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Monday, December 29, 2008

NURSING LIFE STORY: 'Nurse, wife and mother in the UK'

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By JHOREEN DALUMPINES 12/27/2008 9:29 AM

Editors Note: The story is lifted from the book “Migrants’ Stories, Migrants’ Voices 2 published by the Philippine Migrants Rights Watch (PMRW) with the support from Cordaid, an international development organization based in the Netherlands. The book contains a collection of 13 stories about the many faces of migration and details how migrants and their families cope with the separation. abs-cbnNEWS.com obtained a permission from the PMRW to publish the stories online.

I am a nurse, a wife to a doting husband, and a mother to four adorable children. But in spite of these varied roles, my family knows very well where my priorities lie.

I first worked as a company nurse at the Uniwide Sales Warehouse Club in Marikina right after passing the Nursing board exam in 1993. I later transferred to the Research Institute for Tropical Medicine (RITM) hospital in Alabang in 1996. That same year I married my boyfriend for two years, Claro, who is also a nurse.

I was still a nurse at RITM when my two boys were born. Worried about our kids’ future, however, my husband decided to try his luck abroad. In 2001, he applied for a nursing job in London. Many of our batchmates and colleagues have long left for distant shores and were doing fine in their jobs while we in the Philippines confronted the perennial lack of career advancement and making ends meet with our meager salaries. While we have invested in some properties in Laguna and in an aquarium supplies shop, we felt it was necessary to seek greener pastures overseas to ensure a bright future for our growing family.

It took my husband only two months to complete the entire application process. Back then no placement fee was collected from UK-bound nurses and we only had to pay P3,000 for his work visa. He left for London in 2001 and began working as a regular nurse after a 5-month adaptation/mentoring period under a senior nurse.

Taking care of two toddlers became a challenge for a full time nurse and a “full time” mom. I literally became a single parent in an instant and it was not easy.

It helped that my hospital was mom-friendly. They did not mind if I showed up for work with my kids tagged along. The hospital has a daycare room exclusively allotted for hospital personnel where they can breastfeed their children.

I was losing weight. Claro was urging me to quit work but knowing he was not yet getting his full salary I told him quitting would not be practical. I stayed with the hospital and told my husband not to remit anything yet so he can save some money.

I know we will one day join him and we will need that money when that happens because it would take a while for me to land a job.

There was even a time when I went home from work and found my son Ethan vomiting and dehydrated. I never thought twice about rushing him to the hospital even though it was midnight and the streets were flooded because of a storm. A mother would always be a mother come rain or high water. It helped that the hospital where I used to work was just a few blocks away from home. Poor Ethan was confined in the hospital for three days because of food poisoning. Our house helper, according to the doctor, might have accidentally fed him stale baby food.

Life is tough without a man in the house. Even at night I could not help but stay half awake worrying about the thieves that may be lurking outside our apartment. We did actually lose our washing machine to thieves just like that. Who knows what they will take away next.

Our house helper then only confined herself to watching over my children and washing the clothes. The rest was left for me to do. I could not do anything because at that time it was very difficult to find someone more trustworthy and reliable. Luckily a month before we left for London I was able to persuade my brother to live with us. He had been a big help because his presence gave me peace of mind.

Technology helped shorten the distance for me and my husband. One of my husband’s first major purchases in London—partly through a loan from his elders sister—was a computer that cost him £500. Since we had a computer at home we regularly wrote each other emails. The internet was very effective, efficient and convenient; not to mention it was much cheaper than phone calls. Eventually, my husband became used to his regular work shift and even had tome to render extra work. This meant additional income, especially on weekends and holidays where the daily rate was paid higher. He was soon able to pay his loans after a few months.

It also helped that I have a very thoughtful husband. In fact, it helped a lot in easing the burden of raising children and made me realize that the sacrifice was well worth it. I remember vividly, for instance, how he surprised me with a bouquet of tulips on our first wedding anniversary. Claro asked his sister to buy me flowers and she made sure I would get them by delivering them herself. It was such a romantic, albeit unexpected surprise.

After seven months Claro went home for a vacation. Afterwards, he immediately had our application for family reunification processed and started looking for a nursing-related work for me. In 2002, he took another vacation and went back to the UK with me and our two kids. Finally, we were going to be together as a family.

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Sunday, December 28, 2008

Nursing Shortage: Emergency on the wards

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by Joanna Hartley

Friday, 26 December 2008

Well-trained and motivated nursing workforce is a key component in quality healthcare, but in much of the Middle East nurses are a transient workforce in short supply. In the first of a two-part series, Jo Hartley investigates the future of nurse recruitment and the moves to attract local talent.

Globally nurses make up the largest chunk of healthcare professionals and the middle east is no exception. Across the six member countries of the GCC there are around 130,000 nurses and midwives - about double the number of physicians.

In a region facing rapid population growth and soaring rates of chronic diseases, the need for qualified nurses and midwives is set to explode. Set this against the ambitions of some arab states to become world-renowned health hubs, add a worldwide shortage of nurses that has existed for more than 20 years, and the problem of nurse staffing becomes abundantly clear.

Official figures show there is already a 100,000 strong nurse shortage in Saudi Arabia. A study published in human resources for health in march 2007 shows that the density of people working in health in the eastern mediterranean region is the second lowest in the world.

A quick Google search for ‘nursing jobs in the Middle East' brings up listings of recruitment websites offering all manner of nursing positions. These are hallmarks of an industry fuelled by international recruitment, the main method for shoring up nurse numbers in the region's shortage-plagued countries.

Saudi Arabia is a case in point. Seventy six percent of the nursing and midwifery workforce is made up of overseas recruits - just last month the government recruited another 2,000 Filipino nurses. The United Arab Emirates has 85% foreign nurses, while Qatar takes the number one spot with more than 95% of its nursing workforce recruited overseas, according to nurse sources.

Favoured countries for mass recruitment are the Philippines and India with Malaysia, Indonesia and China being the latest countries to join the nurse exporter list. More senior nurses typically come from the UK, South Africa and Australia. Even Middle East countries such as Jordon, Lebanon and Egypt export homegrown nurses to their neighbours.

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Nursing Job Update: LOCAL NEWS: RP to start deployment of nurses to Japan in early 2009

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By Mayen Jaymalin Updated December 24, 2008 11:29 AM


More jobs await Filipino nurses in the coming year despite the prevailing global economic crisis.

The Department of Labor and Employment (DOLE) reported that the deployment of Filipino nurses to Japan will finally start early next year.

“We hope to come out with the necessary guidelines on the hiring of our nurses middle of January and the actual deployment will start probably by April,” Labor Secretary Marianito Roque disclosed.

Roque noted that the government is expecting about a thousand Filipino nurses to be hired in Japan.

“Initially only few nurses will be deployed, but we expect the number to increase eventually since Japan is in dire need of nurses because of their aging population,” Roque pointed out.

“The only problem we see is language barrier, workers have to learn the Japanese language prior to deployment,” Roque said.

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Nursing News: Pinoy nurses, teachers won't feel lay offs in US and Europe

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12/24/2008 01:40 PM

MANILA, Philippines - Filipino nurses and teachers would remain in demand in North America and Europe despite the global economic crisis.

Ernesto Herrera, Trade Union Congress of the Philippines secretary general, said teachers, nurses, pharmacists, medical technologists, physical therapists and trained caregivers are still welcome in countries hardest hit by the economic meltdown.

"If we examine closely the recent employment trends in North America and Europe, only their healthcare and education sectors are actually creating new jobs," said Herrera a former Senator and chair of the labor committee.

Filipino nurses who acquire post-graduate training to qualify themselves in teaching posts are even more attractive to the US market, the TUCP officer said.

More than 20,000 Filipinos strive to enter America's nursing profession every year, according to the US National Council of State Boards of Nursing Inc.

Unfortunately, the same could not be said for unskilled Filipino workers such as domestic staff as well as semi-skilled laborers in construction, semiconductors and electronics, and the travel and hospitality industries, which Herrera said are "exceptionally susceptible" to job cuts.

Since October this year, a total of 3,000 overseas Filipino workers (OFWs) from Taiwan and Macaua arrived home jobless as casualties of the global meltdown increased.

Many of the Filipinos laid off were factory workers while the rest worked in casinos and restaurants, Carmelita Dimzon, head of the Overseas Workers Welfare Administration (OWWA) told GMANews.TV on Monday.

For her part, Labor undersecretary Rosalinda Baldoz said that only 1,400 Filipino workers in Taiwan have become jobless overseas due to the crisis.

Baldoz told GMANews.TV that these OFWs came from Taiwan and they have not received similar displacements from other countries.

