2012 -

Issue 5, August 2012

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2014 - 2012

14

Become More
Assertive, One Step
at a Time

2012 - 1433

26
29

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P.O. Box 22533 - Postal code 13086 Safat - Kuwait - Tel 25735008 - Fax 25735007
E-mail : q8nursing@windowslive.com








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alotaibi@hsc.edu.kw
alsaihani.blogspot.com
twitter.com/dralotaibi
facebook.com/muhammad.alotaibi
www.linkedin.com/pub/dr-muhammad

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References:
)1. Alotaibi, M. (2007
Factors affecting
nurses decision to
join their professional
association,
International Nursing
Review, 54 (2):160165, US.

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27

Become More Assertive, One Step at a Time

by Donna Cardillo, RN, MA
www.dcardillo.com and www.nurse-power.com
Assertiveness is frequently misunderstood. Some people believe you have to be confident to be assertive. But being
assertive is less about being confident and more about valuing yourself and your profession. It's about believing you're
entitled to be somewhere, that you have basic rights as a human being and as a healthcare professional, and that as much
as you give respect to others you deserve the same in return. Don't confuse the concept of assertiveness with aggressiveness, which often is defined as being pushy, boisterous or overbearing.
Becoming more assertive can lead to increased respect and recognition as a person and as a nurse. It can get you more
of what you want and need in life. If you feel you are someone who often is the recipient of bullying or belittling by
another, acting assertive can help to minimize or avert that. Remember, you cannot change someone else's behavior, you
can change only your own. Becoming more assertive is a process. It's not something that happens overnight. You can,
however, make some small changes now to start moving in the right direction.
Stop apologizing all the time. Many of us have a bad conversational habit of saying "I'm sorry" on a regular basis
without even thinking about it. We say, 'I'm sorry, I didn't hear you," or "I'm sorry, are you busy right now?" Although we
say it in an effort to be polite, it sounds like we're apologizing. I remember a former supervisor once telling me how her
airline reservations had gotten mixed up and she would have to change her travel plans. She seemed quite upset, so I said
"I'm so sorry that happened." She looked at me rather surprised and said "Why are you apologizing? It wasn't your fault."
Of course that's not how I meant it, but that's how it sounded. When you say you're sorry all the time, it sounds as if you're
taking the blame for everything that happens. It's annoying to many people, and it makes you seem like a self-appointed
scapegoat. Don't say "I'm sorry" unless you've done something for which you truly need to apologize.
Learn to take a compliment. When complimented on a job well done, many managers, project leaders and association executives I've known respond, "Oh, I didn't do anything. It was the team that did all the work." A more appropriate response
would be to say, "Thank you. I had a great team to work with on this." Accepting a genuine compliment is not a sign of
conceit. It's simply a gracious way of appreciating someone's acknowledgment of something you did. How many times
has someone said to you, "Thanks for what you did for me" and you responded with, "It was nothing" or "Don't mention
it," thereby minimizing your actions? A more assertive reply would be, "It was my pleasure." or "I'm happy I was able to
help." This type of response is important because when you deflect a compliment, you're basically saying, "My actions
were meaningless or minimal and unworthy of acknowledgement."
Don't be self-deprecating. Merriam-Webster defines self-deprecating as "belittling or undervaluing oneself; excessively
modest." While modesty is an admirable trait, taking it to an extreme is counterproductive. I once attended an awards ceremony sponsored by a local nursing organization. Several RNs were being honored for outstanding work in the field. One
nurse walked up to the podium after being introduced and said, "I don't deserve this award." In her well-meaning attempt
to not appear boastful, she was negating the contributions of all nurses. Her comments were unnecessary and inappropriate. She simply might have said, "I'm honored and humbled by this recognition. I accept this award on behalf of all my
fellow nurses who do such outstanding work every day and often remain in the shadows."
Act confident even if you don't feel confident. Force yourself to make good eye contact with people and use a steady,
audible voice when speaking. Stand or sit erect with your head upright and straight on your shoulders, not tilted to the side
or bent forward. Act like you have a right to be there, even if you don't yet feel that way. If someone attempts to interrupt
you while you're talking, keep talking until you are done and raise the volume of your voice if necessary to be heard. If
you stop talking midstream in an effort to be "polite," you are making a statement that they have more of a right to speak
than you do.
Being assertive is not about being combative or aggressive. It's about firmly holding a belief that you're someone who
matters. Acting in a more assertive manner actually will make you feel more assertive and lead to increased confidence.
Just as important, it will help you get noticed and listened to and start to garner the respect you and your profession deserve. Take some small steps in the right direction today.
Copyright Nursing Spectrum Nurse Wire (www.nursingspectrum.com). All rights reserved. Used with permission.

