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Home News

Tuesday, June 16 2009

Niche nursing

The Star Online

TAKE the concept of meals-on-wheels and apply it to nursing services; that’s mobile nursing in a nutshell. Rather than trivialise the nursing profession, the imagery is intended to help people look beyond the conventional borders of the field.

Generally, the public is more familiar with nursing services in institutional settings like private and public healthcare facilities, clinics or nursing homes. In these environments, the nurse has clearly defined roles and scope of services.

She (or he) is usually responsible for many patients at the same time, instead of just one exclusive patient. There’s easy access to doctors, thereby creating the perception that nurses are mere assistants to doctors.

“This is a misconception as both are professionals in their own right, and their respective duties and responsibilities are complementary to one another,” says Yakob Abdul Rahman W. Scholer, founder of Home Nursing Providers Sdn Bhd (HNP), claimed to be Malaysia’s first fully-integrated mobile nursing provider. It offers a comprehensive range of medical and nursing services in the comfort and convenience of the patient’s home.

Over 40% of patients in long hospital stays are only retained for nursing purposes,’ says Yakob Scholer.

“Mobile nurses are expected to have a higher degree of independence and discretion, and beyond observing medical conditions and administration of prescription, they are supposed to make initial investigations of the patient’s overall health. This is then communicated to the main caregivers with recommendation for further consultation with a doctor,” he adds.

Originally from Mainz, Germany, nursing consultant and applied psychologist Yakob first came to Malaysia in 1963. He has since contributed to many health institutions in the country, including Yayasan Pusat Pertolongan and Yayasan Alkoholisma Malaysia in Ipoh, and initiated the creation of Malaysia’s first AIDS Awareness Committee (now known as the Malaysian AIDS Council).

Today, Yakob helms HNP as its nursing programme director, and conducts various local and international seminars on proper patient care in the home environment as well as lectures on health psychology at Universiti Teknologi Mara.

The nursing services provided by HNP are usually taken up by individuals who need post-hospitalisation care such as those who have had a major procedure done in a hospital, require proper wound management or even terminally-ill patients who need palliative care.

The main criterion is whether the family needs professional support in the care and management of a patient at home. This has to take into account time constraints, or the need for a skilled and qualified nurse due to the patient’s complex condition.

“For example, whilst the family can be coached to perform proper general nursing care such as bathing and feeding a patient, they will still need a qualified nurse to perform other tasks such as taking blood samples, changing the feeding (Ryle’s) tubes or urethral catheters, or performing complex wound management.

“I’ve noticed that families who exhibit a deep sense of devotion and filial piety towards their sick family members are more inclined to engage mobile nursing services as they want to assure that the best care is given to the patient,” adds Yakob. If you look at the big picture, the nurses are also regarded as educators, councillors and motivators to the patients and their family members.

Mobile nurses are also helpful for stroke patients who need to undergo full mobilisation training to regain strength and functionality in the affected body parts. Apart from having the right physical skills, they can also help motivate and encourage patients to push themselves to the limit. By having a qualified nurse to visit, the length of hospitalisation is reduced, thereby reducing medical costs and expenses for the patient. He or she is also spared the long waiting hours and repeated visits for simple procedures at the hospital.

“It is reported that over 40% of patients in long hospital stays are only retained in the hospital for nursing purposes. A recent study in the United States revealed that patients suffering congestive heart failure who receive home nursing care services will require only half the length of acute hospitalisation in their lifetime as compared to those who did not,” explains Yakob, who feels that some patients can recuperate faster in the family setting.

“Then the patient will not feel a sense of loss or rejection which can lead to severe depression, a common occurrence with the sick or elderly placed in a nursing home or long-term hospital care.”

In countries like Germany, the United States and Australia, mobile nursing is officially recognised by government institutions and covered by government-funded social insurance programmes. The family will receive financial support for taking care of the patient at home, based on the severity of the illness and nursing dependency.

There are a total of 11,500 mobile nursing agencies in Germany while the United States has over 10,000 agencies, the majority of which participate in the government’s Medicare insurance programme.

Some countries have streamlined their mobile nursing operations based on areas of specialty and scope of services such as geriatric or paediatric home care, and some focus specifically on terminal and respite care.

“In Malaysia, however, mobile nursing is still a new venture and there is a lack of public awareness of this niche area of medical nursing services. As such, it is yet to be recognised for government financial assistance purposes or private health insurance coverage,” says Yakob.

Based in Kelana Jaya, Selangor, HNP provides consultancy and education, basic and professional nursing, disease and wound management as well as mobilisation, physiotherapy and rehabilitation services. The independent company is private-owned and not attached to any organisation.

Currently, its services are available in Kuala Lumpur, the Klang Valley, Seremban, Malacca and Ipoh. Upon special request, the company has provided services to patients in Penang and Langkawi as well.

The medical and administrative personnel are full-time employees and the nurses, mostly Malaysians, are qualified State Registered Nurses, including male nurses who cater to the needs of male patients.

Recently, HNP has also established its Home Oxygen Therapy arm in collaboration with MOX-Linde Gases Sdn Bhd to supply the products and administer Home Oxygen Therapy to patients. – By Patsy Kam