IJCNE: JUL–DEC 2005, VOL 06, NO 2

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Editorial
Global Epidemic of Diabetes, A Serious Burden Among Developing Countries (Punitha Ezhilarasu)

Concepts and Issues
Assertiveness in nursing (Leah Macaden)

Clinical Articles
Preparing nurses for genomic era (Jothi Clara, J.)
Emotional needs in critically ill patients (Mamatha Shivananda Pai)

Student Articles
Dementia – The role of nurses in its recognition and management (Karunakaran, K.P., Sheeba S.Chandy, Helen Charles, Manoranjitham, S.)

Research Articles
Role of the community health nurse as a Family Nurse Practitioner (Jayanthi Milka Bai, Chellarani Vijayakumar, Rosaline Jayakaran, Rajarathnam Abel)

Continuing Education Series
Pathophysiology and management of patients with Type 1 Diabetes mellitus – Part I (Shanthi Johnson, Leah Macaden)

Research in Brief
Management of breast engorgement (Shanthi Margoschis, Janet Jones, Alice Augustine)


Abstracts

ASSERTIVENESS IN NURSING
* Leah Macaden, M.Sc (N)
ABSTRACT
Assertive behaviour is the ability of an individual to honestly express either his or her positive and negative feelings, setting limits and have the initiative to speak up. The current trend in health care settings is inclined towards team working with a multidisciplinary approach. The nurse within a multidisciplinary team can play a pivotal role in providing quality care to the patients under his / her care. There are several misconceptions about assertiveness but nurses need to be assertive in order to be an effective patients’ advocate and empower them. Non assertiveness can lead to stress, low self esteem, helplessness and poor job satisfaction leading to poor job retention and high staff turnover. It is therefore very crucial that nurses are taught and encouraged to be assertive in their practice.

PREPARING NURSES FOR GENOMIC ERA
* Jothi Clara J., M.Sc (N)., Ph.D
ABSTRACT
Genetics based health care is an emerging paradigm. Therefore, it is essential for the nurse to expand their understanding and ability to promote quality health care to the individual, family and by and large society. In fact, Collins (1999) stated that in the near future, individual risk profiling based on an individual’s specific genetic makeup would be used to tailor prevention, treatment, and ongoing management of health conditions. Additionally, the National Coalition for Health Professional Education in Genetics (2001) asserted that all health professionals must know basic human genetics principles and applications to meet these revolutionary changes in healthcare. Hence, the nursing profession is no exception to this scenario. This article will sensitize and bring to realization of nursing students and nurses to be basically prepared to stay current and develop competence in clinical application of genetics.

[Key words: human genetics, genome, genomic era, DNA, gene, genotype, phenotype, Mendelian pattern, genetic trait, inherited condition, inherited predisposition, proband, chromosomal disorders, family tree]

EMOTIONAL NEEDS IN CRITICALLY ILL PATIENTS
* Mamatha Shivananda Pai, M.Sc (N)
ABSTRACT
With advance in science and technology, often there is a tendency to concentrate more on machines than on patients while taking care of patients. In our daily routines, the warmth of the human touch is an often needed mission; Studies have supported the notion that the ward environment, such as monitoring equipment and unfamiliar routine, is frequently a major stressor. Families often experience stress and the family unit tends to become disorganized because of disruptions to its routines, roles and relationships. Given this information, the nurse’s role should include looking beneath the patient’s mask of fear and anger developing a contextual understanding, familiarizing the patient to the environment, collaborating with the patient and expanding the context to include families and reassuring them. In this context, the emotional needs of critically ill patients and their families are identified and nurse’s responsibilities in meeting them are discussed in this article.

DEMENTIA – THE ROLE OF NURSES IN ITS RECOGNITION AND MANAGEMENT
* Karunakaran, K.P., DPN student
** Sheeba S. Chandy, M.Sc (N)
*** Helen Charles, M.Sc (N)
**** Manoranjitham S., M.Sc (N)
ABSTRACT
Dementia is a commonly known disease in the West, but awareness about this condition is poor both among the nursing community as well as the public in India. This article is meant to increase awareness through the case report and subsequent discussion. It also allows the reader to review the criteria for recognition and care of an individual with dementia.