Data collected by GMA News Research from the DOLE Information and Publications Service and the OWWA Repatriation and Assistance Division indicated that 2,247 Filipinos from four countries namely Australia, Brunei, Taiwan and the United Kingdom have been laid off as of December 15. - GMANews.TV


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Wednesday, December 24, 2008

Nursing News: Filipino nurses is being so far from their kin at Christmas time

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And the hurt for Filipino nurses is being so far from their kin at Christmas time.

FILIPINO NURSE Nora Robles will be sharing in her family's traditional celebrations at midnight on Christmas Eve in the southern Philippines. She will watch her son, her parents, four sisters and extended family opening gifts.

But 38-year-old Robles will be sitting upstairs in a three-bedroom house on the outskirts of Naas, Co Kildare, at four in the afternoon, thousands of miles away. She must depend on the video link in her laptop computer to bring her into her home in Mindanao.

She is hoping the signal will hold up at this busy time of year for telecommunications in and out of the Philippines, where 10 per cent of the 90 million population are registered as overseas workers.

Robles is one of millions of Filipino mothers working abroad while their children are raised at home without them. A study commissioned by Unicef estimates that one in four children in the Philippines has at least one parent employed abroad, and more than half of those emigrating now are mothers who find it easier than their husbands to get better paid jobs, as nurses, care assistants and housekeepers.

Working at a nursing home in Maynooth, Robles is used to being apart from her family and tells herself that seeing them happy is her happiness. But it still hurts, particularly at Christmas.

"I will not let them see me cry. I will switch off the camera sometimes because I do not want to let them see me sad," says Robles, who shares the Naas house with a single Filipino woman.

The instant communication with her family is one consolation. When she first started working abroad, in Taiwan, houses in her town did not have phones. She used to have to rely on letters or ring the town's one phone centre and the operator would go to fetch her mother and her son, Rheinhart, for a follow-up call an hour later.

Rheinhart was eight when Robles left the Philippines 10 years ago.

She had become pregnant during her first year of nursing studies but finished the course while her parents looked after the baby. She then worked as a registered nurse there for four years.

However, the plan was always to go abroad if she could, to secure a lucrative foreign salary. Her husband was working as a sailor, returning home for just three months each year, but his money was going towards their son's education.

"I would really like to pay back my parents," she explains. "It was a double responsibility for my parents: they were taking care of my son and they were sending me to college."

Going abroad as a mother is very hard, she says. "It's really a suffering; it's a surrendering." Yet divided families are an accepted fact of life in the Philippines.

She has seen the children of fellow migrants get into trouble and become drug addicts. "When a son knows his parents are abroad they are only thinking they have plenty of money," she says.

"Before deciding to leave I really made sure there would be a significant other in place of me, who was going to take care of my son like me, and that is my mother. I really make sure that I can have money and that my son will become a better man.

"As a mother, you must always be the light of your son. So even though I am away I will make sure that I am the light for him and not my mother." She says there is a tendency for grandparents to spoil their grandchildren.

"When I went home after a year and a half, I noticed that my son had changed. For instance, it was a rule for me that my son never held money and then I saw my mother sneaking money to him."

She decided to end her contract in Taiwan after three years. "When he was still young, under seven, I knew he already had some values learned at that stage. That is why I was sure that I could leave him.

"Then at 10, 11, 12, there would be different values when he became a teenager. So I decided to stop, to focus on my son, to help him become a better man. So his future wife and children will not suffer because the man is like a mama's pet!"

When Rheinhart reached third grade in high school in 2003, Robles said she felt enough trust in her son to leave again. "It's like a kite: at 11, 12, 13, I am always holding him. After that I know that I can release him, let him fly."

She applied for jobs abroad, aiming at the US, "but I ended up here in 2006", having spent one year in Saudi on the way. Her son was 15 when she left again and she and her husband also separated that year.

Rheinhart had not seen his mother for more than a year and a half when he came to Ireland for three months last summer.

"He graduated from high school with my mother and my father, my sisters and his cousins." Another milestone that Robles missed.

"You can feel the emptiness, but for me living here, as long as they are happy, I can send money, send obligations, that is my happiness."

She is also looking forward to a bit more freedom for herself after her son graduates in nursing in the Philippines. He had wanted to study political science with a view to doing law, but she convinced him that nursing is the passport out of the Philippines and that he could take up law at a later stage, in another country.

They enjoy a close relationship and sometimes, when she is tired and depressed on the night shift, she will ring his mobile at 2am "just to hear my son's voice". But she tries to make sure she's in an upbeat mood when she rings for chats.

However, she believes it is important that children of absent parents realise the sacrifices and hard work that lie behind the money sent home to the Philippines. The perception is that if your parents are abroad, you have plenty of money.

"When my son was here, I let him see the reality of our life here. I let him see when we are working 12 hours a night that I am really tired.

"I brought him to the nursing home I was working in then. I let him see the nature of our job. Your children, even if you tell them about it, they cannot really feel, or empathise. For them they say 'you are a nurse, a nurse is easy'.

"So I let him see the reality of working as a nurse: you are going to clean the bum, you are going to lift the resident. So he can see that having the money to give to him is not really that easy."

Robles finds it "discouraging" being away from her family in exchange for the money - not to become rich but to help all her extended family. But she is confident that the way she has balanced blocks of time at home and away has helped secure the future for her son; that he will be "a good man and that he can have a better job soon", and that he in turn can help support her in her old age.

Meanwhile, long after her family have gone to bed in the Philippines, Robles will be off to midnight Mass in Ballycane church in Naas, to see in another cold Christmas morning, alone in a foreign land.

Click here for more nursing news around the world.

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Nursing News: Mentally ill man stabs Filipino nurse in Riyadh

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RIYADH: A Filipino nurse was assaulted by a mentally ill man armed with a knife at the National Guard Hospital’s emergency ward here on Friday evening.

A witness, on condition of anonymity, said the assailant was aged between 18 and 20, and arrived at the hospital in his own car with his face covered with his head scarf.

He added that the knifeman exited his car and entered the emergency ward where he grabbed the nurse and attempted to slit her throat with a knife. The young man was quickly apprehended by military police who were on duty at the hospital and then handed to police.

The witness added that the man wanted to kill the nurse because she was wearing makeup and said he would return when released. The nurse is in stable condition and recovering at the hospital’s VIP ward.

Police said the young man has a long history of drug abuse. They added that he is mentally unstable and will be made to under go psychiatric tests.

The knifeman’s father is a National Guard officer who lives in the National Guard Hospital’s compound.

The witness added that contrary to newspaper reports, the incident was not a long drawn affair, but was handled and dealt with quickly and diligently.

The National Guard Hospital’s media affairs department had no comments regarding the incident.

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Saturday, December 20, 2008

Nursing News: Filipino caregivers face hurdles

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By DARIO AGNOTE
Kyodo News

MANILA — Filipino caregiver Stella Lelis trained in Japan for three years and speaks basic Japanese.

Like thousands of Filipino nurses and caregivers, the 28-year-old hopes to be among the first batch who will be allowed to care for Japan's seniors.

But notwithstanding the Japan-Philippines Economic Partnership Agreement that entered into force last week, Lelis and other Filipino caregivers face a tough hurdle: They will have to take licensing exams in Japanese.

Even Japanese nurses and caregivers are known to have flunked these daunting examinations, a fact that further dents the confidence of Filipino health workers wanting to work in Japan.

"Our Japanese friends in Okayama failed the exams. I'm not sure we'll fare better when we are not native speakers," Lelis said recently.

The entry of Filipino nurses and caregivers to Japan is one of the main highlights of the partnership agreement designed to strengthen economic links between the Philippines and Japan.

Under the agreement, Filipino nurses and caregivers are expected to arrive in Japan next April to June to undergo language training for half a year before going to work at hospitals and nursing-care facilities across Japan.

They will try to acquire national qualifications in three to four years from their arrival in Japan. The candidates, however, will have to return home if they fail to win Japanese qualification.

Separately, some caregiver candidates will try to win qualification by receiving training at schools in Japan. They plan to arrive in Japan next October and enter the schools in April 2010.

In the Philippines, more than 400 nursing schools are producing more nursing graduates than can be employed by hospitals and rest homes. Many of the fresh graduates are pinning their hopes on finding a job overseas.

News that Japan was opening its labor market to Filipino nurses and caregivers had been initially met with much excitement.

But as details about the language barrier came to light, more and more Filipino nurses and caregivers have opted to explore opportunities elsewhere, including the U.S., Canada, Australia, New Zealand, Britain and the Middle East.

"We hope Japan will treat our nurses professionally and with dignity," said Gisela Luna, dean of St. Luke's College of Nursing.

"The language barrier, low salary and their entry to Japan is not as welcoming compared with other destinations," Luna said. "That's the big drawback."

Besides providing a framework for liberalizing trade and investment between the two countries and allowing Filipino nurses and caregivers to work in Japan, the agreement also details possible cooperative programs, including training courses for the regulation of and supervision of financial institutions, trade and investment cooperation, cooperation in the field of small and medium enterprises, technical cooperation in the field of science and communications technology and promotion of tourism.

