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November 16, 2017

Make Malaria Drugs Free: Senate Tells FG

November 16, 2017 0

The Senate yesterday urged the Federal Ministry of Health to procure effective antimalarial drugs and supply them free of charge to all public health facilities across the country.

The resolution followed a motion sponsored by Senator Rabiu Musa Kwankwaso (APC, Kano) on the upsurge in malaria cases in the country.

The Senate also urged the Federal Government to sensitise Nigerians on how to take appropriate and effective malaria preventive and treatment measures.

Moving the motion, Kwankwaso said in recent times the outbreak of malaria has exponentially increased particularly northern Nigeria to an epidemic level.

In his comments, Senate President Bukola Saraki said the motion raised by Senator Kwankwaso was genuine and germane, and that the malaria issue could be addressed with the implementation of the 2014 National Health Act.

“We must also work ensure that the Appropriations Committee works to ensure that we meet the requirements of the National Health Act in the 2018 budget,” he said.

Source: Daily Trust News

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Nurse Be Nimble, Nurse Be Quick

November 16, 2017 0

The notion of pivoting in your nursing career isn't a new one, and that readiness to pivot can emerge emerges from a nimbleness of mind and a willingness to read the tea leaves of your career. Are you nimble?

Nurse Be Nimble, Nurse Be Quick

Being nimble in terms of your career means that you're willing to think beyond what's right in front of you. It also means doing the work of preparing and paving the groundwork for something that you want -- and if you don't know what you want, you're at least asking the right questions.

Many nurses appear to settle into an area of nursing, rest on their laurels, and think less of the future than perhaps they should. These nurses don't necessarily think a great deal about what they may want in five or ten years; thus, when they're suddenly feeling unhappy and itchy for change, there's much more work to be done due to the years they've spent avoiding any forward movement or thought for the future.

In a post from 2015, I wrote:
Listen to the voices that you hear. Pay attention to the ever-evolving zeitgeist of your industry. Know what other people are thinking, and if you work in an evidence-based profession, follow the evidence when it pertains to you and your area of expertise.
The Consequences of Non-Action

In Buddhism, the concept of non-action is an important one. You know the old adage, "Don't just sit there, do something"? Well, in certain circumstances, it's sometimes better to turn that around, and say, ""Don't just do something, sit there." However, when it comes to your career and its ongoing trajectory, I prefer action, even if that action is listening, thinking, and asking salient questions.

Let's say you're a nurse like me who worked in home health for the first decade of your career. You've never worked in the hospital, and while you love home health, you've actually been feeling called to finally take the plunge and enter the world of acute care. This may be a tough row to hoe since you've been in outpatient nursing for your entire career, but there's no saying it's not possible.

During these past ten years when you've been focusing exclusively on home health, you haven't done any networking, your resume is a mess, and you have few contacts beyond your small universe of home care colleagues. All along, you've never considered that any of the hospital staff whom you've met could be helpful to your career in any way, so you haven't connected with anyone on LinkedIn, built relationships, or otherwise laid the groundwork for the future.

In your mind, you'd like to jump right into the ICU, but common sense says that without any hospital experience since nursing school, you're going to have to pay some dues, prove your mettle, and begin with a position in med-surg, step-down, or a sub-acute floor. Sure, you'd love to land an ICU position, but you simply don't have the nursing skills or the connections to get you there. Your road will be challenging, but it's not impossible -- it'll just take time, and diligent action on your part.

Reading the Inner Landscape

Being nimble of mind means being open to possibility. It also means that, in terms of your career, you're steeped in curiosity and expansiveness, rather than wearing blinders.

As a nurse who is nimble of mind and quick to grasp opportunity, you not only read your immediate surroundings and the healthcare landscape around you; you also read the landscape within your heart and mind.

If there's an inkling in your head or heart that what you're doing now won't hold water for you in a few years, now is the time to take inspired action in a new direction. That inspired action can simply be chatting with a nurse or manager who you know and trust, reaching out to a career coach for inspiration or seeking informational interviews with professionals who are holders of information that may be helpful to you.

If you maintain awareness of how you're feeling about your career and work life, you're more likely to take preemptive action that will foment change, rather than being reactive when the going gets tough remain Awake and Aware.

We can all get sleepy and lazy at certain points in our lives. We feel comfortable, we settle into the status quo, and we conveniently forget or ignore the fact that we may want something more down the road.

You must remain awake and aware to possibility, understanding that every colleague who you meet could be a source of brilliant information that will wake you up to something new. If you're feeling complacent in your career, there's no time like the present to do something about it and take a forward step.

As professionals, there's always the micro and the macro. The micro is the minutiae of the day to day, the details of our lives and work. Meanwhile, the macro is the bigger picture, the bird's eye view, and this is where we need to keep at least a little attention. It's easy to get caught up in the web of details, but those details can blind you to the wider career horizon.

Being nimble and quick doesn't necessarily mean turning on a dime or being blown in some new direction with every wind that comes your way. Being nimble and quick means that you're listening, that you're willing to change, and that you are quick to perceive that change may be in the air.

Is your workplace unstable? Are you becoming unhappy in your role? Do you feel limited or stuck? Is there something you've always wanted to do as a nurse? Is your current specialty area drying up and being supplanted by new technologies or skills?

I'm glad if these questions make you uncomfortable, because a little discomfort will galvanize you towards change, if change is what is called for.

Nurse be nimble, nurse be quick. Nurse, consider your future, and keep your eyes wide open.

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By
Keith Carlson, RN, BSN, NC-BC.

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November 15, 2017

Becoming a person of value.

November 15, 2017 0
Becoming a person of value. 

Value is an indicator of worth. Value defines quality. Value determines the quality of influence or impact. Value could be an upward surge or a downward spiral; it could be worthwhile or worthless; its quality could be excellent or mediocre; its influence or impact could be positive or negative. In our context, value connotes superior quality that distinguishes from all others. To become successful, you must become a person of value. In fact, until you become valuable you can never become successful. The more valuable you become, the more successful you become. This invariably implies, you do not seek to become successful rather you seek to become a person of value and you will automatically become successful. The level of contribution you make to life is dependent on the level and quality of value you create for others. Your influence increases when your value increases. Every human being has equal intrinsic value or self-worth; however, value can be appreciated or increased and value can also be depreciated or decreased. Value is increased through personal growth and development. Value could be decreased through self-depreciation and a stagnating or negative mindset. Value is a product of the level you have grown your mind through investment in self. The quality of investment in self is proportionate to the value you create for others. Therefore, value births influence and influence is the lead way to relevance. The start-up of a life of value is living a life of integrity. A person of value is not for sale because his or her life is built upon the rock solid foundation of integrity. And upon the rock solid foundation of integrity, towering heights of influence is built. The person of value does not compromise values that are based on eternal or timeless principles. Moral breakdown is the cause of societal breakdown. In fact, moral breakdown is the lead way to emotional breakdown; mental breakdown; relational breakdown and even financial breakdown. When morality is trampled underfoot, value erodes from life. When morality is elevated, value is enhanced. Integrity is not an outdated idea rather it is an upgraded version of living without regrets. What matters in life is the small things that adds up to make the big things. The root of integrity bears the fruit of respect, dignity and trust. Without integrity, value is lost. When there is a breakdown of integrity, there will be a breakdown of trust and when there is a breakdown of trust there will be a breakdown of harmony and when there is a breakdown of harmony, life loses its potency. Integrity is not flexible in nature; it is not situational; there is no middle ground-it’s either you have integrity or you are void of integrity. John Maxwell reveals, “Integrity commits itself to character over personal gain; to people over things; to service over power; to principle over convenience; to the long view over the immediate.” Crisis does not make character rather crisis reveals character. Everything you have done in the past and everything you’ve neglected to do unfold under moral pressure. Integrity is not a behavioral modification rather it is the modification of the thought processes. Integrity or character is not a product of upbringing or circumstances rather a life of integrity is a product of choice. Upbringing and circumstances undoubtedly influence your character. And except you are in your childhood, you are absolutely responsible for your choices through life including the character choice. The level of your value to the world is determined by the strength of character rather than the weight of your credentials. Credentials exploit rights and are short-lived; character expresses responsibility and it is timeless. The value of credentials starts and ends with self; it is self-focused. The value of character positively impacts the lives of others; its people centered. Credentials brags about past accomplishments or achievements. Character builds destinies thereby leaving a timeless legacy in people. Credentials stirs up envy or jealousy in people. Character attracts respect and trust from others. Credentials can open doors but character keeps the door perpetually open for you and consistently open greater doors and keeps them open. Character is the real deal. Public image is superficial unless it harmonizes with a strong moral character. D. L. Moody expresses, “If I take care of my character, my reputation will take care of itself.” How you treat people who cannot hurt you and whom you can gain nothing from is a test of the greatness of your character or lack of it. When you role-play based on the person you are with, you rule-out trust and a long term relationship with them. When you are not transparent with others, you trample relationships and business opportunities with others. Your commitment to live a life of integrity sets you up for victory in the moments of crisis or temptation. Integrity grows from the little things or minor things to the big things or major things. Integrity has no price-tag for its value is inestimable; it’s highly esteemed far above power, revenge, pride or money. Therefore, a person of value cannot be bought.


