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Story Time About the Dog and His Owner.

"You must give everything to make your life as beautiful as the dreams that dance in your imagination"-Roman Payne.
My handsome big dog dedicated to his owner.Runs errand for the owner.
The dog is asked to go into the house and bring kola nut(this could be anything for
entertainment)

It is a bedtime story about a dog and his owner.The owner surprisingly had visitors that they were not expecting .So the owner started a song like this.

My handsome big dog go into the house in the living room and get me some kola nut, so that we can give to these uninvited visitors.I did not invite them and I am sure that you did not invite them.So come on big boy go into the house and get me some kola nut so that we can give to these strangers.Hopefully the kola nut will force them to tell us why they are here.

So the dog went into the house and got the kola nut.The uninvited strangers ate the kola nut.After eating the Kola nut (coca cola) they confessed that they are interested in buying the piece of land in their backyard so that they could be their neighbor.Sometimes a kind gesture can lead to meeting pretty nice people.The dog owner told them that she owns the land but the land is not for sale.So they left back to where they came from.The big dog and his owner live happily there after .The End.

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My Honor As A Nurse.

On my honor as a Registered Nurse.


I will provide compassionate excellent Nursing care.

I will do my best now and tomorrow.
Be a good leader,not a follower.
I must Move Nursing Agenda Forward.
I must do my Best all the time.
I promise to update and obtain required CE every two years.
Advance my knowledge,education,and experiences.
I will be Knowledgeable not Knowledge Deficit.
Team player,work effectively with my colleagues and other ancillary.
Clock or sign in on time.
Clock or Sign out on time. Have all my equipment such as Stethoscope,Pen and Pencils.
I must Reason,and be Reasonable.
Perform my assigned role effectively and efficiently. Follow Hospital policies and Regulations.
Comply with JCAHO Standards of Care and Regulations.
Carry out Doctors Orders on Time.
Troubleshoot and be Supportive of my Colleagues. Know and Understand Patient Bill of Rights.
Respect Patient and Families. “The very First Requirements in a Hospital is that, it should do the sick no harm “Florence Nightingale .
Give medications by mouth and intravenously as ordered. Advocate for my Patients.
And provide TLC.
Must not Abuse Patients Physically, Emotionally or Sexually.
Promote Health and Prevent Diseases.
“I attribute my Success to this -I never gave or took any excuse”- Florence Nightingale .
Nursing Assessment.

DO YOU KNOW.(Saliva,Digestion, Esophagus, Tracheostomy stoma)

1.Do you know that 1000 to 1500 saliva is produced every day by three pairs of salivary glands these are the sub maxillary gland, sublingual gland and the carotid gland?.

2.Do you know that the some of the complications of extubation are glottic edema, sore throat,laryngeal dysfunction, vocal cord paralysis and hoarseness?.

3.Do you know that after the removal of a tracheostomy the stoma is covered with a dry dressing??

4. Do you know that the esophagus is a collapsible tube that lacks cartilage. It is 9 to 10inches long and 1/2 to 1 inch (1cm to 2cm )wide,narrowest part of the digestive tube and lies posterior to the trachea and the heart?.

5.Do you know that the major function of the gastrointestinal tract is digestion. Yes it will convert ingested food into simpler forms from tract to ports of circulation and are used in metabolic process?.

CERTIFIED NURSING ASSISTANT.(My observation and other findings)

In order to become a certified nurse assistant you will undergo three months training in Community College, or America Red Cross or in hospital training.After the training you will take a test ,pass the core skills test before you can become Certified nurse assistant. Since you are trained you get better pay than the nursing assistant without portfolio (untrained).The roles of the certified nurse assistant are to provide care to patients and to help with activities of daily living which patients/ clients are no longer capable of doing such as bathing, dressing up, brushing their teeth or denture. They also help and support medical staff to take care of the patients. It is difficult to have good nursing assistants. Their job involve lot of physical stamina. But most of the time the good nursing assistants are abused,overworked ,discriminated against (by the Registered nurses if the nursing assistants are of different race )without any appreciation. Some of the Registered nurses will sometimes pretend that because she is a certified nurse assistant, she has suddenly developed eight hands and eight legs.Then the nurse assistant will walk ,run at the same time to take care of some of the things that the Registered nurses can handle. With time the nurse assistant will leave or transfer to another unit.Be compassionate and pamper your assistant so that she or he can continue to serve. They are not made of pile wood materials. They are human beings. Give thanks for a great certified nurse assistant. Majority of the certified nurse assistant are immigrants who are dedicated, committed and ready to do their best.Most of them are not around to blow their horns but are there to serve and take care of their families in USA and abroad.