29

Fig ( 1 ): Lange Skinfold Caliper

Fig ( 2): TSFT Measurement

Fig (3): MAC measurement

Biochemical Tests is another approach which aids to assess nutritional status. Because it may give information concerning nutritional status before the appearance of clinical or anthropometric changes. Laboratory tests
can provide information about protein energy balance, vitamins-minerals status, fluid balance, body composition, organ function, and metabolic status. The pediatric nurses should have knowledge and skills to interpret
biochemical data such as serum albumin, creatinine, glucose, potassium , sodium, calcium phosphors ,urea and
hemoglobin.
Diagnosis Phase
A number of nursing diagnoses become evident based on assessment of the child. The most relevant in the
majority of the cases are increased risk for injury related to accumulated electrolytes and waste products. Fluid
volume excess is related to failure of renal regularity mechanisms. In addition, an altered nutrition less than
body requirement is related to restricted diet. Furthermore, body image disturbance related to chronic illness,
altered family process related to a child with a chronic disease.
Planning Phase
In developing a nutritional care, plan must use the assessment data collaborated with the children and health
care team for identifying the nutritional goals. Planning for meeting short term goals among child with CRF as
follows; first, prevent weight loss, second, ensure adequate nutritional intake, third, and replace nutritional loss
from uremic symptoms and fluid electrolyte imbalance. Long term goals of care for the child with CRF and his
family make the child receive encouragement to normal growth and development with minimizing the impact
of the disease process, the child will remain free of complications. The child and family will receive appropriate
support, guidance, and education .
Implementation Phase
Implementation to manage the multiple complications of CRF is based on medical protocols prescribed
which are for the care of those specific problems. The pediatric nurse and dietitian should assume primary
responsibility for monitoring the impact of nutrition intervention on the children with CRF undergoing hemodialysis. The nurses take responsibility for teaching the children and family what they need to know in order to
promote nutritional requirement for enhancement of growth and development of those children. The pediatric
nurse should discuss method for meeting energy intake to prevent weight loss and rebuild body tissue during
hemodialysis treatment .Moreover ,the intake of all vitamins and minerals should meet the recommended dietary allowance after assessment the needs of children individually. Fluid balance is most important in children
with kidney impairment so, fluid intake or restriction should be according to children condition and needs.
Evaluation Phase
The effectiveness of nursing interventions is determined by continual reassessment and evaluation of care
based on the observational guidelines as observing and interviewing family regarding compliance with the
medical and dietary regimen.

2012 - -

30

Role of the Nurses in

Managing Nutritional
Problems in Children with CRF
Undergoing Hemodialysis
C.I Trainee Mariam Mohammad
Ms.N Pediatric Nursing
Staff Development Unit
The goals of nursing intervention for children with chronic renal failure (CRF) are directly to physical and psychological care to minimize complications specially nutrition which is caused by CRF and hemodialysis. So, a competent
and qualified pediatric nurse has an important role in the prevention of malnutrition and improvement of nutritional
status. She has multiple roles while caring for the child under hemodialysis such as assessment, diagnosis child problems, planning, implementation and evaluation.