By Udeme Archibong





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NMCN RE-OPENS PUF PORTAL!

November 15, 2017 0
You will recall that Nursing council of Nigeria directed all nurses and midwives registered with NMCN  to go online and complete the online professional update form ( PUF ) 

However, it was observed that some nurses and midwives couldn't complete the update as at October 31st when it closes. Since the closure, Council has received series of appeal for the reopening of the PUF portal. 
In view of this, the management of the council has directed that the PUF portal should be re opened with effect from november 13th to Dec 31 2017 to enable all nurses and midwives complete the exercise.

Below is the circular as obtained by fellow Nurses Africa.


Oluwatosin K.O RN,
For fellow Nurses Africa
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AMERICAN HEART ASSOCIATION PRESIDENT SUFFERS HEART ATTACK, COLLAPSES IN A CONFERENCE

November 15, 2017 0
American Heart Association President Suffers A HEART ATTACK At The Annual Conference For Cardiologists - After Giving A Speech About His Family History Of Heart Issues


The 52-year-old president of the American Heart Association suffered a heart attack during the organization's annual conference. John Warner, CEO of UT Southwestern University Hospitals in Dallas and a practicing cardiologist, suffered a 'minor' episode on Monday morning in Anaheim, California.

It came hours after he delivered his keynote speech on Sunday afternoon about preventing heart attacks in older people, sharing that all the men suffered heart conditions in their 60s.

Warner was taken to a local hospital near the conference, where doctors inserted a stent to open a clogged artery - a common move that Warner performs often himself, but one that was brought into question by a recent study which found the operation carries more risks than benefits.

He was met at the hospital by his wife, daughter and son who all had come to watch his speech at the conference.

AHA president John Warner, 52, (pictured) gave a speech on Sunday afternoon at the annual AHA conference in Anaheim, California. On Monday morning he suffered a 'minor episode' and received a stent to open a clogged artery

Nancy Brown, CEO of the AHA, said in a statement that Warner is recovering, and hopes this episode sends a message to everyone about the importance of heart health.

'John wanted to reinforce that this incident underscores the important message that he left us with in his presidential address yesterday – that much progress has been made, but much remains to be done. Cardiac events can still happen anytime and anywhere,' Brown said.

Warner was appointed the organization's volunteer figure head in July, going on to lead meetings in Panama, Beijing and Washington, D.C.

In his speech on Sunday, he revealed he has a family history of heart disease and heart complications.

His father and paternal grandfather required heart bypasses in their 60s. His maternal grandfather and great-grandfather died of heart disease.

'Earlier in my talk, I told you there were no old men in my family,' he told the conference.

'I know this is also true in far too many other families, not just in the U.S., but around the world.

'I believe the people in this room have the power – and even the duty – to change that.

'Together, we can make sure old men and old women are regulars at family reunions.'

He added: 'In other words, I look forward to a future where people have the exact opposite experience of my family, that children grow up surrounded by so many healthy, beloved, elderly relatives that they couldn't imagine life any other way.'

The episode came at the beginning of the four-day conference, which ends on Wednesday.

Papers presented thus far have included research on dietary methods to improve heart health, and data showing the astronomical rates of heart conditions among African Americans compared to white Americans.

Possibly the most significant release was an update to the guidelines on blood pressure, with the AHA lowering the threshold for 'hypertension'.

It means 30 million Americans who thought they were 'high normal' and deemed at-risk, and now have to urgently make lifestyle changes.

By Mia De Graaf Health Editor, Dailymail
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November 14, 2017

FREE ADMISSION FORMS INTO INTO NURSING SCHOOL

November 14, 2017 0
FREE ADMISSION FORMS FOR FEMALE STUDENTS OF KEBBI, SOKOTO AND ZAMFARA STATE ORIGIN SEEKING A NURSING CAREER
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November 12, 2017

LESSONS LEARNED FROM LITIGATION: LEGAL AND ETHICAL CONSEQUENCES OF SOCIAL MEDIA

November 12, 2017 0

Lessons Learned from Litigation: Legal and Ethical Consequences of Social Media.
Brous, Edie JD, MPH, MS, RN; Olsen, Douglas P. PhD, RN

Editor's note:
To the surprise of many, a Canadian nurse's Facebook post complaining about the medical care a family member had received resulted in disciplinary action by the licensing board. We asked our legal and ethical contributing editors to provide some insight on the issues of this case.

LEGALLY SPEAKING
Misunderstandings regarding the constitutional protection of free speech can lead to legal problems. The First Amendment of the U.S. Constitution states, “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances” (emphasis added)
.1 Note that the amendment prevents government interference in freedom of expression. The First Amendment does not allow the government to punish people for expressing their views. That protection does not extend to the public or to private businesses.

Because the amendment does not apply to private actors, it does not prevent employers from taking disciplinary action against employees. It does not prevent schools from expelling students. It does not prevent private citizens from alleging defamation. It does not prevent untoward consequences for taking to social media to address grievances. For nurses, it is important to understand that the First Amendment does not prevent a board of nursing from disciplining one's license to practice. Posts on Facebook or publications on other social media platforms can violate standards of professionalism and ethical conduct codes. A recent Canadian case illustrates the peril nurses face when using social media improperly.

On February 25, 2015, Canadian nurse Carolyn Strom posted complaints on Facebook about the care her grandfather had received at St. Joseph's Health Facility. She posted such comments as “Not everyone is up to speed” regarding end-of-life care and referenced “subpar care.” She also identified herself as an RN. The staff at St. Joseph's did not respond to the post but did write a letter to the Saskatchewan Registered Nurses’ Association (SRNA), the regulatory body for RNs in Saskatchewan. The SRNA met in February and March of 2016 to “hear and determine a complaint of professional misconduct” against Strom.

2.Six RNs from St. Joseph's testified at the hearing that they found Strom's posts to be humiliating and embarrassing and that their reputations had been tarnished.3, 4 One of the nurses complained, “I think it's common sense that you don't cut your fellow professional.”5 The American Nurses Association (ANA) agrees: “Social media is also a place where nurses need to remember their ethical duties to respect patient–nurse boundaries and their duties to co-workers.”6

The attorney for the SRNA suggested penalties that include a formal reprimand, course work, a review of professional standards and the Canadian Nurses Association's Code of Ethics for Registered Nurses, a $5,000 fine, and a $25,000 fee to cover costs of the investigation and hearing. The total costs, including Strom's legal fees, would amount to almost $143,000.4, 7 The decision is being appealed, but the case provides an example of licensure problems as a consequence of impulsive social media posts.

Nursing boards take professional misconduct seriously and will impose discipline when a nurse engages in social media activity that violates nursing law or professional standards.
There are many charges a board could bring, including

patient abuse.
a violation of patient privacy and confidentiality.
revelation of a privileged communication.
lateral violence.
a violation of professional boundaries.
a violation of employer policies.
unprofessional conduct.
unethical conduct.
moral turpitude.
mismanagement of patient records.
Many nursing boards have issued practice alerts, advisory opinions, newsletters, public statements, or other communications regarding a nurse's use of social media. Ohio's, for example, posted an administrative code update that “specifically prohibits nurses from using social media, texting, e-mailing, or other forms of communication with or about a patient, for non–health care purposes or for purposes other than fulfilling the nurse's assigned job responsibilities” and warns nurses that violation of these rules can result in disciplinary action.8

The Virginia Board of Nursing has published social media guidelines for nurses that discuss common myths and misunderstandings, such as mistaken confidence in privacy or the belief that removing patient identifiers is adequate.9 Similarly, the Minnesota Board of Nursing has found that “most instances of nurses disclosing private information about patients on social media outlets are unintentional. That is, the nurse failed to recognize that their post or message disclosed protected health information or other data that might identify or embarrass a patient.”10

Many nurses misunderstand their First Amendment rights and assume their employer or the nursing board has no authority over them when they're off the job, at home, or using personal devices. The truth is, however, that there is no clear dividing line between personal and professional lives for the licensed professional. As C. Lee Ventola notes, “By making public posts, a person has willingly made information available for anyone to view for any purpose. For some, it logically follows that candidates who don't use discretion in deciding what content to post online may also be incapable of exercising sound professional judgment.”11

Posting as a private citizen still has the potential to damage both one's livelihood and the image of nursing. More important, inappropriate posts can cause emotional distress and harm patients. As the Texas Board of Nursing notes, “Online postings may harm patients if protected health information is disclosed. In addition, social media postings may reflect negatively on individual nurses, the nursing profession, the public's trust of our profession, or the employer and may jeopardize careers.”12

The ANA, the National Council of State Boards of Nursing (NCSBN), many professional organizations, and individual nursing boards have published guidelines for social media use. An ANA poster offers six tips for avoiding difficulties13:

Remember that standards of professionalism are the same online as in any other circumstance.
Do not share or post information or photos gained through the nurse–patient relationship.
Maintain professional boundaries in the use of electronic media. Online contact with patients blurs this boundary.
Do not make disparaging remarks about patients, employers or coworkers, even if they are not identified.
Do not take photos or videos of patients on personal devices, including cell phones.