ROLE OF THE COMMUNITY HEALTH NURSE AS A FAMILY NURSE PRACTITIONER
* Jayanthi Milka Bai, M.Sc (N)
** Chellarani Vijayakumar, M.Sc (N)., Ph.D
*** Rosaline Jayakaran, M.Sc (N)
**** Rajarathnam Abel, M.B.B.S., MPH., FICN.
ABSTRACT
Family Nurse practitioner is a nurse who has received additional education and training necessary to function in the role of a primary care provider, performing many of the same tasks as a family doctor. In India, 80% of the health facilities are concentrated in urban areas. The rural areas where nearly 74% of the population live, do not enjoy the benefits of modern curative and preventive health care services. There is concentration of doctors upto 73.6% in urban areas where only 26.4% of the population live. In the College of Nursing Community Health programme (CONCH), Christian Medical College, Vellore, nurse run clinics are conducted by Community Health Nurses with some experience. They examine, diagnose and prescribe treatment for the patients in the programme area as per the standing orders. This research study was undertaken to study the extent to which the nurse in the role of a family nurse practitioner meets the primary care needs of the people and to recommend additional preparation needed by the nurse to function as a family nurse practitioner. The study revealed that the graduate nurses need additional preparation to function as family nurse practitioners in the field of community health.

CONTINUING EDUCATION SERIES – NO.9
PATHOPHYSIOLOGY AND MANAGEMENT OF TYPE 1 DIABETES MELLITUS – PART I

* Shanthi Johnson, B.Sc (N)
** Leah Macaden, M.Sc (N)
In this series, the pathophysiology and management of Type 1 Diabetes Mellitus (DM) are discussed.
ABSTRACT
Diabetes mellitus is a syndrome characterized by many disorders where there is increased blood glucose concentration which is caused by an absolute or relative lack of insulin, a hormone produced by the Islets of Langerhanns in the pancreas. Diabetes has serious long term implications not only for the individual but also on a global scale; its rapidly increasing prevalence is a significant cause for concern. The number of people with diabetes is expected to increase alarmingly in the coming years.

Good management of diabetes involves an active health promotion component which is highly possible within the scope of nursing. Therefore, it is very crucial that nurses and other members of the health care team equip themselves with current knowledge to provide comprehensive care to people with diabetes.

RESEARCH IN BRIEF
MANAGEMENT OF BREAST ENGORGEMENT

* Shanthi Margoschis, M.Sc (N)
** Janet Jones, M.Sc (N)
*** Alice Augustine, M.Sc (N)
ABSTRACT
Breast feeding her child is the most natural thing for every mother. Sometimes, problems like flat or inverted nipples, breast engorgement are faced by the mother which cause apprehension and anxiety. These can be overcome by careful guidance, reassurance, encouragement and simple measures. A quasi experimental study was done to compare the effectiveness of manual expression of milk and warm bottle application in mothers with breast engorgement in the postnatal wards of Christian Medical College (CMC), Vellore. Based on random sampling, 30 mothers were studied in each group. Three scales were used; a five point analog scale was used to assess breast engorgement and another one for assessment of pain. The breast was observed using an observational check list.Group I consisted of 30 mothers with breast engorgement on whom moist compress was applied and then breast milk was manually expressed. Group II consisted of 30 mothers for whom breast milk was expressed with a warm bottle. The comfort of the mother and the degree of breast engorgement relief were assessed before and after the procedure for both the groups. The findings of the study showed that both the methods were effective in reducing the breast engorgement as well as the pain expressed by the mother. On comparing both methods it was found that mothers in group II where breast milk was expressed using a bottle had significant reduction of breast engorgement (p value < 0.01) than the mothers in Group I who had a moist compress application and manual expression of milk. Pain was significantly reduced in mothers belonging to Group I than mothers in Group II.