporary colostomy stoma. This was after presenting with sepsis secondary to a ruptured appendix. Further discussions with his surgeon revealed that the child had been presenting to different ERs with severe abdominal pain and would always be discharged with analgesics and at times even dewormers. It had been unclear in all those visits that he maybe suffering from an acute abdomen and by the time it was being identified his abdomen was taut, very tender and he was in septic shock. Maybe it is just me but in my years of practice am coming to appreciate how challenging it can be to handle this special population. This has further been reinforced with the children being at home in this pandemic season.  In the past several months, we are witnessing an influx of children presenting to the ER or outpatient with one form of emergency or another. Depending on the gravity of the situation some actually then end up in the pediatric wards, HDUs, ICU and the most fortunate are just sent back home for observation.


At this point then I pose the question. As a health professional or as a working parent in any career. Do you have children? Are you the primary caretaker/guardian of this special group? Are you content with the fact that if anything was to happen to them they would receive the most appropriate care in any health facility they are attended at? That includes where you currently practice. Well, the World Health Organization creates a dim outlook in its updated 2016 guidelines. They begin by stating that most pediatric deaths occur within the first 24 hours of admission. They majorly attribute this to;

  •  Ineffective triage processes.
  •  Delay in presenting the sick child to the hospital.
  • Inadequate resources at the health facilities.
  • Lack of basic skills and knowledge among the health workers in initiating appropriate treatment.


To explore this further read the following pdf document Updated guideline: pediatric emergency triage, assessment, and treatment: care of critically-ill children. Johanson et al; stated that in low-income countries, emergency care is among the weakest parts of its health systems. This is despite these systems experiencing higher patient loads and mortality than other regions, particularly for pediatric emergency patients. To view, this journal article click here Accessibility of basic pediatric emergency care in Malawi.

According to etat guidelines, pediatric emergencies are commonly categorized as trauma, seizures, respiratory distress, and toxicologic emergencies. A lot of emphasis is currently being placed in medical emergencies and it is wonderful that we are now observing a gradual improvement in practice. This has been facilitated further by the provision of periodically updated  MOH guidelines for instance  Basic pediatric protocols for ages up to 5 years. However, what strides have we made in handling pediatric surgical emergencies? How many specialists are available? Is it easy to even access those who are currently present?


Did you know that Africa is considered the most dangerous continent to live in? Naidoo and Murckart deduced so from the extensive studies they reviewed while conducting their own research. In their study, they identified that among the 181 children admitted with trauma injuries in their  Trauma Intensive Care Unit(TICU) 26 of them died. Among those who died, 88.4% of them had head injuries, 46.2% had injuries to their extremities, 38.5% had external injuries, 34.6% had abdominal or chest injuries, 19.2% neck injury and 11.5% had facial injuries. For a more in-depth analysis view it here  Paediatric polytrauma admitted to a level 1 trauma intensive care unit over a 5-year period. A study done at a tertiary teaching hospital in Kenya found that of all the pediatric trauma cases admitted in the facility most injuries were amongst boys (65.3%) and the very young had a mean age 6,  42.4% of the injuries occurred at home while 25.7% at residential institutions. The injuries were typically caused by falls (56.3%) or penetrating trauma (13.2%) and that they mostly resulted in extremity fractures (45.8% closed, 4.9% open)other types of injuries were burn or head injuries (in infants and small children). This study further revealed that their patients either received very little or no pre-hospital care (51.4% no care). Additionally, children with burns, brain injuries, or poly-trauma had the longest hospital stays and the highest rates of mortality. Such figures should prompt us to do better. What role have you played to make the needed improvements? To view the above article click here Patterns and outcomes of pediatric trauma at a tertiary teaching hospital in Kenya.

Simple ways we can improve outcomes is such cases can be broadly categorized as;

1. Human factors

  1. Effective documentation to capture details on conditions and contributing factors present in the environment.Retrospect analysis of such data aid in the establishment of the root cause. eg Intentional trauma versus accidental trauma, good documentation makes it easier for researchers aiming to conduct chat reviews for further studies in this field, effective documentation provides a great opportunity for the collection of full information needed to conduct case presentations, etc. 
  2. Effective communication - Asking the right questions the right way helps obtain information that may aid in treatment and identifying the mechanism of the injury which facilitates the early introduction of appropriate care.
  3. Building a culture of learning- By enhancing our skills and knowledge on special groups it will help avoid the confusion and human errors generated by the use of the inappropriate intervention.