Promptly report a breach of confidentiality or privacy.
The NCSBN offers the following guidelines on how to avoid disclosing confidential information14:

Nurses must recognize that they have an ethical and legal obligation to maintain patient privacy and confidentiality at all times.
Nurses are strictly prohibited from transmitting by way of any electronic media any patient-related image. In addition, nurses are restricted from transmitting any information that may be reasonably anticipated to violate patient rights to confidentiality or privacy, or otherwise degrade or embarrass the patient.
Nurses must not share, post, or otherwise disseminate any information or images about a patient or information gained in the nurse–patient relationship with anyone unless there is a patient-care–related need to disclose the information or other legal obligations to do so.
Nurses must not identify patients by name, or post or publish information that may lead to the identification of a patient. Limiting access to postings through privacy settings is not sufficient to ensure privacy.
Nurses must not refer to patients in a disparaging manner, even if the patient is not identified.
Nurses must not take photos or videos of patients on personal devices, including cell phones. Nurses should follow employer policies for taking photographs or videos of patients for treatment or other legitimate purposes using employer-provided devices.
Nurses must maintain professional boundaries in the use of electronic media. Like in-person relationships, the nurse has an obligation to establish, communicate and enforce professional boundaries with patients in the online environment. Use caution when having online social contact with patients or former patients. Online contact with patients or former patients blurs the distinction between a professional and personal relationship. The fact that a patient may initiate contact with the nurse does not permit the nurse to engage in a personal relationship with the patient. Nurses must consult employer policies or an appropriate leader within the organization for guidance regarding work-related postings.
Nurses must promptly report any identified breach of confidentiality or privacy.
Nurses must be aware of and comply with employer policies regarding use of employer-owned computers, cameras, and other electronic devices, and use of personal devices in the workplace.
Nurses must not make disparaging remarks about employers or coworkers. Do not make threatening, harassing, profane, obscene, sexually explicit, racially derogatory, homophobic or other offensive comments.
Nurses must not post content or otherwise speak on behalf of the employer unless authorized to do so and must follow all applicable policies of the employer.
It is imperative that nurses know their state board of nursing's definition of inappropriate use of social media and adhere to professional standards. This is true even when posting from personal devices unrelated to employment. The Constitution, particularly the First Amendment, does not offer protection from the consequences of inappropriate social media posts.

ETHICALLY SPEAKING
Central to the SRNA's decision to sanction and recommend financial penalties for Carolyn Strom was that she prefaced her derogatory remarks about the care given by the long-term care facility's nursing staff with the phrase, “As a nurse.” In making that declaration, she invoked professional standards by intentionally creating a reasonable expectation that her statements were informed by knowledge and experience beyond that of the lay public. It was this lack of professional due diligence before publicly criticizing care provided by others that led to the SRNA's finding of misconduct and not the breach of privacy that may be more familiar in discussions of social media ethics.

The credibility added by identifying oneself as the holder of a nursing credential is deserved and therefore carries serious responsibility. Nursing licensure is intended, in part, to assure the public that the bearer is skilled in assessing clinical nursing care in relation to accepted standards; evaluating the accuracy and relevance of clinical information; and communicating those assessments professionally, for constructive purposes. Nurses who identify themselves as such must take care that all communication is accurate; is respectful of person; follows accepted ethical practice in communicating information; and is intended to further patient health, either directly or through policy.

The voice of nursing—because of the knowledge learned in the classroom and through intimate contact with healthy, sick, or dying patients—is essential to keeping public discourse on health care rational and moving toward better quality of life for all. Both the International Council of Nurses’ and the ANA's codes of ethics clearly state that nurses have an obligation to be advocates for population health and social justice. Therefore, public communication by nurses needs to meet the highest professional standards to maintain credibility.

The public legitimizes nursing and empowers nurses through licensure and in return expects value in the form of high-quality nursing care, which includes thoughtful, knowledgeable contribution to public health care discourse and policy formation. In a process that is similar to shared decision making with patients, this involves an exchange: the public expresses its needs and aspirations for health care and nursing responds by informing the public what good nursing care is and how it can contribute to social health care goals, and by communicating the resources required to accomplish agreed-upon goals. Public communication that fails to meet professional standards is much like giving poor nursing care. It violates nurses’ obligation to the public; damages their standing with public trust; and harms the “patient”—in this case, society.

The blurring of the distinction between public and private communication on the Internet and in social media threatens a person's ability to maintain professional standards in public communication. Many social media platforms have the appearance of personal communication. A nurse's Facebook page might include baby pictures and holiday cookie recipes or health and lifestyle tips offered “as a nurse.” Such tips are entirely appropriate and add to the good reputation of nursing, provided that they conform to ethical and legal standards for public communication by professionals in relation to their expertise.

Social media has a veneer of intimacy, an aura that seems personal. It is easy to post quickly and without the same deliberation that one would typically give a more clearly public presentation, such as giving lifestyle advice at a health fair. Social media also has the potential to expose one's views to a far larger audience than was possible before the Internet. Statements are instantly and permanently available to millions.

The following suggestions are offered to keep all communications ethical—whether on social media or not—when one is speaking “as a nurse.”

Statements about the clinical effectiveness or efficacy of an intervention or recommendation should be grounded in evidence sufficient to support clinical action. Where the evidence is equivocal or less certain, that should be stated. Technical details in discussions of evidence should be appropriate to the audience: not too complex when targeting a lay audience, but sufficiently detailed when aimed at professional peers to help them in applying the information. For example, general health tips on a Facebook page should be easily understood by a lay audience, whereas a posting about empirical matters in a professional forum such as AJN’s blog, Off the Charts, should demonstrate consideration of the available evidence that a nurse could evaluate. 

Still, even statements intended for other professionals made in a publicly available forum must be consistent with ethical standards for public communication.

Statements regarding service delivery should be based on evidence. Where evidence is lacking, the rationale for the statement should be provided—for example, “In my experience as a patient, wait times are…” or “In my practice, patients report…”

When posting or otherwise discussing care witnessed as a patient, friend, or family member, mentioning one's status as a nurse—in other words, attaching one's credentials or degree to one's name—makes any statement a professional communication. Such communication would also be considered professional if posted or discussed in a venue that merely implies one's status as a nurse, such as allnurses.com.

Before publicly discussing problematic care of an individual, one should report the problem through the proper channels—speaking, for example, with the nurse providing the care that may be problematic. The nurse reporting the problem should listen carefully, consider all pertinent issues, and if still not satisfied, speak to the charge nurse or nurse manager and on up the chain of authority if necessary.

If the problem involves abuse, the nurse should look to her or his mandated reporter obligations before considering public revelation.

If the problem involves criminal or dangerous behavior, the nurse should look to the proper authorities before considering public revelation.

Before discussing problematic care of an individual, the nurse should ensure that all relevant information is in hand and that she or he has reviewed it thoughtfully before reaching conclusions about the care.

A nurse should never identify a patient with whom she or he has a clinical relationship or use identifying information—which includes the patient's name or address or any Health Insurance Portability and Accountability Act (HIPAA) identifiers or other information by which the patient could be identified—without clear, informed authorization from that person. It is important to remember that removing patient identifiers is not enough. Discussing a patient even when identifiers have been removed still violates nurse practice acts and can subject a nurse to licensure discipline; this is particularly true with photographs. State privacy laws can be more stringent than HIPAA, so nurses must know the laws in their states. 

(For detailed guidance on deidentifying patients in accordance with HIPAA, go to http://bit.ly/2qkS9lA. For a quick reference, see http://bit.ly/2pPYgud.)

If a nurse is seeking a person's authorization to disclose information publicly, the patient should be informed of likely consequences. For example, if the person's information was being used in politically controversial testimony, she or he should be informed of possible negative publicity or that reporters might seek her or him out for further information.

Nurses are not protected by authorizing documents alone; they also must be compliant with employer policies and get approval from their organization's HIPAA compliance officer.

Although one is not bound by HIPAA in relation to information obtained outside a clinical relationship or other role as a nurse—say, when told by a friend about an illness—common morality and respect require that any public revelation be explicitly approved by the person with the illness. Further, the nurse should be aware that there are many ways to communicate one's professional status inadvertently on social media that would make a posting a public communication.

Events occurring in the context of nursing care should not be revealed for the sake of humor, such as the periodic postings of odd items shown in X-rays or extracted from patient's bodies, even when the patient's identity is protected.

Narrative accounts of the nursing experience should reflect well on the profession and bring problems to light in the spirit of working to improve matters.

Before discussing systemic or institutional problems or abuses, the nurse should follow proper reporting procedures. If those responsible do not respond in a satisfactory way, the nurse should consider whistle-blowing. However, when considering whistle-blowing, the nurse should consider how to do so in a way that confers the most credibility regarding the accusations and maximizes whatever protections are available. 