The agreement was signed in September 2006 between Philippine President Gloria Macapagal Arroyo and then Prime Minister Junichiro Koizumi, but it took the Philippine Senate nearly two years to ratify it after some senators called for renegotiation on grounds it was "riddled with constitutional defects."

Environmental activists also called on the government to junk the treaty, saying its provisions were "flawed" and more advantageous to Japan.

The Diet ratified it in December 2006, while the Philippine Senate, which is controlled by Arroyo's foes, followed suit last Oct. 9, ending an uphill battle for the president.


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Friday, December 19, 2008

Nursing Jobs: Migrant workers at sharp end of US economic crunch

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MIAMI - Erik Bengoche came to the United States with high hopes, ready to sweat it out as a laborer and short-order cook, and expecting to send home a modest stack of greenbacks.

But about a year ago, work started drying up. Now he sits in the parking lot of a home improvement store, hoping to pick up odd jobs, and looking forward to Christmas day, when he will fly back to Honduras.

"I owe three months rent. Sometimes you don't eat," he said, sitting on the curb under a shade tree. "I want to go back."

Low-wage immigrants like 25-year-old Bengoche find themselves on the sharp edge of the US economy slump, and some are packing their bags.

In October, a study by the Pew Hispanic Center suggested the number of undocumented immigrants in the United States was declining after years of robust growth. It put the current undocumented population at 11.9 million, down from 12.4 million a year earlier. It also tracked fewer new arrivals.

The data followed the center's earlier finding that non-citizen immigrants were being hit particularly hard by the crumbling economy.

In Florida, many had flocked to take advantage of a once bustling construction industry. But it was one of the first economic engines to sputter and stall when the mortgage crisis hit. Others work in hotels and restaurants -- businesses which are suffering as tourism dips.

"Everything is about the economy. With the crisis here, there are less jobs, so living here is apparently not as attractive as it was until a few months ago," said a Brazilian diplomat who has been monitoring reverse migration to her home country.

Requesting anonymity, she described those most likely to head home again as people who have been in the United States for two to five years, "not fluent in English," and "unattached."

The Pew Center said many factors could be at play. A majority of US immigrants come from Latin America, where economies have remained stable relative to the United States. Another factor could be a ramped-up immigration enforcement.

Bengoche, for example, said it had become harder to get work in big companies without identification papers proving legal status in the United States.

Drivers licenses, once considered valid proof of ID, are increasingly out of reach for undocumented immigrants, as officials comply with new federal anti-terrorism laws clamping down on access to such licenses without proper supporting documents.

Supporters of the restriction note that several 9/11 highjackers managed to obtain licenses, which they used to board the planes used in the 2001 attacks.

Immigrant advocates say the measure has pushed people like Bengoche further into the shadows, not to mention increasing the difficulty in getting to work in a country known for its car culture. Authorities are also ratcheting up deportations.

Economic woes are dragging down remittances too -- money sent home by immigrants to their families that often serves as a lifeline.

The Inter-American Development Bank recently reported that three million Latino immigrants stopped sending money home during the last two years. Many Latin American countries are still seeing an increase in remittances, but the increase has slowed.

"The reason remittances are down is because the US economy is slowing down, and because the immigration climate is still very negative," said Robert Meins, a remittance specialist at the Inter-American Development Bank.

In some cases, he added, immigrants are dipping into their savings to keep money flowing to loved ones.

"That's not to belittle how difficult they're finding it. Migrants are extremely adept and very resilient," he said.

In the meantime, US patrols are catching fewer immigrants on treacherous desert hikes across the Mexican border, and in overcrowded boats aiming for Florida's shoreline.

"I've lost my time," said Bengoche, who originally planned to stay in the United States for at least five years. By Christmas, it will be two. "I thought there would be more work."


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Thursday, December 18, 2008

NCLEX Made Ridiculously Simple - Review

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General interventions to minimize anxiety in the hospitalized client include providing information, social support, control over choices related to care, and acknowledging the client’s feelings. Being far from the nursing station is unlikely to reduce anxiety for this client. Limiting visitors reduces social support, and leaving the door open with hallway lights on may keep the client oriented, but may interfere with sleep and increase anxiety.

Clients who are withdrawn may be immobile and mute, and require consistent, repeated approaches. Intervention includes establishment of interpersonal contact. The nurse facilitates communication with the client by sitting in silence, asking open-ended questions, and pausing to provide opportunities for the client to respond. The client is not left alone. Asking direct questions to this client is not therapeutic.

PTSD is precipitated by events that are overwhelming, unpredictable, and sometimes life threatening. Typical symptoms of PTSD include difficulty concentrating, sleep disturbances, intrusive recollections of the traumatic event, hypervigilance, and anxiety.

Adolescents who withdraw from peers into isolation struggle with developing identity.

Signs of depression include withdrawal, lack of interest, crying, anorexia, and apathy. Insomnia may be a sign of anxiety or fear. Ignoring symptoms and activity restrictions are signs of denial. Apprehension is a sign of anxiety.

Distancing is an unwillingness or inability to discuss events. Self-control is demonstrated by stoicism and hiding feelings. Problem solving involves making plans and verbalizing what will be done. Accepting responsibility places the responsibility for a situation on one’s self.

The first step in client teaching is establishing what the client already knows. This allows the nurse to not only correct any misinformation but also to determine the starting point for teaching and to implement the education at the client’s level.

The signs of alcohol withdrawal develop within a few hours after cessation or reduction of alcohol and peak after 24 to 48 hours. Early signs include anxiety, anorexia, insomnia, tremor, irritability, an elevation in pulse and blood pressure, nausea, vomiting, and poorly formed hallucinations or illusions.

The monotony of immobilization can lead to sluggish intellectual and psychomotor responses. Regressive behaviors are not uncommon in immobilized children and usually do not require professional intervention.

Presbycusis occurs as part of the aging process and is a progressive sensorineural hearing loss. Some clients may not adapt well to the impairment, denying its presence. Others withdraw from social interactions and contact with others, embarrassed by the problem and the need to wear a hearing aid. Clients show adequate adaptation by obtaining and regularly using a hearing aid.

Bald spots on the scalp are most likely associated with physical abuse. The most likely assessment findings in sexual abuse include difficulty walking or sitting; torn, stained, or bloody underclothing; pain, swelling, or itching of the genitals; and bruises, bleeding, or lacerations in the genital or anal area. Poor hygiene may be indicative of physical neglect.

The client is at risk for developing gestational diabetes with each pregnancy. The client also has an increased risk of developing diabetes mellitus and needs to comply with follow-up assessments. She also needs to be taught techniques to lower her risk for developing diabetes mellitus, such as weight control. The diagnosis of gestational diabetes mellitus indicates that this client has an increased risk for developing diabetes mellitus; however, with proper care it may not develop.

Exercising 3 to 4 hours every day is excessive physical activity and unrealistic for a 16 year old. The nurse needs to further assess this statement immediately to find out why the client feels the need to exercise this much to maintain her figure. Although it’s unfortunate that her best friend had this disease, this is not considered a major threat to this client’s physical well-being. A weight that exceeds 15% below the ideal weight is significant with anorexia nervosa. It is not considered abnormal to check weight every day. Many clients with anorexia nervosa check their wei

An inactive older person may become disoriented due to lack of sensory stimulation. The most appropriate nursing intervention would be to frequently reorient the client and to place objects such as a clock and a calendar in the client’s room to maintain orientation. The family can assist with orientation of the client, but it is not appropriate to ask the family to stay with the client. It is not the within the scope of nursing practice to prescribe laboratory studies. Restraints may cause further disorientation and should not be applied unless specifically prescribed. Agency policies and procedures should be followed before application of restraints.

A client experiencing paranoia is distrustful and suspicious of others. The health care team needs to establish rapport and trust with the client. Laughing or whispering in front of the client would increase the client’s paranoia.

It is possible to have a sexual relationship after a spinal cord injury, but it is different than what the client experienced before the injury. Males may experience reflex erections, although they may not ejaculate. Females can have adductor spasm. Sexual counseling may help the client adapt to changes in sexuality after spinal cord injury.

Signs and symptoms of a brain tumor vary depending on location and may easily be attributed to another cause. Symptoms include headache, vomiting, visual disturbances, and change in intellectual abilities or personality. Seizures occur in some clients. These symptoms can be easily attributed to other causes.

Rest is an essential component of bone healing. Nurses can help clients understand the importance of rest and find ways to balance work demands to promote healing. Nurses cannot demand these changes but need to encourage clients to choose them. It may be stress relieving to do work; however, in the immediate post-cast period, it may not be therapeutic. Stress should be kept at a minimum to promote bone healing. Setting limits on a client’s behavior is not a mandated nursing role.