2. Organizational factors

  1. Provision of needed equipment- Availability of basic emergency apparatus such as different branula bores, intravenous fluids, bag valve masks, oxygen therapy, splints, etc go a long way in stabilizing most trauma cases as a further plan of action is being created.
  2. Creation of policies and guidelines that encourage adoption of appropriate care.- Policies by themselves create little to no change but the emphasis in their adoption does.
  3. Put under consideration the development of health workers' exchange programs- Exchange programs aid in exposure to different setups hence one is more likely to learn while maintaining cost efficiency. This is so true when one gets the opportunities to train in resource-rich centers and transfer the new knowledge and skills to the resource-limited environment.

Other useful resources


In conclusion, as we seek to improve our health delivery services let us build a culture of thinking while doing and in this way, we shall be able to generate creative ways in improving the services we deliver. Remember this; “All children are born to grow, to develop, to live, to love, and to articulate their needs and feelings for their self-protection.”Alice Miller



Thursday, 20 August 2020

SYNERGY


 12 Growth Experts to Follow “Every moment of one’s existence, one is growing into more or retreating into less.” Norman Mailer

Wolves are protected even in human settlements, top EU court rules | News |  DW | 11.06.2020 Over the past few years, I have had an opportunity to create beautiful friendships with people whom I have met at my workplace. Over time we have each slowly grown into our own space some of us more slowly than others but lest the same, growth has been evident. With this, it has meant that we move to different departments or regions and as much as it has been difficult it is proving to be worthwhile. John Maxwell a great American author once said, “Growth is the great separator between those who succeed and those who do not. When I see a person beginning to separate themselves from the pack, it is almost always due to personal growth.” For anyone left behind as this happens one experiences a barrage of emotions. One is happy to see them grow but then despondency creeps in. One can not fathom not seeing them for a long time. On some days despite offering our unmerited support we are left asking ourselves when is our time coming too. I am here to let you know that it is okay to feel unsure, the only difference is how you respond to it.

When the girls are packing their apartment, the boxes in the background  show more of Monica's towel categories! : howyoudoin A few weeks ago I was helping my friend pack her household belongings ready for the big move and she came across her vision board. I was quite taken aback by the intricacies within it. I remember seeing her lips moving but honestly not listening to what she was saying. My eyes were so glued on it. As far as I could tell she had achieved some major things on it and had modified some of the goals that were yet to come to pass. This current big move she was making was directly linked to all this and through revising her previously set goals she was on the right path to achieving them. I felt proud and decided maybe its time I put down mine too. Get all my ideas from my head to paper. Well, I did so and then this morphed into a learning process where I came across the term career mapping.

Mind mapping your career | Guardian Careers | theguardian.com Career mapping is the process of generating methods for individual progression within a particular area of one's choice of a career within a specified time frame. It differs greatly with professional development in that the latter only focuses on obtaining new skills and knowledge meant to remain relevant. As highlighted in some of my previous posts job satisfaction is key. It directly affects so many aspects of our lives that we can not afford to be lax about it. We invest too much of ourselves into it and when we can do something about it I believe we owe it to ourselves to do something.

Bee Reading glasses Cat eye reading glasses women reading | Etsy Analysis of research papers on this topic among the different databases revealed that for nurses, in particular, our career map is mainly informed by three key things;

  1.  The level of formal education
  2. The length and nature of our work experience
  3.  Competency assessment
For a better understanding of this, I suggest the analysis of the article attached to the following link nurse career mapping. As an employer, one would be quick to dismiss this but do you know this also directly affects the services delivered. The benefits of engaging or being involved with your staff in their career mapping include:
  • Reduced rates of staff turnover
  • Better service delivery through the use of current knowledge and skills.
  • Development of genuine loyalty to an organization. No trade secrets spilled
  • Better work relationships by reducing work-related conflicts 
There are so many ways to generate a career map. To obtain the best out of it do proper research on what you wish to achieve. Be open to trying what you put down as proficiencies and new skills needed and guard it. Why? because not all people you wish to share with will be ready to assist you to achieve it some are more ready to be a hindrance. Here is a simple guide to creating your own simple career guide or map. It is never too late to start. Detailed description

  1. Determine a starting point
  2. Determine a final goal
  3. Identify how to connect the two points
  4. Create a series of smaller goals within two points
  5. Put it at an easily accessible place where you can see it on a regular.
Additional resources on the above topic
10 Uplifting Quotes To Make Your Day As we continue developing into the best versions of self lets us identify what we enjoy doing and as Katherine Whitehorn said  “Find out what you like doing best and get someone to pay you for doing it."