Facebook and similar social media are not the appropriate venues for serious whistle-blowing communications. (For information on whistle-blowing, see http://bit.ly/2qoZQVL from the ANA and http://bit.ly/2ra8Bpx from American Nurse Today.)

Nurses should know the legal consequences of their actions. The use of social media is an area that carries the potential for severe legal consequences. The inspiration for this writing was a disciplinary hearing about Facebook postings, yet several colleagues have expressed surprise over the finding that the nurse violated the Canadian Nurses Association's Code of Ethics for Registered Nurses.

Common sense is the starting place for assessing the appropriateness of postings and public discussion. Nurses should consider the effects of any potential public communication or posting from the nonnurse perspective. They should never post out of spite or anger. They should try to ensure that messages are accurate and, whenever possible, reflect well on nursing. When criticizing the profession, nurses should ensure that any message they post is accurate and balanced, while offering reasonable solutions as often as possible. Even if the nurse has no specific solution, a message can be framed so that it invites others to be creative and leads to a constructive dialogue about improving the situation.

REFERENCES
1. U.S. Congress. U.S. Constitution—Amendment 1: Freedom of religion, speech, press, assembly, and petition. 1791.
Cited Here...
2. Saskatchewan Registered Nurses’ Association. Investigation committee of the Saskatchewan Registered Nurses’ Association and Carolyn M. Strom, Saskatchewan RN # 0037024. Decision of the discipline committee of the Saskatchewan Registered Nurses’ Association. Regina, Saskatchewan 2016.
Cited Here...
3. CBC News Nurse who ‘vented’ online found guilty of professional misconduct. 2016 Dec 3. http://www.cbc.ca/news/canada/saskatchewan/srna-discipline-social-media-nurse-saskatchewan-1.3880351.
Cited Here...
4. Martin A Complaining about granddad's care on Facebook could cost nurse $30Gs. Toronto Sun 2017 Feb 18. http://www.torontosun.com/2017/02/18/complaining-about-granddads-care-on-facebook-could-cost-nurse-30gs.
Cited Here...
5. Martin A Nurses lay into RN at hearing about ‘inappropriate’ post complaining about care for her dying grandpa. National Post 2016 Feb 11. http://news.nationalpost.com/news/canada/shes-attacking-me-as-a-colleague-registered-nurse-facing-discipline-over-critical-facebook-post.
Cited Here...
6. American Nurses Association. Social media and your nursing career. 2014. http://nursingworld.org/Content/Resources/Social-Media-and-Your-Nursing-Career.html.
Cited Here...
7. Menz K Lawyer asks for $30K fine against Sask. nurse for Facebook post. CTV News-Saskatoon 2016 Feb 17. http://saskatoon.ctvnews.ca/lawyer-asks-for-30k-fine-against-sask-nurse-for-facebook-post-1.3290926.
Cited Here...
8. Ohio Nursing Board Defense Counsel. Ohio nurses and social media. Ohio Board of Nursing; 2017 Jan 30. https://legalcounseltoprofessionals.wordpress.com/2017/01/30/ohio-nurses-and-social-media.
Cited Here...
9. Virginia Board of Nursing. Virginia Board of Nursing: guidance on the use of social media. Henrico, VA; 2012 May 15. Guidance document 90-48. Guidance documents: discipline and compliance; https://www.dhp.virginia.gov/nursing/nursing_guidelines.htm.
Cited Here...
10. Minnesota Board of Nursing. Professional boundaries and social media guidelines for nurses. For Your Information 2014 Fall 21(3):5. https://mn.gov/boards/assets/Newsltr_Fall_2014.pdf_tcm21-37163.pdf.
Cited Here...
11. Ventola CL Social media and health care professionals: benefits, risks, and best practices P T 2014 39 7 491–520
Cited Here... |
PubMed
12. Texas Board of Nursing. Postion statement 15.29. Professional boundaries including use of social media by nurses. Austin, TX; n.d. Practice—Texas Board of Nursing position statements; https://www.bon.texas.gov/practice_bon_position_statements_content.asp#15.29.
Cited Here...
13. American Nurses Association. 6 tips for nurses using social media. Silver Spring, MD 2011.
Cited Here...
14. National Council of State Boards of Nursing. A nurse's guide to the use of social media. Chicago; 2011 Nov. https://www.ncsbn.org/NCSBN_SocialMedia.pdf.

Source: American Journal of Nursing

Photo credit: Google
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November 04, 2017

ISAAC ADEWOLE ESSAY COMPETITION FOR NURSING STUDENTS AND OTHERS: IF I WERE THE MINISTER OF HEALTH

November 04, 2017 0
OFFICE OF THE NATIONAL DIRECTOR OF HEALTH, NANS
         Presents
PROFESSOR ISAAC FOLORUNSO ADEWOLE ESSAY COMPETITION
  
PRIZES:
1st position #250,000
2nd position #150,000
3rd position. #100,000
And other consolation prizes
*GUIDELINES:*
✅Participants should be students of medicine,pharmacy,nursing,dentistry, medical laboratory science,radiography,physiotherapy, optometry, physiology,anatomy or any allied health science or technology undergoing undergraduate or post graduate study in any tertiary institution in Nigeria.
✅Essay  on "if i were the minister of health" should be between 1000-2000 words and submitted with name,school,registration number, email address and phone number in soft copy to the emails: 1. prof.isaac.adewole.essay@gmail.com
2. nanshealthessay@gmail.com
✅Deadline for submission is *4th* *December*, *2017*
✅submission of soft copy,hard copy of essay should be addressed and mailed or submitted in person to the office of the National director of health,NANS, c/o office of provost,college of health sciences
Nnamdi Azikiwe university,Nnewi, Anambra State,Nigeria.
Signed
Adebola Mercy Adeola
Secretary
National directorate of health,NANS
For further inquiries call 07066969915
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November 02, 2017