Clients receiving TPN are at risk for development of essential fatty acid deficiency.

Clients who are on narcotics often have well-founded fears about addiction, even in the face of pain. The nurse has a responsibility to provide correct information about the likelihood of addiction while still maintaining adequate pain control. Addiction is rare for individuals who are taking medication to relieve pain.

CPT is an intervention to assist in mobilizing and clearing secretions and enhance more effective breathing

Depression is a common problem related to clients who have long-term and debilitating illness.

Accurate information reduces fear, strengthens the nurse-client relationship, and assists the client to deal realistically with the situation.




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Nurse Update: Nursing education

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A Filipino doctor based in Fresno, California, has radically changed the concept of a nursing school, which may become the future template for Philippine nursing education.

Dr. Johnny Fong, a University of the Philippines graduate, is pioneering an innovative nursing education model which cuts by half the period for nursing degree courses, dramatically reduces tuition cost, and awards US diplomas without the aspirant actually going to the US. Here is how it works.

A regular Bachelor of Science degree in Nursing (BSN) takes four years. Add one more year for the local board exam, and you have five years. Johnny’s concept reduces this to two years based on an Associate of Science Degree in Nursing (ASDN), which involves an intensive trimester system and includes taking the board exam, not the local but the US one called National Council Licensure Exam (CLEX). The difference between the BSN and the ASDN are the non-clinical courses added to the BSN curriculum. Beyond that, it is the same training in terms of skills for nursing, demanding the same salary and job description. It must be clarified that the ASDN course produces not Licensed Vocational Nurses (LVNs) but licensed Registered Nurses (RNs).

Johnny’s fast-track model involves two affiliated nursing schools, one in Metro Manila, the St. Ignatius Health Science College, and one in Saipan, the University of Loyola (UOL). A key ingredient in the model is that Saipan is part of the US Commonwealth of Northern Marian Islands (CNMI), where nursing courses are accredited by the US nursing education system based on a US curriculum. In other words, one ends up with a US diploma, not a local one. With a US degree, nursing graduates are given first preference in hospital hiring. There is also no need to take the English proficiency exam.

A nursing student goes through an intensive trimester curriculum in Manila for 20 months, then four months in Saipan, for a total of two years. The St. Ignatius Health Science College prepares the student nurse for the final four months at UOL, which will grant the ASDN. After graduating in Saipan, the nurse can obtain a Saipan working visa and work while waiting for a US visa. While a BSN holder in the Philippines spends five years to finish the US board exam and another three years to get a visa, or a total of eight unproductive years, an ASDN holder in Saipan spends only two years and is already earning money before she even gets a US visa. A nurse in Saipan earns more than a nurse in the Philippines, since Saipan has the same labor standards as mainland USA. In fact, a Saipan nurse earns more than a US nurse because she pays no federal tax and spends less owing to Saipan’s lower standard of living. Finally, if you still want your BSN, you can take courses part time while working in Saipan or the US.

This looks attractive, especially to parents selling their last carabao to make their daughter a nurse, since the tuition expenses for two years is smaller than for four years. But there is a catch. The model adheres to American educational standards. Johnny knows that in order for the model to be sustainable, the Filipino diploma-mill system cannot be applied. The rigid screening process involves US-designed entrance exams, essay writing, and an interview by a five-member panel. If only 20 are chosen from 500 applicants, that is the way it would be. Whether you are a well-educated Manila student or the daughter of a Bukidnon farmer, as long as your skills meet the requirements, you are in the program. In short, the model, based on skills, levels the playing field for the rich and the poor.

Under our diploma-mill environment, a nursing school accepts practically everyone. The entrance exam is just a formality. Students go through a program which 90% eventually fail to finish. The diploma mill milks the poor farmer from Bukidnon only to find his daughter is not qualified after three years of trying. At the root of the problem is that some of our educators are not really interested in educating but in making money.

In the new system, you are not admitted into the program if you are not qualified by US standards. It does not waste your time or your money. If you are in the program, you get a US-designed nursing curriculum, you finish the course in half the time, you get a US diploma, a US license, and the chance to earn money early. Every year you earn $60,000, the US nurse’s salary scale. What more can you ask?

The program is run by the non-profit non-stock Loyola Medical College Foundation, which awards scholarships to 20% of the student populace and tuition loans to 40%. The remaining 40% are regular paying students, the income from whom is plowed back into the system and is enough to support the scholarships and tuition

To fulfill its mission-vision to bring more globally competitive, highly trained Filipino nurses into the US health care system, UOL is now expanding its program, seeking affiliations from existing nursing schools, potential educators, and community leaders to bring the program to their respective communities.

SOURCE




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Wednesday, December 17, 2008

Nursing News: Pinoy alleges nurses exam cheating in Oslo

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By MACEL INGLES, ABS-CBN Europe News Bureau, Oslo | 12/15/2008 12:02 PM

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The Pinoy nursing community in Oslo is reeling from an allegation that Filipino nurses were involved in cheating in a nursing exam conducted by a local college here.

The allegation stemmed from a report from the local paper, Dagavisen, quoting a Filipino nurse called “Romeo” revealing that he was part of cheating in an exam held by the Høgskolen i Vestfold in 2002 with the help of his recruiter, Rizalina Jenssen.

“Romeo” alleged that Jenssen was present during the exam and was giving his answers to other recruits of ASOR to make sure that they pass the exams and make them eligible to work in Norway as nurses.

Rizalina Jenssen is the owner of the recruitment agency, ASOR, that recruits nurses from the Philippines to work in Oslo.

Outraged by the allegations, around 50 nurses from Oslo met at the Philippine embassy last Friday to discuss what they are going to do about the revelations that they claim had tarnished the image of Filipino nurses in Norway.

The nurses belonging to two major nursing organizations, the Philippine Nurses Association (PNA) and the Filippinsk Integrering og Interessegruppe (FIIG), are considering launching a signature campaign condemning the allegations of cheating and calling for an investigation of the matter.

In the meeting at the embassy, Helen Locsin, leader of FIIG admitted that the scandal has affected all Filipino nurses in Norway.

“We are here to find a solution on how we can uplift the credibility of Filipino nurses and to stop the allegations kung hindi tutuo,” she said.

PNA leader Cynthia Baluyot said she seriously doubts the truth behind the allegations but she called an investigation of the college that conducted the probe.

Both Jenssen and the Vestfold College have denied that the cheating took place in separate newspaper reports.

The Statautorisasjonkontor (SAFH) called the college to verify the report and had been reassured that the allegations had no basis.

SOURCE



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Nursing News: Filipinos top the immigrant and temporary-worker lists

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MARINA JIMÉNEZ

December 17, 2008

For the first time, the Philippines has become Canada's largest source country for immigrants and temporary workers combined, signalling an important shift in immigration patterns.

China has been the No. 1 source country for several years; but as its economy soared, it was surpassed by the Philippines, which sent 19,064 immigrants and 15,254 temporary workers to Canada in 2007.

Permanent residents from China, while still the most numerous, decreased by one-third between 2005 and 2007, while immigrants from India, the second-largest group, dropped by 20 per cent in this period. Permanent residents from the Philippines are the third-largest group, and their numbers have more than doubled in the past decade. In 2007, more Filipinos arrived in Canada as temporary workers than any other nationality, except for Americans.

Jack Jedwab, executive director of the Association for Canadian Studies, attributes the increase to Canada's new focus on temporary workers, and the influx of Filipinos who have filled caregiving and service-sector jobs in Ontario, British Columbia and Alberta.

"Fewer Chinese workers are coming in because of the economic boom there, and we are filling service-sector jobs with Filipinos," said Mr. Jedwab, who analyzed the data, released earlier this month by Citizenship and Immigration Canada.

Altogether, Canada admitted 236,758 permanent residents last year and 115,470 temporary workers. The latter category has steadily increased in recent years, nearly doubling since 1998. The number of immigrants fluctuates between about 200,000 and 250,000 a year.

Despite their numeric significance, Filipinos have a low profile in Canada. They are primarily focused on sending their salaries to their families back home, said Flordeliz Dandal, executive director of the Kababayan Community Centre in Toronto, a newcomer-settlement group.

"Most Filipinos who come to Canada are really motivated to work and then send their salaries back home," she said. "They don't care about politics, and they don't yet have time to engage in Canadian political life unless they have been here a long time."

The Filipino community is still in transition, Mr. Jedwab agreed, and is focused more on family reunification and economic survival than on building a profile in its adopted homeland.

Most temporary workers from the Philippines are teachers, nurses and caregivers, and two-thirds are women. Last month in the Philippines, 89,000 people took the professional board exam for nursing, many with an eye to obtaining employment overseas, Ms. Dandal said.