Assessment Phase
Assessment of the child with CRF is primarily involved monitoring the health status of child, observation and early
detection of any signs of complications such as growth failure, developmental delay, and hypertension. The nurse
works with individuals, families and groups to identify health needs and develops plans for addressing those needs.
The vital role of nurse to gather accurate data about the child nutritional health to aid in the development of a holistic
plan of care of the child. In some practice setting, there is no dietitian in staff, so the nurse needs to be knowledgeable about the component of nutritional assessment. Since malnutrition problem is a common problem for children
with CRF, it is important to use assessment of nutritional status to recognize substrate deficiencies early. A complete
nutritional assessment comprises four major components relying on historical information, physical examination,
anthropometric measurement, biochemical analyses.
A diet history provides a record of children eating habits and food intake and can help identify possible nutrient
imbalances .In addition it provides valuable clues about how a child will accept diet changes.
The nurse should routinely incorporate the nutritional aspects of physical assessment into the nursing process .
Essentially, assessment by clinical signs is based on examination for changes believed to be related to inadequate or
excessive nutritional intake, that can be seen or felt in superficial epithelial tissues, especially the skin, eyes, hair, and
mouth, or in organs near the surface of the body such as the thyroid, and the skull.
Anthropometric measurement is a series of noninvasive, inexpensive and easy to perform indices including body
measurements usually are weight and height. Accurate height and weight are required for calculation of BMI .It is
calculated the same way as for adults (BMI = weight (kg) / height 2(m2)), but then compared to typical values for
other children of the same age. The BMI percentile allows the nurse to compare between children of the same sex
and age. Triceps skinfold thickness (TSFT) measurement is considered an important factor in assessing nutritional
status. This method measures only one type of fat (subcutaneous adipose tissue). The nurse should become practiced
at doing skinfold measurement before reliably performing it on children (fig. (1,2)). In addition, the nurse must
compare the measurement founded with reference values for children according to their age and gender . Mid Arm
Circumference(MAC) is an anthropometric measurement of the upper arm is an indicator of muscles and nutritional
status . Measurements are done at midpoint between the olecranon process and the acromium process (fig. (3)). Moreover, the nurse must compare the measurement found with reference vales for children according to their age and
gender.

31

Nursing means care.

When we give it to the maximum we change the lives of people and thus we heal the
souls of the sick and that it might reach farther more to the healthy people and community.
Nurses with passion are the nurses the makes the difference . People need sometimes a
smile more than the doctors advice . We create life by what we give . Nurses give and
never ask anything in return. Nursing as a career tends to change our personality; changes
how we use to look at things . Moreover , we began to look at world from a different aspect
; from the patients eyes, from the dying person , from chronic illness patient , from a
Sickle Cell Anemia patient we became addict to pain killers, from a child who comes for
the chemotherapy. How all this people see the world ? We began to view it and try to
imagine it and see it as every day we go to work we will encounter one of them . Its not
easy in fact, but as days passes by we learn to do our job and to care for them at the same
time. To hold their hands in one hand and give medicine in the other. Simply because we
are carrying a white heart.

And here in Kuwait , we are trying to come up

the quality of nursing and in fact change it . So, a
group of a volunteer Kuwaiti nurses has came up
with a community health teaching group . Lead
by Mohammad Baqer and Sadiq Al Feeli , and
because of the type of our profession there could
be no better name than WHITE HEART for the
small group. White Heart targets the community
! As the more health teaching and awareness we
give in the society the more educated the people
become and eventually we will have less patients
in the hospital . If people are fully aware of the
complications of obesity and how it linked to Diabetes , how there have been an increasing in the
rate of obesity among kids; junk food ; sedentary
lifestyle ; all these are related and the cause many
severe chronic diseases. Road accidents from another hand have lead to many disabilities among
the youth and young adult .

By Amal Mahmoud
Surgical Department
Adan Hospital
Co-founder of
White Heart

White
Heart

Whom to blame ? Whom to advice?

The answer is the community . And part of our nursing is called Community Health
Nursing which is to get involved in the society and can be the number one difference in
health care. The aim of the group is to visit schools , malls and exhibitions ; be more close
to the people and give them all the health and awareness thats possible. To encourage
Kuwaiti nurses to create and raise the health care, to get every member involved in the
awareness and be responsible for it. Most of all we should never forget that this would lead
to a better image of nurses in Kuwait.