HOW TO COPE WITH NIGHT SHIFTS

November 02, 2017 0
By Hannah Nichols
What do doctors, nurses, firefighters, truck drivers, and air traffic controllers all have in common? Many of them work night shifts.
Whether you are an early riser or a night owl, working shifts at night can be challenging. We have compiled some tips to help you cope with working into the late and early hours of the day.
Due to our modern 24-hour society, nearly 15 million people in the United States work full-time night shifts, evening shifts, rotational shifts, or other such irregular schedules. What is more, almost 19 percent of adult workers work for 48 hours or more every week, and more than 7 percent work for 60 hours or more each week.
Shift work and long working hours have been linked to a number of health issues, according to the National Sleep Foundation. These include an increased risk of metabolic problems, heart disease, gastrointestinal difficulties, obesity, and certain cancers.
Night shift work may also interfere with the body's ability to repair DNA damage that occurs from normal cellular processes. The suppression of melatonin — which is the hormone responsible for regulating the internal body clock — may play a role.
Individuals need to work through the night for numerous reasons. Finding ways to cope can be the difference between living a healthy existence and being subjected to the many health and safety risks that are elevated during night shifts. Here are Medical News Today's coping strategies for working after dark.
1. Manage sleep patterns
Some people can work at night with no problem at all, while others experience sleep deprivation and fatigue. This is because the human body is designed to sleep at night-time.
The human body is controlled by an internal body clock, or circadian pacemaker, which is located in the suprachiasmatic nucleus (SCN) of the hypothalamus. The SCN generates circadian rhythms, which regulate behavioral and physiological processes in the body, including alertness, sleep, temperature control, and hormone production.
Circadian rhythms run in 24-hour cycles and are significantly influenced by the natural light and dark cycles. Many of the processes in your body that are active in the daytime slow down at night to prepare you for sleep. At night, the circadian pacemaker releases the sleep hormone melatonin from the pineal gland, which causes you to feel less alert and raises your desire to sleep.
Night shifts cause you to battle against your natural rhythms by trying to be alert when you are programmed to be sleeping. Similarly, when you go home after a night shift, the cues from your internal body clock and daytime light exposure tell you to be awake and active.
Adults need between 7 and 9 hours of sleep to function at their best. If you sleep for under that amount, you will incur "sleep debt." The only way to pay back sleep debt is to catch up on sleep you have missed, and this has to occur as soon as possible after it is incurred.
Working at night involves successfully managing your sleep during the day — that is, to keep sleep debt to a minimum — and your fatigue during the night. Daytime sleep can be lighter, shorter, and of poorer quality than sleep at night due to light, noise, and temperature.
Try these steps to keep your sleep in check and make your environment more favorable for sleep.
Do not delay going to bed. The longer you delay going to bed, the more awake you are likely to become.
Try to set aside a block of 7 to 9 hours to dedicate to sleep after a night shift.
Have something to eat and drink before you go to bed. Pangs of hunger or thirst may wake you up.
Avoid alcohol before you try to sleep. Alcohol may help you to fall asleep, but it diminishes sleep quality and disturbs the deep stages of sleep, which will leave you feeling unrefreshed the next day.
Avoid smoking before bed. Nicotine is a stimulant and can therefore cause you to experience difficulties in getting to sleep.
Stay away from activities that make you feel more alert until the hours before your next shift.
Make sure your bedroom is quiet, dark, and at a comfortable temperature. Use earplugs to block out daytime noise and blackout curtains to prevent daylight entering the room. Electric fans can be useful to keep air circulating and provide neutral background noise.
Notify friends and family of your working hours so that they do not disturb you.
If this is your last shift in a block of night shifts, remember that the more days in a row that you have been working through the night, the more sleep debt you will likely have accrued. Repaying some of the sleep debt that you accumulate as quickly as possible will help you to recover sooner.
2. Control light exposure
Exposure to light cues chemical events to be triggered by the circadian pacemaker that affects your sleep and wake cycles. For example, melatonin is released as it gets dark in the evening to make you feel drowsy, while melatonin is suppressed and cortisol elevated by the morning light to make you feel more awake.
Artificial light can affect your circadian pacemaker in the same way as sunlight, and timed exposure to bright light can help to alter your body's sleep cycle.
During night shifts, you can try to "trick" your body into an alert state with exposure to bright light, and promote sleep by suppressing light exposure after your shift.
Research has shown that night workers who were exposed to bright light during their shift and wore sunglasses on the way home to suppress light drifted off to sleep quicker and slept for longer after their shift than people who received no bright light exposure. Furthermore, another study found that intermittent exposure to bright light is almost as effective as continual exposure.
Beware of exposure to blue light emitted from digital devices, such as your smartphone, tablet, or television, before you go to bed after a night shift. Research has suggested that blue light knocks our circadian rhythms off-kilter, which signals to your brain that it is daytime and results in poorer sleep quality.
Ways that you can control your exposure to light include:
increasing bright light exposure during your shift with regular overhead lights or a bright desk lamp or lightbox
wearing sunglasses on your journey home
using blackout blinds, curtains, or drapes or a sleep mask to block out daylight in your bedroom
not watching TV before you go to bed
switching off digital devices situated in your bedroom, including powering down tablets and computers, putting your phone away, and blocking light from bright alarm clocks
Keeping your bedroom dark will help to keep your body in sleep mode until it is time for you to wake up and begin your day.
3. Watch your diet
When typical daily rhythm is thrown off balance, so too is metabolism. Night shift workers are more likely to experience metabolic syndrome and have a 29 percent increased risk of becoming overweight or obese due to poor diet and the disruption of the body clock.
Planning your meals can help you to stay alert during your working hours and be more relaxed when you need to sleep.
Try to stick to a similar eating pattern to the one that you would follow during the daytime.
Eat frequent light meals or healthful snacks to avoid the drowsiness that is associated with heavy meals.
Choose foods that are easy for your body to digest, including bread, rice, pasta, salad, milk products, fruits, and vegetables.
Avoid foods that are difficult to digest, such as fried, spicy, and processed meals.
Steer clear of sugary foods. Although they provide a short-term energy boost, this is quickly followed by an energy dip.
Snack on fruits and vegetables. Sugars from these are converted slowly into energy, and they are an important source of vitamins, minerals, and fiber.
Keep hydrated while you are working to promote physical and mental performance, but do not overload the bladder with fluid before bed.
Access to the grocery store and adequate facilities to prepare food can be hard for night workers. Be prepared and take food to work to ensure that you eat properly and stay alert.
4. Take a nap
Taking a nap can become an essential element of working safely overnight. While a short nap before you start your shift can help to combat fatigue, a nap during your break may be vital for maintaining alertness and remaining vigilant.
A nap taken midway through the day has been shown to boost and restore brainpower. Even naps of 20 to 45 minutes in length have proven beneficial for shift workers to counteract fatigue.
Ideally, your night shift naps should not exceed 45 minutes. Sleep is comprised of different stages, which complete in cycles of between 90 and 100 minutes. One sleep cycle runs from light sleep to deep sleep.
Be careful about how long you nap for in order to ensure that you do not wake up during deep sleep. Deep sleep waking is associated with greater sleep inertia, meaning that you will take longer to feel alert and will not feel refreshed.
5. Use caffeine wisely
Caffeine is a stimulant. When used carefully, your daily dose of coffee can help you to remain alert throughout a shift. However, improper use can cause gastrointestinal upsets and muscle shakes.
Most people take a huge dose of coffee at the start of their shift in order to jump-start their day. However, research suggests taking a different approach to maximize the effects of caffeine for shift workers.
Workers that consumed smaller — equivalent to quarters of cups of coffee — and more frequent doses of caffeine throughout their day experienced enhance wakefulness, performed better on cognitive tests, and had fewer accidental naps than those who had had no caffeine.
Some evidence suggests that the effects of caffeine kick in after around 20 minutes, and that a small dose of caffeine before a nap can counter the sleep inertia you may experience after you awake.
Caffeine use should be stopped around 6 hours before bedtime to ensure that the stimulant does not affect your sleep.
Every person is different, so finding the right combination of techniques that suit you best may take time. Applying some of the above strategies may help you on your way to coping better with working at night and ensuring that you get the right amount of sleep to function properly.
Source : Medical News Today
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October 31, 2017

NURSING WAS NEVER A FEMALE'S PROFESSION

October 31, 2017 0
Before I got into the nursing profession, the picture of a young lady in white uniform and cap receiving order from a Doctor was the first thing that came into my mind anytime I hear the title 'Nurse'
There's been this long standing misconception in the society of ours that only females meet the criteria to be nurses. To them only females can care for the sick naturally because the act of caring they believe is innate.
Florence nightingale, the mother of modern nursing once said "Men have no place in nursing except where physical strength is needed"  ( KeithRN )
In her words, Men's hard and horny hands are not fit to touch, bathe and dress wounded limbs however gentle their hearts may be.
More than 2000 years ago, only men were considered “pure” enough to enter what is thought to be the world’s first nursing school, which was founded in India about 250 B.C. For the next two millennia, nursing remained male-dominated. It took warfare in the 19th and 20th centuries to transform nursing from being considered a man’s job to a women’s profession (Thunderwolf, 2006).
In the Ancient Rome, the nosocomi, who were men provided nursing care in hospitals. There were also the religious orders that provided care for the sick and the well known military nursing other. This was where the term " Nosocomial"  originated from.
Judging from the above, Nursing was never a female's profession. It was predominantly for men.
Nursing became the female- dominated profession as it is today after the introduction of of nursing education to answer the need for better patient care together with the  rise of modern medicine in the 1800's
In Nigeria today, Nursing remains a female dominated profession. The society doesn't give due recognition to men in nursing. Many male nurses are even wrongly addressed as Doctors. For them, every woman within the hospital setting is a nurse and every man is a Doctor.
Many men are running away from the profession on daily basis because of intimidation, unfavorable working conditions, and job dissatisfaction. The few ones that has chosen to stay aren't being encouraged and motivated.
The ratio of students being admitted into the nursing school has never being fair. Men who managed to secure the admission  remain the minority in the class. Hardly will you find 10 males in a nursing class of 50 students.
In the midst of this challenges, some passionate individuals has taken the bull by the horn to savage the situation by organizing an association for Nigeria men in nursing to speak with one voice.
The association , Men In Nursing Assembly Of Nigeria ( MNAN ) has taken up the responsibility of empowering , encouraging, advocating and providing mentorship for Men in nursing. The platform will also be use to push for policy reform and promote professional development
Between 30th December and 1st of November this year, the association will be holding its maiden edition of Men In Nursing And Midwifery Leadership Conference  at Barcelona Hotel, Abuja, Nigeria in partnership with the LAMP AFRICA.
Below is the program of event for this historic event.
First Men in Nursing and Midwifery Leadership Conference
30th November & 1st December, 2017@Barcelona/Ayalla Hotel, Abuja
Registration details: Group of five - N10,000 each, Early bird (3weeks to conf.) - N10,000, Nursing students - N5,000, Corper Nurses- N6,000, Post earlybird - N15,000
FEMALENurses are allowed to register to participate in the Technical Sessions ONLY
Session Guides
Date/time
Topic
Outcome
Facilitator
7:00 – 8:30 am
Arrival and Registration
8:00 – 8:35 am
Opening Prayer
National Anthem
8:35 – 8:40 am
Opening remark & Objective of conference
YasirSani
8:40 – 8:50 am
Welcome address &Overview of THE LAMP AFRICA
Introduction of Guest Speaker: Dr. Jonas Nguh, PhD, FACHE, NEA-BC, RN
Egorp Emmanuel

08:50 – 9:40am
Session 1: Leadership and Management in Health
Building Leadership skills, improving shared vision and drawing strategic action plans
Dr Jonas Nguh:Global Initiative Officer, AAMN; Editor-in-Chief Int. Journal of Health
care Policy;
Ass. Sec. American College of Healthcare Executive, National Capital Region
9:30:-10:30 am
Tea Break
10:30 – 1:30pm