SOURCE


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Monday, December 15, 2008

Nursing News: Pinoy nurses’ problem greets new ambassador in Oslo PE

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December 15, 2008 8:44 am by pna

OSLO, Norway Dec. 15 – Nurses problem greeted newly-arrived ambassador to Norway Elizabeth P. Buensuceso who arrived on Dec. 11 to assume her post vice Ambassador Victoria S. Bataclan who went back to Manila after completing her tour of duty.


Members of the first batch of 2002 Filipino nurses in Oslo who took the Drug Administration test during that year met at the embassy on Friday, Dec. 12, the day Ambassador Buensuceso reported for work, to draw plans how to counter the cheating charges leveled against them.

Speaking before the nurses, Ambassador Buensuceso advised them to plan thoroughly their course of action and promised that the embassy will assist them in the best way possible to bring their action to the proper channel.

The ambassador also called on the other members of the Filipino community who came to welcome her to do away with the Filipino crab mentality and instead help each other to progress.

Meanwhile, the nurses deplored the charge leveled against them saying it has greatly affected the good reputation they had built difficultly. A nurse related the racial discrimination she had experience saying that local patients shun black-haired nurses.

On the other hand, Philippine Nurses Association (PNA) President Cynthia Baluyot said that Filipino nurses in Norway are highly regarded adding that it was very unfortunate that the old issue on cheating came out again.

Mrs. Baluyot called on her fellow nurses to continue dispensing their duties diligently and prove that they are competent and efficient workers.

In a story published in a local Norwegian paper recently, a certain “Romeo” approached the paper and reported that Mrs. Rizalina Jenssen, general manager and owner of ASOR recruitment agency, was allegedly responsible in the cheating.

ASOR is responsible for bringing in nurses to Oslo and reports have it that since the signing of agreement with the Oslo government in 2003 to provide health workers, ASOR has earned close to NOK 40 million.

Romeo told the paper that Ms. Jenssen copied all his answers and distributed the same to all the examinees adding that she took the answers from him because she knew that he had the competency and experience in drug administration.

“(And) the proctor did nothing to deny Jenssen’s access to the school or even stop her from talking with the examinees,” the paper reported based on Romeo’s narration.

A member of the batch vehemently denied Romeo’s allegation saying that Mrs. Jenssen was not present when they took the exam.

“She was nowhere to be seen while we were taking the exam,” Cesar dela Cruz said. A fellow nurse corroborated his statement saying that she only saw Mrs. Jenssen when she unlocked the door where the exam took place.

Fifty examinees took the test administered by Hogskolen i Vestfold. The school management denied the allegations and said that Mrs. Jenssen was possibly there before the examination but she was not present during the examination.

And contrary to Romeo’s report that almost all passed the exam, the school said that only half passed the test administered during that time. (PNA)

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Retrogression Update: Era of overseas migrant workers ending

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December 14, 2008 20:58:00
Vincent Cabreza
Philippine Daily Inquirer


BAGUIO CITY, Philippines--An economic and political analyst has said the Philippines has reached the end of an era of overseas workers’ migration in light of the world economic breakdown.

A feared contraction in the United States public health sector due to an American recession awaited Filipino nursing graduates, said University of the Philippines professor Walden Bello on Friday.
Bello focused on the overseas migrant industry during a forum on the global financial crisis at the University of Baguio here on Friday.

He said universities that jumped on the bandwagon during the peak of a foreign demand for Filipino nurses should start reviewing their curriculum.

"It is time to change your economic calculations. If we do not warn citizens, they will continue to train for overseas work," he said.

No one has been telling parents the truth, he said.

He warned parents about reports coming from the World Bank and the International Monetary Fund that forecast a rosier Philippine economy in 2010.

He called them political, not economic forecasts.

Bello said parents should realize that the influence of WB and the IMF had diminished after the international banking sector became affected by the economic crisis.

Parents should also beware the massive drop in oil prices this month.

This meant that fewer countries have been buying the commodity, even during winter when gasoline was usually in peak demand, he said.

Bello said: "If the economy is contracting, then demand is contracting. Oil drop shows how fast the economies are contracting… It may be good, but I don't like the trade-off. Prices are dropping but job loss is rising."

"Would you prefer low prices of oil and commodities and a high unemployment rate or high prices and low unemployment, so people can still buy?" he asked.

He said the Philippine government's commitment to globalization was partly to blame.

In a forum attended by UB political science students here, Bello said the Philippines failed to protect vital industries like agriculture when it prioritized export industries.

"Hindi sila naniwala (They did not believe the objections to globalization). Not [former President Fidel] Ramos. Not [former President Joseph] Estrada. Not Gloria (Ms Arroyo). Not [the late former President Ferdinand] Marcos. Not [former President Corazon] Aquino," he said.

He said the consequent collapse of the financial system forced many countries to nationalize.

Bello said this meant that governments would be forced to strengthen their local economies and domestic markets, with "destination economies (the countries which import from the Philippines)" stopping from their purchases of products.

Agriculture and a domestic-market oriented manufacturing sector would rise out of the crisis, he said.

Gold would be a safe commodity and mining could finally have a role in domestic development, unlike previous years when this industry produced to satisfy an export market, Bello said.

"Listen to your relatives [abroad, particularly in the US]. They know what is happening. They are on ground zero," he said.

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Nursing News: Some Pinoy nurses in Austria willing to retire in RP

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By HECTOR PASCUA, ABS-CBN Europe News Bureau | 12/05/2008 9:50 AM

In the early 1970s, the regular influx of Pinoy nurses to Austria was a normal phenomenon since Austria asked the Philippine government to send professional healthcare workers to the country.

In the late 80s, however, the Austrian government stopped the flow of nurses from the Philippines after some European borders opened up, resulting in the influx of healthcare workers from neighboring countries.

At present, those Filipino nurses who went to Austria at the height of the deployment program are nearing retirement age.

ABS-CBN Europe News Bureau was able to talk to some of them about their choice of either staying in Austria or retiring in the Philippines.

Elisabeth S." was one of the pioneer nurses who came to Austria in 1975 after finishing the GN course in Manila. Together with 10 other fresh Pinoy nursing graduates, they were given the chance to study the German language and after some basic German course.

“Needless to say I have been working as a nurse here in Austria since 1976 and I have been working in a county-owned hospital as a civil service RN, therefore as a government employee I have been eligible to retire next year. Well, I have already planned to enjoy my retirement in the Philippines. There's no place like home... yes, life can be so good here in Austria but the best things in life are free and they're in the Philippines! Money can't buy them,” she said.

Alfred and Carmina Santos, both nurses, meanwhile, thought at first about retiring in the Philippines. However, they decided to stay in Austria.

“My wife and I contemplated of retiring in the Philippines but after careful considerations we decided that we will be staying in Austria for the rest of our lives. Our two grown kids are both Austrian-born and most of our relatives live here. Whenever I go back to my hometown I know very few people there now because most of the people I knew when I was growing up have also moved abroad,” said Alfred.

Rosel Villanueva, on the other hand, thinks otherwise.

“Still the Philippines is very close to my heart. I have working here in Austria for the last 30 years. I am very much convinced that I will be spending the rest of my life in the Philippines. I will just be visiting Austria once or twice a year after I take my retirement from the government-owned hospital where I currently work. In the Philippines, I plan to establish a small business to keep myself busy, keep my skills current and of course earn extra pesos so that I can afford to fly back and forth to Austria in order to visit my children and apo’s here.”

Rosel will be enjoying her pension starting May next year.

Nida Resch is also waiting for the approval of her early retirement, after serving in a private hospital in Vienna. She is very eager to spend her retirement in the Philippines, together with her Austrian husband Gustav. The couple decided to invest in real estate in the Philippines.

“Surely, we will still get homesick now and then, most especially my husband. Though, we will surely be visiting Austria. If we are in the Philippines, we will try our best to contribute in our small and humble way to the economy of the country.”


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Sunday, December 14, 2008

Retrogression Update: United Kingdom has re-opened its doors to Filipino nurses

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By Mayen Jaymalin Updated December 05, 2008 12:00 AM

Here’s good news for the growing number of jobless Filipino nurses.

The Department of Labor and Employment (DOLE) reported yesterday (Dec. 4) that the United Kingdom has re-opened its doors to Filipino nurses.

“After a lull of over a year, the United Kingdom is again hiring Filipino nurses,” Labor Secretary Marianito Roque said in an interview.

Roque said an initial batch of 160 Filipinos would be deployed to various hospitals and retirement homes in Britain.

Over a year ago, the United Kingdom adopted stricter regulations in the hiring of foreign nurses, thus virtually closing the door for the employment of Filipino nurses there.

“For a while there has been no vacancy for Filipino nurses in UK, but because of the aging population there, they realized they need our Filipino nurses to take care of them,” Roque noted.

Roque expressed confidence that the recruitment of 160 Filipino nurses in UK signals the start of growth in demand for Filipino nurses worldwide.