2012 - -

32

Casualty department or emergency room

By Malika Jamea - Mubarak Al Kabir Hospital - Operations

Emergency room (ER) or casualty department is a medical treatment facility specialising in acute care of patients who
present without prior appointment, either by their own means or by ambulance. The emergency department is usually found
in a hospital or other primary care center.
Due to the unplanned nature of patient attendance, the department must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention. In some countries, emergency
departments have become important entry points for those without other means of access to medical care.
The emergency departments of most hospitals operate 24 hours a day, although staffing levels may be varied in an attempt
to mirror patient volume.
Critical conditions handled:
Unconscious and not breathing - adults
If a person does not respond to the sound of your voice or to gentle pressure applied to their body, it is likely they are
unconscious.
Breathing problems
Breathing is vital to life. Every time we breathe, we not only take oxygen in but breathe carbon dioxide out. Without oxygen the cells of the body will start to die in about three minutes.
Breathing problems can be caused a number of ways; it may be through injury, such as damage to the chest wall, or disease
such as cancer or emphysema. Some respiratory conditions, such as asthma or hyperventilation, can have a rapid onset and
may need assistance from first aiders.
Unconscious but breathing - children and adults
If a person does not respond to the sound of your voice or to gentle pressure applied to their body, it is likely they are
unconscious.
Heart attack
A heart attack is most commonly caused by a sudden blockage of the blood supply to the heart muscle itself, for example
a blood clot. The main risk is that the heart will stop beating.
Stroke
A stroke is caused by a portion of the brain being starved of oxygen. This can be due to a burst blood vessel or a clot
blocking a blood vessel. The lack of oxygen causes damage to the brain. The long-term effects of a stroke depend on what
part of the brain and how much tissue is affected.
Fractures
Complete or incomplete break or a crack in a bone due to an excessive amount of force.
Choking
A foreign object that is stuck at the back of the throat may block the throat or cause muscular spasm.
Young children especially are prone to choking. A child may choke on food, or may put small objects into their mouth and
cause a blockage of the airway.
If the blockage of the area airway is mild, the casualty should be able to clear it; if it is severe they will be unable to speak,
cough, or breathe, and will eventually lose consciousness.
Wounds and bleeding
Any break in the surface of the skin (wound), will not only allow blood and other fluids to be lost, but allow germs to enter
the body. If the wound is minor, the aim of the first aider is to prevent infection. severe wounds may be very daunting to deal
with but the aim is to prevent further blood loss and minimise the shock that could result from the bleeding.
Some closed wounds such as bruising could indicate an underlying injury and first aiders need to be aware of the cause of
injury as this may alert you to a more serious condition, such as internal bleeding.
Any open wound is at risk of becoming infected, it is important to maintain good hygiene procedures to guard against prevent cross infection between yourself and the casualty.
Severe allergic reactions (Anaphylaxis)
A severe allergic reaction will affect the whole body, in susceptible individuals it may develop within seconds or minutes
of contact with the trigger factor and is potentially fatal.
Possible triggers can include skin or airborne contact with particular materials, the injection of a specific drug, the sting of
a certain insect or the ingestion of a food such as peanuts.
Effects of heat and cold
The human body normally regulates its own temperature very well, but can be affected in a number of ways when it suffers the effect of extreme temperature, in particular the very young or elderly are the most susceptible to the effects of heat
and cold.
Contact to hot materials/surfaces can cause burns or scalds, the longer the contact the more severe the injury will be.
Corrosive chemicals can also cause burns. Exposure to extreme heat can cause conditions such sunburn, prickly heat and
possibly heatstroke. Extreme cold can also lead to hypothermia and frost bite.
First aiders should always remember ensure that any danger to you is removed before attempting to commence treatment.
2012 - -

34

of blood cells. Basically, the more HLA markers a child and the potential donor have in common, the greater the
chance that the transplant will be successful.
Unlike with an autologous transplant, there is a risk of rejection. Sometimes, despite the donor being a good match,
the transplant simply may not take. Other times, the donor cells can begin to make immune cells that attack the
recipients body. This condition is called graft-versus-host disease, and can be quite serious. Fortunately, most cases
are successfully treated with steroids and other medications.
Sometimes, an upside of graft-versus-host disease is that the newly transplanted cells recognize the bodys cancer
cells as different or foreign, and actually work to fight them.