Opening Ceremony/Special guest/NMCN Registrar’s address, AAMN President speech, Goodwill messages from development partners, policy makers, nation and various nursing union leaders(NANNM, UGONSA, FHIN, NANPAN, PAPHNON, LGA NURSES, PRIVATE PRACTICE NURSES etc)
&
Launch of #DELIVERY MEN INITIATIVE (Frontline Skilled Birth Attendants in Conflict Zones )
1:30 – 2:30pm
Session 2: Practical Approach to Care Kit (PACK)/Q & A
Improving quality of care by more accurate diagnosis
Prof John Ana: Executive Chairman/Lead Senior Fellow
Africa Centre for Clinical Governance Research & Patient Safety (ACCGR & PS)

2:30 – 3:30pm
                       Lunch
3:30-5:00pm
Session 3: Policy development & Advocacy/Q & A
Understanding of:
·     Policy impact and process
·     Advocacy skill
Association for the Advancement of Family Planning (AAFP)
5:00- 7:00pm
Session 4: Making Plans to Succeed &Career Development Opportunities/ Q & A
Understanding of the motivation contract; the individual performance assessment
Dr. Jonas Nguh
5:00- 7:00pm
Group discussion and nominations of interim executive committee for MEN IN NURSING ASSEMBLY OF NIGERIA (MNAN)
Yasir/Princewill
8:00- 9:00pm
Closing and return to hotels
Day 2
7:00 – 8:30 am
Arrival and Registration

8:00 – 8:40 am
Session 5: Psychosocial support for conflict/violence victims including Internally Displaced Persons (IDPs)/Q & A
Explain the concept and processes involved in Psychosocial support:
Counselling, treatment, follow-up


HajiaAishatuAbubarka (Mandela Washington and Common Wealth Fellow)
8: 40 – 9:40 am
Session 5: Overview of Health System reform approach: Performance Based Financing (PBF) –Nigeria State Health Investment Project (NSHIP)
Explain the concept and implementation of PBF-NSHIP

Identified capacity building opportunities for nurse/midwives
NPHCDA NSHIP-Project Implementation Unit/World Bank
9: 40 – 10:30 am
Tea Break
10: 30 – 2:30 pm
LAUNCH OF MENEMO SCHOLARSHIP FUND FOR NURSING STUDENTS AND
MEN IN NURSING ASSEMBLY OF NIGERIA (MNAN)
American Association for Nursing Association
2: 30 – 4:00 pm
Lunch
4: 00 –5:00 pm
Professional opportunities for nurses in development and M & E/ Q & A
Understanding of the workings of NGOs
Existing opportunities in Monitoring & Evaluation
Mr. Balarabe Gaya
Head, M & E – Women 4 Health, Kano State
5: 00 – 8:00 pm

1st meeting session of MEN IN NURSING ASSEMBLY OF NIGERIA (MNAN)
Interim Executive Committee
8: 00 – 9:00 pm
Closing and return to hotels
      

Part I: Launching of Nigerian Assembly of Men in Nursing
Presentation: “Where are Men in Nursing in Nigeria” by Dr. Jonas Nguh
History of the Nigerian Association of Men in Nursing (NAMN) by Emmanuel Egorp
Remarks by Dr. Brent MacWillaims, President of the American Association of Men in Nursing.
Introduction of the members of the executive of MNAN
Induction of the Association & executives.
Part II: Launching the MENEMO Scholarship Fund
History & Introduction of the Scholarship program by Dr. Jonas Nguh
Presentation of awards.
Remarks by AlhajiFaruk Umar Abubarka (Registrar/General Secretary Nursing & Midwifery Council of Nigeria –NMCN)
Remarks from nursing stakeholders
Vote of Thanks & Acknowledgements
Closing prayer
Reception with nursing officials & photo session.
This is indeed timely and I encourage all men wanting to make impacts in Nigeria nursing profession to be a part of this.
Oluwatosin K.O, RN, Bn.sc. in view
    For Fellow Nurses Africa
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October 26, 2017

INCLUDE OTHER QUALIFIED HEALTH PROFESSIONALS IN RESIDENCY PROGRAM OR ABOLISH IT COMPLETELY: JOHESU WRITES BUHARI

October 26, 2017 0

The attention of the JOHESU/AHPA has been drawn to a malicious publication credited to the Nigerian Medical Association and addressed to the Honourable Minister of Labour and Employment, and widely circulated in the media. The said letter titled "An Urgent Call for an Intervention to Redress Aberrations in Health Service in Nigeria" was laden with a lot of misconceptions and outright falsehood. We are aware of various rejoinders to the offensive NMA article by several highly respected health professional bodies in Nigeria, and will therefore not bother to join issues with the NMA word to word. 

However, we are bound to respond to some very repugnant aspects of the grossly offensive write up, such as that contained in paragraph 3 where the NMA stated "Appointment of other Health Professionals as Consultants/Payment of Specialist Allowance: Having gone through various circulars and court judgments, there is no place it was stated that other professionals should be appointed as consultants in a hospital setting. Every professional with the right qualification can self appoint him/herself as a consultant but NOT in a hospital setting. None of the proposed consultants is useful in patient care as physicians may not need their services. There are consultants in various medical specialties that oversee the work of the allied health workers. 

We at the JOHESU/AHPA are amazed that such repulsive and mischievous statement can emanate from a body that styles itself "custodian and leader of healthcare in Nigeria," towards the end of the 21st century. It is common knowledge the world over that healthcare delivery is a collaborative practice, with the patient at the centre of care. The medical doctor uses his expertise and knowledge of diseases to make a diagnosis, the medical laboratory scientist assists the doctor to confirm or establish the diagnosis by making use of laboratory and other diagnostic tests, while the pharmacist makes use of his competences and skills on drug therapy to monitor treatment outcomes. Nurses provide basic patient care to facilitate response. This is the prototype of medical care in developed nations of the world. That way, no health professional is relegated or undermined. Joint clinical ward rounds take place involving physicians and consultant pharmacists, with resultant improved patient outcomes. This explains why the level of medical tourism to such climes is very high. Unfortunately, this is not the case in Nigeria. Ego of practice and internal squabbles commonly formented by medical doctors bent on one man show, has placed patients at their mercy. Unfortunately, most Nigerians are not aware of this, otherwise a lot of doctors would have lost their operating licenses to their penchance and insistence on solo practice.

By way of digression, Medicine started from creation when God gave man every tree of the field, every fish or creature in the sea as well as all the cattle of the field. As the world began to be populated, differentiation of responsibilities, professionalism and more began to happen as well as institutionalization of education which has happened and is still happening to every endeavor of man. And the global world in appreciation of that haven learnt from the Greeks, gives room to the unknown. But not so for our esteemed colleagues, mates, juniors, seniors in the faculty of medicine in Nigeria. They have the rudiments and control of all knowledge in the world of human medicine and its practice. The NMA has become the proverbial Tortoise whose name is ' all of you' . We even heard how they went to former President Goodluck Jonathan to sign an agreement for them on the 1st working day of January, 2014, to get them to vote for him, as if their singular vote will get Jonathan a guaranteed re-election. But, both he and his partners in unrighteousness forgot that we are first human beings regardless of race, ethnicity, creed or whatever else. 

There are so many doctors who are so pissed with the madness that Prof Olikoye Ransome Kuti foisted on Nigeria's health care system. Like the proverbial feast of birds in heaven so many good hands have left the system to the ' all of you' and their sponsors (their very own- all the Ministers of Health of Nigeria and the government of the days from Ibrahim Badamosi Babangida to date). What a leader in health sector they really have been! 

It is a tragedy that while nations are working out strategies to improve on healthcare delivery by promoting collaboration amongst healthcare providers, the NMA (acting like a slave master) is creating rancor to further plunge healthcare delivery in Nigeria into abyss. It is strange that doctors in Nigeria allocated to themselves, the regulation of their practice, while regulating other professions. A case of control your house and tell another person how to live in his own house or rather they decide their growth and how others should grow also (real slave trade). Doctors dictate their destiny including welfare and also insist on determining welfare package payable to other health workers. 

Back in the 70s, you could see consultants who earned more than their heads of departments, even sometimes the head of hospital because it was about professionalism and the health of the people. All professionals trusted each other and worked together then as a team. People came from all over the world to patronize our healthcare system. The minister of Health then was a Minister of the Health of Nigeria and Nigerians, not that of NMA, as it has been since the time of Prof. Olikoye. And that was why they had the effrontery to threaten and go on strike when Prince Julius Adeluyi was made the Secretary of Health during the interim government of Chief Ernest Shonekan. One would have thought that by now, NMA will be boasting about the technological knowhow they have brought to bear in our healthcare industry and the positive impact on the precious lives of our people here in Nigeria.

We expected that going by NMA's rhetorics, we would have had a Nobel laureate of medicine from Nigeria to celebrate or a new drug or a breakthrough that will impact on Nigeria and the global village. But alas! The achievement is that in the last 30 years or so that this uncurtailed madness started, they are earning much more (in some cases thrice) than any of their counterparts in the healthcare team . That's the 30 year unrivalled achievement of our colleagues in NMA, without a moment's thought for how to add even a penny to the treasury to ensure sustainability of their own scheme. Rather, they fleece the system further by manipulating patients to go on medical tourism to not only India, but any so called Island as long as it is not Nigeria, so that they can make money from the government as well as the patient, making unreasonable demands that are out of this world. Yet, they are leaders in healthcare! 