“We hope that more Filipino nurses will be recruited to work in UK and other countries abroad,” Roque said.

The Philippine Nursing Association reported that the country is now experiencing a surplus of Filipino nurses due to the declining demand in the United States.

Roque had previously ordered a dialogue with all the stakeholders at the Overseas Workers Welfare Administration (OWWA) office to determine the real situation of the country’s nursing sector.

He said DOLE conducted the dialogue to determine whether there is really a shortage or a surplus of nurses so that the government could come out with appropriate measures.

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FREE NCLEX Review Quizzes, Exams, Questions and Resources

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Remember the acronym RACE (rescue, alarm, confine, extinguish) to set priorities if a fire occurs.

In the case of dislodgement of an internal radiation implant, the radioactive source is never touched with the bare hands. It is retrieved with long-handled forceps and placed in the lead container (pig) kept in the client’s room. In many situations, the client has a Foley catheter inserted and is on bed rest during treatment to prevent dislodgement. A lead apron, although one may be in the room, is not the required item. Nurses wear a dosimeter badge while in the client’s room to measure the exposure to radiation and limit time spent in the room.

Proper documentation of unusual occurrences, incidents, and accidents, and the nursing actions taken as a result of the occurrence are internal to the institution or agency and allow the nurse and administration to review the quality of care and determine any potential risks present. Incident reports are not routinely filled out for interventions, nor are they used to report occurrences to other agencies.

Nurse Practice Acts require reporting the suspicion of impaired nurses. The Board of Nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision. This suspicion needs to be reported to the nursing supervisor, who will then report to the Board of Nursing. Confronting the colleague may cause conflict. Asking the colleague to go to the nurses’ lounge to sleep for a while does not safeguard clients.

A Good Samaritan Law is passed by a state legislature to encourage nurses and other health care providers to provide care to a person when an accident, emergency, or injury occurs, without fear of being sued for the care provided. Called “immunity from suit,” this protection usually applies only if all of the conditions of the law are met, such as the heath care provider receives no compensation for the care provided and the care given is not willfully and wantonly negligent.

External cardiac massage is a lifesaving treatment that a client can refuse. The most appropriate nursing action is to notify the physician, because a written Do Not Resuscitate (DNR) order from the physician is needed. The DNR order must be reviewed or renewed on a regular basis per agency policy

A PICC is designed to be a long-term indwelling catheter and is usually inserted into the median cubital vein. The tip of the catheter should lie in the superior vena cava. A PICC does not require the affected arm to be immobilized (a major advantage of a PICC) and can be used for intermittent or continuous fluid infusion. Although the risk of infection is less with a PICC than with a subclavian or other central line, it is possible for phlebitis or infection to develop. Clients must be aware of the need for daily inspection and to report any discharge, redness, or pain immediately to the nurse or physician. Although a PICC can be used for obtaining blood specimens, it is not recommended to routinely aspirate blood to determine patency.

Nurses need their own liability insurance for protection against malpractice lawsuits. Nurses erroneously assume that they are protected by an agency’s professional liability policies. Usually when a nurse is sued, the employer is also sued for the nurse’s actions or inaction’s. Even though this is the norm, nurses are encouraged to have their own malpractice insurance.

Variance analysis occurs continually as the case manager and other caregivers monitor client outcomes against critical paths. The goal of critical paths is to anticipate and recognize negative variance early so that appropriate action can be taken. A negative variance occurs when untoward events preclude a timely discharge and the length of stay is longer than planned for a client on a specific critical path.

he autocratic style of leadership is task oriented and directive. The leader uses his or her power and position in an authoritarian manner to set and implement organizational goals. Decisions are made without input from the staff. Democratic styles best empower staff toward excellence because this style of leadership allows nurses to provide input regarding the decision-making process and an opportunity to grow professionally. The situational leadership style utilizes a style depending on the situation and events. The laissez faire style allows staff to work without assistance, direction, or supervision.

The functional model of care involves an assembly-line approach to client care, with major tasks being delegated by the charge nurse to individual staff members. Team nursing is characterized by a high degree of communication and collaboration between members. The team is generally led by a registered nurse, who is responsible for assessing, developing nursing diagnoses, planning, and evaluating each client’s plan of care. In an exemplary model of team nursing, each staff member works fully within the realm of his or her educational and clinical experience in an effort to provide comprehensive individualized client care. Each staff member is accountable for client care and outcomes of care. In primary nursing, concern is with keeping the nurse at the bedside actively involved in care, providing goal-directed and individualized client care.

Edema of the stump is controlled by elevating the foot of the bed for the first 24 hours after surgery. Following the first 24 hours, the stump is usually placed flat on the bed to reduce hip contracture. Edema is also controlled by stump wrapping techniques.

The pregnant client who tests positive for hepatitis B virus should be reassured that breastfeeding is not contraindicated if the infant receives prophylaxis at birth and remains on the schedule for immunizations.

Vena cava and descending aorta compression by the pregnant uterus impedes blood return from the lower trunk and extremities, therefore decreasing cardiac return, cardiac output, and blood flow to the uterus and subsequently the fetus. The best position to prevent this would be side-lying with the uterus displaced off the abdominal vessels. Positioning for abdominal surgery necessitates a supine position, however, so a wedge placed under the right hip provides displacement of the uterus. Trendelenburg positioning places pressure from the pregnant uterus on the diaphragm and lungs, decreasing respiratory capacity and oxygenation. A semi-Fowler’s or prone position is not practical for this type of abdominal surgery.

Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of contact with ribavirin (Virazole). Therefore, goggles and a mask may be worn.

Tonic-clonic seizures cause tightening of all body muscles followed by tremors. Obstructed airway and increased oral secretions are the major complications during and following a seizure. Suction is helpful to prevent choking and cyanosis.

Copies of a living will should be kept with the medical record, at the physician’s office, and in the client’s home. A copy should also be maintained in the lawyer’s office. The emergency room does not maintain these documents in its files. A copy of a client’s living will is not sent to the social security office

The nurse turns the water on first and then allows the warm water to wet the hands, applies soap to the hands, keeps the hands pointed downward, and rubs them vigorously. Warm water is used for hand washing because it increases the sudsing action of the soap. Hands should be kept downward to enable the unsanitary material to fall off the skin. The nurse then rinses the hands, dries the hands using a paper towel, and turns the water faucet off with the paper towel. The faucet is turned off by using a paper towel to prevent the hands from getting recontaminated.

At the door of the room and next to an appropriate receptacle, the nurse unties the gown at the waist but does not remove it yet. The nurse then removes the gloves. The gown is then untied at the neck, allowed to fall forward from the shoulders, and removed. The gown is then discarded in the appropriate receptacle. The nurse then removes the mask and goggles and discards them. The hands are then washed.

The defense mechanism of regression is characterized by returning to an earlier form of expressing an impulse.

During the adolescent period, there is a heightened awareness of body image and peer pressure to go on excessively restrictive diets. The extreme limitation of omitting all fat in the diet and weight loss during a time of growth suggests inadequate nutrition and a possible eating disorder.

Play therapy is a nonthreatening avenue through which the child can use artwork, dolls, or puppets to act out frightening life experiences.

Victimization in a family can take many forms. When analyzing a specific client situation, it is important to understand which form of abuse is being considered. Physical abuse can take the form of battering (hitting, slapping, striking) or can be more subtle, such as neglect (failure to meet basic needs). Emotional and psychological abuse can involve inflicting verbal statements that cause mental anguish or alienation of the victim. Sexual abuse can involve unwanted sexual remarks, sexual advances, and physical sexual acts.

Because the client with bipolar disorder is easily stimulated by the environment, sedentary activities are the best outlets for energy release. Most bipolar clients enjoy writing, so the writing task is appropriate. An activity such as planning a dance or supper might be appropriate at some point, but not for the newly admitted client who is likely to have impaired judgment and a short attention span.

The compulsive act provides immediate relief from anxiety and is used to cope with stress, conflict, or pain. Although the client may feel the need to increase self-esteem, that is not the primary goal of this behavior.

The school-aged child understands best with visual aids and concrete language.

An important consideration in alleviating the anxiety is to assist the client to recognize their behavior.

Psychodrama involves enactment of emotionally charged situations. Reality therapy is used for individuals with cognitive impairment.





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Saturday, December 13, 2008

Retrogression Update: Nurses, therapists still needed in US

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OVERSEAS Filipino workers (OFWs), in particular nurses and therapists, remain in demand in the United States.

Recruitment consultant Manny Geslani said representatives from a US-based well-known healthcare employment provider will be arriving in January to interview selected applicants of St. Georges Recruitment International Inc. who desire to work in the US and qualified to work in the emergency room, ICU/CCU, Telemetry and Medical/Surgical areas.

According to Geslani, the US is in urgent need for 600 registered nurses and physical and occupational therapists that will be deployed immediately to US hospitals.