Transplantation

Stem cell transplantation is a very complex process that may span several months. A team of doctors is usually
involved in determining if a child is a candidate and, if so, whether the transplant will be autologous or allogeneic.
For an allogeneic transplant, a compatible donor will be sought among family members or through a national registry
of volunteers. Once a match is found, the donors stem cells will be harvested. Three different types of hematopoietic
stem cells can be collected or harvested:
1. Peripheral blood stem cells are harvested from donated blood. The stem cells are separated and collected and the
rest of the blood is returned to the donor.
2. Bone marrow stem cells are collected from the patients hip bone through a surgical procedure.
3. Cord blood stem cells are collected from a mothers placenta immediately after a child is born.
While all three types can replenish a patients blood and bone marrow cells, there are advantages and disadvantages
to each. The doctor will suggest the best type of stem cell for your childs illness.
The next step in the transplantation process is conditioning therapy, which is when very high doses of chemotherapy
and/or radiation are given to the child to kill cancer cells. These treatments have side effects: Theyll destroy the
childs bone marrow and weaken the immune system. But from a transplant standpoint, these consequences are potentially useful. They not only help to make room in the bone marrow for the new cells to take hold, but they also
suppress the immune system, thus lessening the chance of rejection.
Soon after the conditioning phase, the transplant itself will be done through infusion and healthy stem cells will be
introduced to the childs body. After the infusion, the child will be watched very closely to make sure the new stem
cells are settling into the marrow and beginning to manufacture new blood cells (called engrafting). Doctors will
watch for any signs of rejection as well as graft-verses-host disease in kids with allogeneic transplants.
Engrafting takes an average of 2 weeks, but can be as quick as 1 week or as long as 6 weeks. Your child will receive
medicines to promote engrafting and prevent rejection and graft-verses-host disease.

Recovery

Kids who receive stem cell transplants have a high risk of infection because during conditioning therapy and while
the transplant is grafting, their immune systems are compromised and unable to fight bacteria and other germs that
enter the body. Children who receive an allogeneic transplant have an even greater risk of infection because they
require medications to further suppress their immune systems to reduce the chance of rejection.
Because of these risks, a child whos had a stem cell transplant will not be released from the hospital until doctors
are sure the transplant has successfully engrafted and the child is otherwise doing well.
Once released, a child needs very close monitoring and follow-up care. School and other public indoor areas may be
off limits for 6 months to a year, and other places might be restricted as well. This is because for kids with a compromised immune system, even a simple infection like a common cold can be serious and even life-threatening if
untreated.
2012 - -

36

Nadia Ali Al Enezi

National Bank Hospital
Ward 1
Hematopoietic stem cells are immature cells that are capable of developing into the three types of blood cells:
1. red blood cells that carry oxygen
2. white blood cells that fight infection
3. platelets that help blood to clot
Hematopoietic stem cells can be found in bone marrow (the spongy tissue inside bones), the bloodstream, or the
umbilical cord blood of newborn babies.
A stem cell transplant can replenish a childs supply of healthy hematopoietic stem cells. Its used to treat a wide
range of diseases, including cancers like leukemia, lymphoma, neuroblastoma, Wilms tumor, and certain testicular
or ovarian cancers; blood disorders; immune system diseases; and bone marrow syndromes.
Transplanted hematopoietic stem cells are introduced (or infused) into the bloodstream through an intravenous (IV)
line, much like a blood transfusion. Once in the body, they can produce healthy new blood and immune system cells.