It is noteworthy that the biggest legacy of the leadership of doctors in healthcare remains the negative indices which characterize our health system once rated 187 outof 191 health systems. 

Still on the issue of consultancy, research from various parts of the world has shown that teamwork, communication and collaboration between health professionals are important for the safe and effective delivery of healthcare. 

For instance a Literature review by the National Prescribing Service in far away Australia "identified significant problems associated with medication misadventure." According to them, "approximately 6% of hospital admissions are associated with adverse drug reactions and high error rates during transfer of care. They concluded that increased interprofessional collaboration between care providers could therefore reduce the considerable medication —related morbidity and mortality." 

In the United Kingdom, a project in 2001 where elderly patients received multidisciplinary medication reviews on admission, revealed enhanced clinical outcomes, reduced costs associated with inappropriate prescribing and improved communication with general practitioners. Quite unlike what the NMA would have the nation believe, in the United Kingdom, within the context of expanding practice and service changes driven by the modernization agenda, non medical consultant posts have been introduced into a number of other professions (in 1999 for nursing and in 2000 for Allied Health Professions). 

Fundamental changes to service delivery and design are leading to wide-ranging opportunities for all health professionals, and pharmacists are already fulfilling some of these new and innovative roles. Pharmacists have been successful in developing clinical and specialist roles in hospitals and primary care for a number of years. No wonder many Nigerians, including very highly placed ones are trooping to the UKfor medical attention.

In UK, there exists consultant pharmacists for such specialized care as anticoagulation therapy, antiasthma care, older people's care and so on, with resultant improved patient outcomes. Consultancy status is also reality in nursing, physiotherapy and radiography. The real benefit of the consultant role is in the combination of skills the consultant brings to the post, providing not just the professional expertise but the skills to utilize this expertise to best effect by researching, educating and encouraging others to develop their roles. 

The four main functions of consultants include expert practice, research and evaluation, practice and service development, education mentorship and > overview of practice and professional leadership. In the United States of America, while the concept of consultant pharmacy originated about three decades ago, today more than 10,000 consultant pharmacists provide a broad spectrum of administrative, distributive and clinical services to several million in a wide variety of care environments. 

A consultant pharmacist is a provider of pharmacy systems, an educator, a drug information resource, a clinical practitioner, a patient care advocate, and a member of the health care team. This advancement is same in nursing where over 20 specialist cadres exist and in physiotherapy where practitioners continue to excel in vital areas like cardiology and orthopaedics. 

The West African Post Graduate College of Pharmacists (WAPCP) and West African Postgraduate College of Nurses are professional bodies that are involved in post graduate training of pharmacists and nurses in the West African sub region that qualifies them to become consultants by increasing and polishing the skills and competencies of these practitioners. This equips them to tackle greater challenges as is obtainable in developed nations. 

A similar body, the West African College of Physicians is responsible for awarding fellowships to doctors in the West African sub region that entitles them to be called medical consultants. It is therefore ridiculous and contemptuous for the NMA to allege that "other professionals can self appoint him/herself as a consultant." We make bold to state here that the post graduate fellowship of these colleges is equivalent to that of the medical consultants. The programme has become modernized with the recent introduction of residency training in various specialty areas similar to those obtainable in various post graduate training institutions across the world. 

To date, the post graduate college in pharmacy has trained well over 2,000 consultant pharmacists, with many of them majoring in clinical pharmacy, the branch of pharmacy where pharmacists provide patient care that optimizes the use of medication, promotes health, wellness and disease prevention. It is instructive that it is only in Nigeria that government sponsors residency training for medical doctors. Other professionals including pharmacists, nurses and laboratory scientists pay through their nose to sponsor themselves for the fellowship programme and other post graduate training like Masters and PhD. The additional knowledge and skills they acquire is ploughed back to improve on patient care services. 

Elsewhere in the world, medical doctors pay for their residency training from their pockets. This information can be readily verified. Notwithstanding the sponsorship of medical doctors' residency training by government, what does the government get in return from them? Rather than settle down and give back to government and the nation for sponsoring them, they resort to blackmail and endless strike actions, to cajole government to increase their salaries, while at the same time trying to belittle and undermine the integrity of other hard working healthcare professionals. 

Demands 
i. It is very obvious that this trend can no longer continue. We hereby call on the federal government to include other duly qualified healthcare professionals in the residency programme, or abrogate the programme completely and let everybody fend for himself as is obtainable elsewhere in the world. The money so saved can be ploughed back to the health sector to improve on service delivery. 

ii. We wish to inform the Honourable Minister of Labour and Employment that Nigerians who have trained to be consultants in various healthcare callings apart from medicine are already working in hospitals, where they are using the additional skills acquired to improve on service delivery in their various practice locations. What is needed now is for government to formally give backing to the enabling programme with the necessary circulars, to enable these consultants in other fields receive appropriate remuneration for services rendered to patients. 

The JOHESU/AHPA is using this medium to call on the Federal Executive Council, through the Office of the Honourable Minister of Labour and Employment, to as a matter of urgency, give approval to the fellowship programme of professions which already have approvals of the National Council of Establishment with enabling circular to enable patients benefit maximally from the additional skills and competencies of these consultants.


iii. The JOHESU/AHPA is also calling on the NMA to realize that she cannot single handedly ensure or guarantee optimal healthcare delivery in the country. She must learn to respect other healthcare professionals and carry them along. She should stop using 18th century tactics to solve problems of the 21st century. She keeps making reference to international best practice when it suits her whims and caprices but suffice it to say that in the US and elsewhere in the world; there is mutual interprofessional respect and trust as well as multidisciplinary approach to healthcare, which in turn has engendered maximum healthcare delivery. This explains why medical tourism thrives in those climes. 

In some medical centers in US, some specialist pharmacists earn as much as medical doctors, while nurses earn more than medical doctors. They are paid on hourly basis, depending on their internally generated revenue and individual input. On the issue of leadership of the healthcare sector, the NMA had this to say "The NMA wishes to advice both government and those that may be seeking autonomy that it is the life of Nigerians including all health workers, their family members and others resident in the country. This fight for professional ego should not be extended to this area as it impacts on patient survival. There cannot > be two captains in a ship." We beg to disagree with the NMA on this issue. The captain of the ship in this case, must not necessarily come from one profession. It is all about leadership roles. 
While we concede that medical doctors are more in number than some equally top rated professionals in healthcare, that does not give the NMA the right to intimidate or oppress the other professionals. Any professional that has undertaken basic courses in the medical sciences, is medically qualified to head hospitals and other healthcare institution

s. The World Health Professions Alliance (WHPA) which brings together the International Pharmaceutical Federation (FIP) International Council of Nurses, World Confederation of Physical Therapy, World Dental Federation and World Medical Association (WMA) is the flagship organ of all healthcare professionals funded on the basis of equality of professions. 

Based on the collaboration Cecil Wilson, President of World Medical Association insists that "high quality patient care is most likely to be achieved when professionals work together". Tragically for NMA it is only about self aggrandisement and pecuniary gains for its members. 

In 2013 the ICN, FIP and WMA sent a joint proposal to the 56th session of the United Nations High Commission on Human Rights seeking the appointment of a UN Special Rapporteur on the integrity of independence of health professionals. This is the beauty of teamwork. 

In conclusion, we make bold to state that there is need for government to call the NMA to order and to curb their excesses. The Healthcare Sector in Nigeria cannot afford to continue like this. This bitter rivalry in the sector engineered by the NMA must stop. The day society realizes that most patient deaths that occur in hospitals actually arise from internal squabbles engineered by the NMA and they litigate in court; the doctor as an individual, the hospital, overindulging the Federal Ministry of Health and by extension, the Federal Government, that will be the day when we shall have some sanity, peace and advancement in our healthcare sector. 

That day surely beckons. 

Please accept assurances of our esteemed regards. 

Com. Biobelemoye Joy Josiah National Chairman JOHESU
Ekpebor Florence National Secretary, JOHESU

TO: HQ/JOHESU/ADM/VOL.I/400 
His Excellency President Muhammadu Buhari, GCFR 
Aso Rock Villa Abuja.

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October 21, 2017

NON-PNEUMATIC ANTI SHOCK GARMENT: A TOOL FOR REDUCING MATERNAL MORBIDITY & MORTALITY IN NIGERIA BY BILKISU UMAR BAYERO RN, RM, RNT, HPDCS, BNSC.