Under their agreement with St. Georges, a reputable POEA licensed agency healthcare professionals mentioned above can be working within three to six months in the US with H1B visas under a non-cap exempt status simply meaning that their positions do not fall under the retrogression period for H1B visas, Geslani said.

Aside from immediate departure to the US, selected applicants will receive a windfall of benefits from Cambridge Healthcare, like the joining of spouse and two children under 21, relocation bonus, assistance and housing allowance, a 36-hour week with 12 hour shifts, lucrative overtime pay, US standard benefits and options, paid legal, licensing and testing fees. The minimum salary is $48,192 a year or higher depending on the experience and qualifications of the selected applicant.

Nurses or therapists with at least one year experience currently working or on volunteer duty and who have worked in a 100-bed capacity hospital are qualified to apply for the limited slots available.

Those NCLEX, IELTS and NPTE passers are preferred but not required; and the employer can assist on NCLEX, visa screen, state licensure, other documents processing. (MSN/Sunnex)

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Friday, December 12, 2008

Retrogression Update: RP workers face layoffs in US, but . . .

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Written by Estrella Torres / Reporter
Thursday, 11 December 2008 00:23

AN official of the Department of Labor and Employment (DOLE) said an estimated 130,000 temporary Filipino workers in the US, mostly in the manufacturing, shipping and domestic services, face job losses due to the global financial crunch.

But Japan is set to open its borders to Filipino nurses and caregivers as the Japan-Philippines Economic Partnership Agreement takes effect on December 11, officials said. The first 500 Filipino health workers to Japan are set to be deployed by April next year, according to a labor attaché.

Labor Assistant Secretary Ma. Teresa Soriano said temporary workers holding seasonal working visas like the H-2B to the United States are the ones likely to be affected by the financial crisis that originated in the US.

Figures from the Philippine Overseas Employment Administration showed there are 128,910 temporary Filipino workers in the US, mostly deployed in factories, shipping as well as in hotels and casinos.

Seafarers in cruise and cargo ships are also set to be affected by the global financial crunch, according to the labor official; there are 47,782 Filipinos in cruise ships and 10,754 in general cargo ships worldwide.

Filipino workers in the manufacturing sector in South Korea, Taiwan and Macau also face threats of job losses due to the global financial crisis. “While some domestic helpers would be safe, those in certain countries may be affected,” said Soriano. She added that Filipino household service workers in Singapore, Macau and Hong Kong, whose employers are active players in the financial industry, may be also be affected.

Philippine Labor Attaché to Japan Danilo Cruz said, meanwhile, that the Japan-Philippines trade deal will benefit the country in terms of providing jobs to nurses and caregivers. But the guidelines in hiring there are yet to be finalized by the two parties.

“We are still discussing it and it may be signed within this month,” said Cruz. He said that Japan is expected to absorb the first 200 Filipino nurses and 300 Filipino caregivers by April 2009.

He said the POEA has yet to issue the guidelines on deployment. “No private recruitment agency will be involved here,” he said.

Cruz said Japan may be one of the rich economies hit by the global recession but with the lingering shortage of medical workers there, Filipino nurses and caregivers are very much needed.

Soriano meanwhile said that new markets like France, Australia, Canada, New Zealand and Guam can be explored by Filipino workers who may lose jobs in the US and other countries. The Philippines is the world’s third largest source of migrant workers, next with India and China. There are around 8.2 million Filipino workers deployed around the world.

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Thursday, December 11, 2008

Retrogression Update: US health care company recruiting 600 Filipino workers

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MANILA, Philippines - Despite massive layoffs threatening overseas Filipino workers (OFW) all over the world, a well-known US-based health care employment provider will be arriving in January to interview selected Filipino applicants who wish to work in US hospitals.

According to recruitment consultant Emmanuel Geslani, Cambridge Healthcare from Maryland, which is connected with 260 world-class facilities all over the US, is in urgent need of 600 registered nurses, and physical and occupational therapists who will be deployed immediately to hospitals all over America.

However, only those selected by manpower agency St. Georges Recruitment International, Inc. will be given the opportunity to work in US hospitals connected with Cambridge Healthcare.

Under the agreement with St. Georges, selected health care professionals will be able to work within three to six months in the US with H-1B visas under a non-cap exempt status, meaning their positions will not fall under the retrogression period for H-1B visas, which is a longer process.

According to the US Citizenship and Immigration Services, the H-1B visa is “a nonimmigrant classification used by an alien who will be employed temporarily in a specialty occupation or as a fashion model of distinguished merit and ability."

Aside from immediate departure to the US, selected applicants will receive extra benefits from Cambridge Healthcare, Geslani said in a statement.

Some of these benefits include a relocation bonus, assistance and housing allowance, a 36-hour week with 12-hour shifts, lucrative overtime pay, US standard benefits and options, paid legal, licensing and testing fees and the option of being joined by one’s spouse and two children under 21.

Geslani also said that the minimum salary is $48,192 or almost P2.4 million a year or higher, depending on the experience and qualifications of the selected applicant.

Nurses or therapists with at least one year experience currently working or are on volunteer duty and have worked in a 100-bed capacity hospital are qualified to apply for the limited slots available.

Passers of the National Council Licensure Examination-Registered Nurse (NCLEX), International English Language Testing System (IELTS), and National Physical Therapy Examination are preferred but not required.

This is because the employer can assist the selected applicant in taking the NCLEX, visa screen, state licensure, etc., Geslani said.

Meanwhile, he said that the screening of applicants is currently on-going and interested applicants may still apply for evaluation.

They can send their resumes via courier, e-mail or walk-in at St. Georges Recruitment International at 7844 Makati Avenue, Makati City or call 899-0557. Email address is rhose@sgrii.com.

Applicants must bring complete documents like IELTS, passport, diploma, transcript of records, employment certificates, and curriculum vitae with detailed job descriptions.- Kimberly Jane T. Tan, GMANews.TV


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Retrogression Update: Processing of "Schedule A" Nurse Visas

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Cisomb Ead Recommendation 36







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Retrogression Update: US relaxes visa requirements for nurses: shortage for nurses may become national security concern

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By Veronica Uy
INQUIRER.net
First Posted 14:49:00 12/11/2008


MANILA, Philippines -- The US government has issued a directive to relax visa procedures for foreign nurses after the Department of Homeland Security (DHS) acknowledged the acute shortage of the health care professionals there.

The directive, Processing of "Schedule A" Nurse Visas, which can be accessed at http://www.hammondlawfirm.com/downloads/CIS_Ombudsman_Schedule_A.pdf, released on December 5, noted that "visa availability" remains the main obstacle for foreign nurses seeking work in the US, whether they intend to become immigrants or not.

The Office of the Citizenship and Immigration Services (CIS) Ombudsman of the DHS, which released the directive, said that while the Department of Labor (DoL) has already allowed employers to bypass the first step in the hiring process, it enjoins the USCIS to adjust its procedures as well.

"Specifically the USCIS should separate and prioritize, as well as centralize, its process for [Schedule A] applications in accordance with Congress' expressed concern over the national nursing shortage and to ensure consistent adjudication of applications," it said.

The DoL has designated registered nurses (RNs) as a Schedule A occupation, meaning there are insufficient US nurses able, willing, qualified, and available to fill the vacancies. The designation also means the wages and working conditions of US nurses will not be adversely affected by the employment of foreign nurses.

The CIS Ombudsman noted that all the criteria needed for automatically expediting such applications from employers apply to the US nursing shortage -- "extreme emergent situation," "humanitarian situation," and "compelling interest of the service."

It noted that the shortage will impact on the quality of patient health care in the US. "The shortage of RNs and an increased workload for current nurses is a threat to the quality of patient care," it said.

On the other hand, centralizing the applications would result in "more efficient processing times and improved consistency in the adjudications."

Lawyer Ibaro Relamida, counsel of Sentosa Recruitment Agency, said the directive will take effect right away. He said Sentosa's 600 Filipino nurses are expected to get their EB3 visas within the month.

"Last month, we were able to send only 20 nurses to the US," he told INQUIRER.net. "We still have the visas of 1,000 being processed."

A 2007 study of the US Department of Health and Human Services shows that the US would need 1.2 million nurses by 2014, about half a million to meet the demand, and 700,000 more to replace those leaving the profession.

In its report, the CIS Ombudsman cited a warning from the Americans for Nursing Shortage Relief to the House Subcommittee on the Nursing Crisis that the "shortage could result in serious national security and health concerns if there is a pandemic flu or other man-made or natural disaster, and the United States does not have adequate health care resources to respond."

The CIS Ombudsman acknowledged that the US cannot expect to meet the growing demand for nurses. It also recognized that the piecemeal approach to visa applications for foreign nurses would not work.