Types of Transplants

The two main types of stem cell transplants are autologous and allogeneic. The type of transplant needed will depend on the childs specific medical condition and the availability of a matching donor.
Autologous hematopoietic stem cell transplant. With this type of transplant, patients act as their own donor. That is,
a child who is about to undergo cancer treatment will have his or her own stem cells removed (harvested) and frozen
for later use. After the child receives chemotherapy and/or radiation, the stem cells are thawed and put back into the
childs body. This procedure may be done once or many times, depending on the need. Sometimes doctors will use
extra-high doses of chemotherapy during treatment (to kill as many cancer cells as possible) if they know a patient
will be getting a stem cell transplant soon after.

Allogeneic hematopoietic stem cell transplant. With an allogeneic transplant, the stem cells come from a donor
often a sibling but sometimes another volunteer whose cells are considered a match for the patient. The process
of finding a match is called tissue typing (or HLA [human leukocyte antigen] typing). HLA is a protein on the surface

37

Is It The Best Of Times Or The Worst Of

Times In Nursing?
It was the best of times, it was the worst of times, it was the age of wisdom, it was the
age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the
season of Light, it was the season of Darkness, it was the spring of hope, it was the winter
of despair, we had everything before us, we had nothing before us The tale of two Cities
by Charles Dickens
The passage above talks about a time of uncertainty where wisdom and foolishness both
were so clearly in front of the people that there was unbridled hope as well as tremendous
despair in the air.
Today the same is true in healthcare, especially in nursing. It is the best of times in nursing and it is the worst of times in nursing. Never in the past had we so many nurses with
advanced degrees serving in various important leadership roles. However, never in the past
has nursing care been so stressful and constrained.
Nurses constantly witness the well-being of their patients sacrificed for corporate good.
We continue to face poor work conditions unable to provide enough attention to each patient. This makes it impossible to provide the compassionate, competent and safe care our
patients deserve, not to mention the toll it takes on our own health and well-being.
But, we constantly have to weigh in the consequence of speaking up for safe and compassionate patient care. If we speak up we face retaliation and persecution to the extent of
becoming so overwhelmed and dishearted that we lose our desire to go on.
One might question, Why in this era of so much nursing advancement are we facing such
abuse of nurses and the patients? The answer here may be difficult to accept but does have
a very simple fix. Although this fix is simple, it still requires diligence, consistency and
commitment.
The main problem in nursing is our inability to come together and have a unified voice.
Often, the nurses in leadership and advanced roles find themselves serving the corporate
agenda. As a result they end up reinforcing the poor work conditions.
The nursing organizations and the academician in nursing preach about increasing the
standard of nursing care, nursing ethics, nurse autonomy and the role of the nurses as patient advocates. However, when a nurse in clinical practice tries to implement these high
standards, she suddenly finds herself all alone.
She finds out that there is not much support for her when her actions for compassionate patient centered care are not received well. As a result, she ends up being disciplined, falsely
accused and often stripped of her license by her own peers.
There is power in numbers. Nurses are the engine that runs the healthcare around the
world. If we were not there to manage day to day and hour to hour care of the patients, there
will be no way to care for the patients. With the increased number of nurses in leadership
positions and with advanced degrees, we are more prepared today than we ever were to take
on healthcare.
Today we are more prepared to provide compassionate patient centered care where everyone comes out a winner. We have the ability to advocate for our patients and change the
face of healthcare from being a power hungry money centered business it has become to a
patient centered compassionate business model that serves our patients as it creates revenue
streams for nurses and physicians alike.
We can only achieve this if we first decide to have a united voice. With this united voice,
each individual nurse can feel confident that her efforts for patient advocacy, patient safety
and compassionate care will be supported by her peers. This way we will be able to change
the face of healthcare and bring it back to the noble and caring profession it was always
meant to be.

Shahina Lakhani

Shahina Lakhani RN
MSN Author,
Poet,
Speaker, Holistic Life
Change Strategist. She
advocates using holistic
strategies in personal empowerment, care of the
sick, the dying and their
loved ones.
Shahina Lakhani has been
a nurse for more than 25
years. She has worked as
an educator, Nurse Practitioner and a Hospice
Nurse. Her passion is to
empower people to Live
Powerfully and experience Wellbeing until their
last breath.

Yours in love, peace and gratitude

Shahina Lakhani
2012 - -

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