October 21, 2017 0
NON-PNEUMATIC ANTI SHOCK GARMENT: A TOOL FOR REDUCING MATERNAL MORBIDITY & MORTALITY IN NIGERIA
BILKISU UMAR BAYERO RN, RM, RNT, HPDCS, BNSC.
SYNOPSIS
. Introduction
. Background
. History
. Definition
. How it works
. NASG-Application and Removal
. Summary
. Conclusion
. Reference

         

INTRODUCTION
In developing countries post partum Hemorrhage (PPH) continues to be the single most common cause of maternal morbidity & mortality , accounting for approximately 25% of maternal deaths Globally and over 90% of these deaths occurs in developing counties, for women suffering from uncontrollable PPH, a method to control the bleeding, reverse the shock and stabilize the patients is a life saving skill, one method to manage PPH is the use of a Non – pneumatic Anti Shock garment (NASG).
NASG is a low technology first aid device used to treat hypovolemic shock. Its efficacy for reducing maternal deaths due to obstetrical haemorrhage is being researched. Obstetrical hemorrhage is heavy bleeding of a woman during or shortly after a pregnancy. Many women in resource poor settings deliver far from health care facilities. Once hemorrhage has been identified, many women die before reaching or receiving adequate treatment. The NASG can be used to keep women alive until they can get the treatment they need.
BACKGROUND
Every year, an estimated 342,900 women die from complications of pregnancy and child birth, 99% of these deaths occur in developing countries. Worldwide, for every 100,000 live births, about 251 women die. In some industrialized countries such as the U.S, this is 13 death for every 100,000 live babies born with American women having a life time risk of 1 in 2,100 of dying from childbirth related complications. However in some countries, such as Afghanistan up to 1,600 women die for every 100,000 live births and women have a I in II life time risk of maternal death.
Maternal mortality:-
“World Health Organization (WHO)” defined MM as “the death of a woman while pregnant or with in 42 days of termination lof pregnancy, irrespective of the duration, site of the pregnancy, from any cause related or aggregated by the pregnancy or its management but not from accidental or incidental causes”
For every woman who dies, there are 30 women who suffer a disability as a result of pregnancy or child birth related complications (or maternal mortality) and 10 who experiences a near miss mortality. (a life-threatening obstetric complication). Morbidities can be serious, lifelong ailment which compromise a woman’s health, productivity, quality of life, family health and ability to participate in community life. If a mother die after childbirth, the newborn is then ten times more likely to die before the age of two, other children are more likely to suffer from poor nutrition and schooling. Many motherless families find it difficult to survive; often with older children having to drop out of school in order to work to help supports the family or being sent to live with a relative. In addition to this, maternal and newborn death , have estimated to cost the world 15 billion US dollars in lost of productivity annually, with maternal health proven to support a country’s economic growth and cut poverty. Maternal death and disability is a human rights issue. It also means hardships and loss of productivity for families, communities and nations.  This is of such great concern that in 2000, world leaders decided that improving maternal health should be one of the 8 millennium development Goals for the international community. To prevent these deaths, there are some emerging technologies which are currently being researched and implemented that seek to prevent these unnecessary deaths. One of these device is NASG, Which is a low technology first-aid device.

HISTORY
In the 1900s an inflatable pressure suit was developed by Crile. It was used to maintain blood pressure during surgery. In the 1940s and after undergoing numerous modifications, the suit was refined for use as an Anti-gravity suit (G-Suit). Further modification led to its use in the Vietnam war for resuscitating and stabilizing soldiers with traumatic injuries from and during transportation. In the 1970s the G-Suit was modified in to a half suit which became known as MAST (Military Anti-Shock Trousers) PASG (Pneumatic Anti-shock Garment).
During the 1980s the PASG garment became used more and more by emergency rescue services to stabilize patient with shock due to lower body haemorrhage. During the 1990s the PASG was added to the American College of obstetrics and Genecology making the part of the recommendation treatment for use by obstetricians and gynecologists in the USA. From the 1970s the new version of a non-preumatic anti-shock garment was developed which was originally used for hemophiliac children but has since been developed into the garment known as NASG.
In 2002 Dr. Carol Bress and Dr. Paul Hensleigh introduced the garment into a hospital in pakistan. Dr. Suellen Miller and colleagues in Mexico, Egypt and Nigeria have completed studies of the NASG (also named the lifewrap). An implementation program with the NASG as part of a continuum of care for post-partum Hemprrhage (CCPPH) has been under way since 2008 in India, Nigeria, Tanzania, Zamfara, Zimbabwe and Peru. The NGO pathfinder international is the lead implementing organization on the CCPPH project and done extensive clinical trials with the device as an obstetric first aid.

DEFINITION
The non-preumatic anti-shock garment (NASG) is a simple neoprene and velcro device that looks like trouser, cut into segment, which is used to treat shock, recusitate, stabilize and prevent further bleeding in women with obstetric hemorrhage.
HOW IT WORKS
The non-pneumatic Anti-shock garment is a low technology first aid device use to treat hypovolemic shock. When in shock the brain, heart and lungs are deprived of oxygen because blood accumulates on the lower abdomen and legs. The NASG reverses shock by returning (Like 1.5 – 2 litres) of blood to the heart, lungs and brain and so also kidneys. This restores the womans consciousness, pulse and blood pressure. Additionally, the NASG decreases bleeding from the parts of the body compressed under it.
Mechanism of actions are based upon law of physics. Recent research has identified that the pressure applied by the NASG serves to significantly increase the resistive index of the internal iliac artery (which is responsible for supplying the majority of blood flow to the uterus via the uterine arteries another recent study has shown the NASG to decrease blood flow in the distal aorta.
Another research shown that circumferential compression of the abdomen and legs reduces total vascular volume while expanding the central circulation. It increases pre-load, peripheral resistance and cardiac output. Tamponade of vessels particularly the splanchnic plexues (are paired visceral nerves that contribute to the innervation of the internal organs) can diminish further bleeding. After a simple training session, anyone can put the garment on a bleeding woman including Doctors, Nurses, Midwives, Ambulance Driver, Health attendant, Traditional Birth Attendants. Once the bleeding is controlled she can be safely transported to a referral hospital for further management
NASG APPLICATION PROCEDURE REMOVAL- RULE OF 100
The NASG can be applied
. If pulse is 100 bpm and above
. Systolic blood pressure is 100 and below MMHG while NASG can be removed
. If pulse rate is 100 bpm and below
. Systolic blood pressure is 100 and above mmHg
APPLICATION
1. If possible it should be on a flat surface.
2. Open NASG and place under the woman with the top of the garment at her lower ribs. If the patient is unconscious, two people can roll her on to her side placing the garment under health her similar to making an occupied bed.
3. Stretch and fasten the garment tightly until it makes a snappy sound, starting with the ankle segment (#1)
4. Continue with #2 segment below the knee and #3 segment around the thighs, for shorter women fold segment #1 into segment #2 before starting.
5. Secure the pelvic segment (#4) tightly at the level of the symphysis pubis. Only one person should secure the pelvis and abdominal segments
6. Place segment #5 over the navel (umbilicus), close by securing segment #6
CAUTION: - If woman is conscious and experiences or complains of difficulty in breathing, slightly loosen but do not remove the abdominal segment. If NASG application does not result in prompt increase in SBP and decrease pulse, check for adequate tightness and give additional I/V fluids.

REMOVAL
NASG must be removed only by a skilled health care provider in a setting where vital signs can be monitored, and there are adequate I/V fluids and blood (should in case). It should not be removed until the woman is haemodynamically stable for at least 2 hours with blood loss of 50ml/hour. start removing from the ankle and proceed upwards allow 15 minutes between opening each segment for the redistribution of blood. Make sure pulse is 100 and below bpm and systolic BP is 100 and above mmHg

SUMMARY
In Egypt and Nigeria, in separate and combined analyses, findings showed that women treated with the NASG fared much better than women who were not treated with the NASG. Results showed significant reductions in blood loss, rate of emergency hysterectomy and incidence of morbidity and mortality. Analyses examining the use of the NASG on cases of uterine atony, post partum hemorrhage and non-atonic etiologies (ante and post-partum) fund similar results.

CONCLUSION
In conclusion, Qualitative research in Mexico and Nigeria has examined acceptance of the NASG and found that overall, there were positive reactions to the garment as a relevant technology for saving womens lives. Research is currently on going in Zambia and Zimbabwe to investigate whether the NASG is more successful if implemented at primary health care facilities where hemorrhage is first identified.
In 2012, the world health organization included the NASG in its recommendations for the treatment of post partum hemorrhage.

REFEFRENCES
. Commission on Behavioral and social Sciences and Education (CBASSE) (2000). The consequences of maternal morbidity and mortality. Report of workshop. Washington, D.C. the National Academes
. Cutler BS, Daggett WM. application of the “G-suit” to the control of hemorihage in massive trauma Annsurg. 1971
. Huggerty J. Anti shock Garment 1996 [cited: Available from:http://www.sti.nasa.gov/tto/spinoff1996/28html
. Miller, Hadiza Galadanchi et.al (2010) “Obstetric hemorrhage and shock management: using the low technology Non-preumatic Anti shock Garment. In Nigerian and Egyptian tertiary care facilities”.
. Procedure manual for BNSC programme (2015) Department of Nursing Sciences, Bayero University Kano.
. WHO, UNICEF, UNFPA. Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNfPA: 2004
. Wikipedia

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