Currently, foreign nurses can work in the US if they have any of the following visas:

* H1C non-immigrant visas, three-year visas for nurses in specified areas with nurse shortage, were issued to 49 in 2007 and 110 in 2008;

* TN non-immigrant visas, also three-year visas with an option to extend in increments of three years open to Canadians and Mexicans, were issued to 194 in 2006 and 356 in 2007;

* H1-B non-immigrant visas, for nurses in specialized occupations, were issued only to 38 in 2006, 66 in 2007, and 136 in 2008;

* EB3 immigrant visas, which gives foreign nurses permanent legal residence (the so-called "green card"), are the ones on DoL's Schedule A. Although the most common visas issued for foreign nurses, they depend on visa availability as determined by the Department of State. In 2007, a total of 9,689 such visas were issued.

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Wednesday, December 10, 2008

Nclex Examination Review 9th Edition

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Following pneumonectomy, the fluid status of the client is monitored closely to prevent fluid overload, because the size of the pulmonary vascular bed has been reduced as a result of the pneumonectomy. Complete lateral turning and positioning is avoided. The head of the bed should be elevated to promote lung expansion. The client should remain on bed rest in the immediate postoperative period.

Pleurisy, also known as pleuritis, is an inflammation of the pleura, the lining of the pleural cavity surrounding the lungs, which can cause painful respiration (also called pleuritic chest pain) and other symptoms.

The client should remain in bed for at least 3 hours following a parenteral dose of diazepam. The medication is a centrally acting skeletal muscle relaxant and also has antianxiety, sedative-hypnotic, and anticonvulsant properties. Cardiopulmonary side effects include apnea, hypotension, bradycardia, or cardiac arrest. For this reason, resuscitative equipment is also kept nearby.

Clonazepam (Klonopin) is a benzodiazepine that is used as an anticonvulsant. During initial therapy and during periods of dosage adjustment, the nurse should initiate seizure precautions for the client.

Applying pressure over the puncture site reduces the risk of hematoma formation and damage to the artery. A cold compress would aid in limiting blood flow; a warm compress would increase blood flow. Keeping the extremity still and out of a dependent position will aid in the formation of a clot at the puncture site.

Insulin is administered via an infusion pump to prevent inadvertent overdose and subsequent hypoglycemia. Dextrose is added to the IV infusion once the serum glucose level reaches 250 mg/dL to prevent the occurrence of hypoglycemia. Administering dextrose to a client with a serum glucose level of 700 mg/dL would counteract the beneficial effects of insulin in reducing the glucose level.

The client with DKA may experience a decrease in the level of consciousness (LOC) secondary to acidosis. Safety becomes a priority for any client with a decreased LOC, thus requiring the use of side rails to prevent fall injuries. The client may be too ill to ambulate and will experience fluid loss (dehydration) rather than overload.

A tort is a wrongful act intentionally or unintentionally committed against a person or his or her property.

Discussing a client’s condition without client permission violates a client’s rights and places the nurse in legal jeopardy. This action by the nurse is both an invasion of privacy and affects the confidentiality issue with client rights.

For negligence to be proven, there must be a duty, and then a breach of duty; the breach of duty must cause the injury, and damages or injury must be experienced.

Passage of a normal brown stool usually indicates that the intussusception has reduced itself. This is immediately reported to the physician, who may choose to alter the diagnostic or therapeutic plan of care. Hydrostatic reduction and surgery may not be necessary. Although the nurse would note the child’s physical symptoms

Primary nursing is concerned with keeping the nurse at the bedside actively involved in direct care while planning goal-directed, individualized client care.

The client has the right to donate her or his own organs for transplantation. Any person 18 years of age or older may become an organ donor by written consent. In the absence of appropriate documentation, a family member or legal guardian may authorize donation of the decedent’s organs.

Case management represents an interdisciplinary health care delivery system to promote appropriate use of hospital personnel and material resources to maximize hospital revenues while providing for optimal outcome of care. It manages client care by managing the client care environment.

Participative leadership suggests a compromise between the authoritarian and the democratic style. In participative leadership, the manager presents his or her own analysis of problems and proposals for actions to team members, inviting critique and comments. The participative leader then analyzes the comments and makes the final decision. A laissez faire leader abdicates leadership and responsibilities, allowing staff to work without assistance, direction, or supervision. The autocratic style of leadership is task oriented and directive. The situational leadership style utilizes a style depending on the situation and events.

Ascorbic acid can interfere with the result of occult blood testing, causing false-negative findings. Colchicine and iodine can cause false-positive results.

The transition point for switching to the forward-facing position is defined by the manufacturer of the safety seat but is generally at a body weight of 9 kg (20 pounds). The car safety seat should be used until the child weighs at least 40 pounds regardless of age.

To facilitate removal of fluid from the chest wall, the client is positioned sitting at the edge of the bed leaning over the bedside table with the feet supported on a stool. If the client is unable to sit up, the client is positioned lying in bed on the unaffected side with the head of the bed elevated 30 to 45 degrees.

Methergine is contraindicated for the hypertensive woman, individuals with severe hepatic or renal disease, and during the third stage of labor. A uterine fundus that is difficult to locate, excessive bleeding, and excessive lochia are clinical manifestations of uterine atony indicating the need for methylergonovine.

Clients who cannot write may sign an informed consent with an X. This is witnessed by two nurses. Nurses serve as a witness to the client’s signature and not to the fact that the client is informed. It is the physician’s responsibility to inform the client about a procedure. The nurse clarifies facts presented by the physician.

Steam from warm running water in a closed bathroom and cool mist from a bedside humidifier are effective in reducing mucosal edema. Cool mist humidifiers are recommended over steam vaporizers, which present a danger of scald burns. Taking the child outside to breathe the cool humid night air may also relieve mucosal swelling.

All pregnant women should be screened for prior rubella exposure during pregnancy. All children of pregnant women should receive their immunizations according to schedule. Additionally, no definitive evidence suggests that the rubella vaccine virus is transmitted from person to person. A positive maternal titer further indicates that a significant antibody titer has developed in response to a prior exposure to the rubivirus.

For optimal upper extremity leverage, the elbow should be at approximately 30 degrees of flexion when the hand is resting on the handgrip. The top of the crutch needs to be two to three fingerwidths lower than the axilla. When crutch walking, all weight needs to be on the hands to prevent nerve palsy from pressure on the axilla.

Restraints should never be applied tightly because it could impair circulation. The restraint should be applied securely (not tightly) to prevent the client from slipping through the restraint and endangering him or herself. A hitch knot may be used on the client because it can easily be released in an emergency. Restraints, especially limb restraints, must be released every 2 hours (or per agency policy) to inspect the skin for abnormalities. The call light must always be within the client’s reach in case the client needs assistance.

To correct an error documented in a medical record, the nurse draws one line through the incorrect information and then initials the error. An error is never erased and correction fluid is never used in a medical record.

Speaking and moving slowly toward the client will prevent the client from becoming further agitated. Any sudden moves or speaking too quickly may cause the client to have a violent episode. Walking up behind the client may cause the client to become startled and react violently. Remaining at the entrance of the room may make the client feel alienated. If the client’s agitation is not addressed, it will only increase. Therefore, waiting for the agitation to subside is not an appropriate option.

Syringes should never be recapped in any circumstances because of the risk of getting pricked with a contaminated needle. Used syringes should always be placed in a sharps container immediately after use to avoid individuals from getting injured. A syringe should not be swept up because this action poses an additional risk for getting pricked. It is not the responsibility of the housekeeping department to pick up the syringe.

To achieve proper traction, weights need to be free-hanging with knots kept away from the pulleys. Weights are not to be kept resting on a firm surface. The head of the bed is usually kept low to provide countertraction.

When the client uses a walker, the nurse stands adjacent to the affected side. The client is instructed to put all four points of the walker 2 feet forward flat on the floor before putting weight on the hand pieces. This will ensure client safety and prevent stress cracks in the walker. The client is then instructed to move the walker forward and walk into it.

With the client’s elbows flexed 20 to 30 degrees, the shoulders in a relaxed position, and the crutches placed approximately 15 cm (6 inches) anterolateral from the toes, the nurse should be able to place two fingers comfortably between the axillae and the axillary bars. The crutches are adjusted if there is too much or too little space at the axillary area. The client is advised never to rest the axillae on the axillary bars because this could injure the brachial plexus (the nerves in the axillae that supply the arm and shoulder area). The nurse should terminate ambulation and recheck the crutch height if the client complains of numbness or tingling in the hands or arms.

Instructions to a client with conjuctivitis includes eye makeup should be replaced but can still be worn. Cool compresses decrease pain and irritation. Isolation for 24 hours after antibiotics are initiated is necessary. A new set of contact lenses should be obtained.

A quad-cane may be prescribed for the client who requires greater support and stability than is provided by a straight-leg cane. The quad-cane provides a four-point base of support and is indicated for use by clients with partial or complete hemiplegia.





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