Certified nursing assistant will work under the supervision of a Registered nurses or LVN.

FUNCTIONS OF THE CERTIFIED NURSE ASSISTANT.

  1. Check for vital sign such as take temperature, blood pressure, count radial pulse and respiration(not in all facilities)
  2. Assist with patients feeding sitting patient in upright position to prevent aspiration.
  3. Assist with activities of daily living such as bathing, personal hygiene, dressing up patients with clean gowns.
  4. Assist with weighing patients(Height and weight)and repositioning frequently for comfort and pressure redistribution with another nurse.
  5. Assist patients with ambulation and help with wheeling patients to their( family )car upon discharge home.
  6. Provide companionship to a lonely person.
  7. Assist with bathroom, bedpans and urinal.
  8. Assist patients with intake and output measurements.
  9. As part of the healthcare team, the CNA interact with the Registered nurses, LVN ,managers and all the members of the healthcare medical team.
  10. Compliance to the rules and regulations of the institutions where they work.
  11. Facilitate the care of their patients with honesty ,respect and compassion .(Don’t claim to clean a patient whereas patient is laying on his or her stool -bowel movements).
  12. Keep patient environment healthy, clean and sanitized.Bedside table clean and organize.
  13. Used as sitters to take care of confused patients and prevent falls in the hospitals.
  14. Follow your facility policy and procedures for certified nursing assistant.

DOCUMENTATION OF INTAKE AND OUTPUT. NURSING ( IN MY PERSPECTIVE)

WHY IS INTAKE AND OUTPUT IMPORTANT?.

1.For accurate measurements of critically ill patients.

2.Adequate record of incontinent patients.

3.Prevent infection in patients with pressure ulcers.

4.To monitor for renal patients.

4.Monitor intake and output of cardiology patients for example CHF( Congestive heart failure)

5.Monitor for urine concentration and consistency,urinary retention. Follow up with HOUDINl FOLEY CATHETER PROTOCOLS.

6.Compare intake with the output.

7.Hospice patients no urine output or very low output is an indication that death is imminent.

Documentation of accurate intake and output is very important. Without adequate documentation of intake and output the doctor will have difficulty in knowing if the patient is drinking,eating or not eating,urinating or not urinating. Even though laboratory is a good indicator but please document intake and output accurately.

Some nursing assistant will give a false intake and output because they have no records. Her record of patient vital signs were wrong and I &0 was equally wrong. Monitor it very well.Once in awhile you will work with the best CNA.If your CNA gives wrong intake and output and you (Registered nurse) document that,you will be in trouble not the CNA.At least eyeball the urinal or Foley catheter each time that you are in patient room. Record immediately after measurements so that you do not forget. Place the intake and output sheet in a designated area.

NB: As soon as the doctor orders that patient intake and output should be measured. The patient, the family members, nursing assistant and caregiver should be informed that anything that goes into the patient should be measured and anything that goes out of the patient should be measured.

If patient is on fluid restriction follow the guidelines. Because of inaccuracies in intake and output measurements, daily weight done at the same time every day will offer more authentic fluid balance status. Laboratory tests (complete blood count, serum electrolytes, patient urine pH,specific gravity,and arterial blood gas )will also help to determine whether there are electrolytes ,fluids and acid based balance.

Why is this important (in a nutshell)

1.Comparison of the intake and output because if what came out is much more than what patient takes in. Then patient is in trouble for FLUID VOLUME DEFICITS.

2. Urine concentration and Volume. Measure with the measuring tools of fluid losses ,all fluid taken in. urine, loss from skin,lungs, gastric,,blood loss.

High specific gravity with a low urine volume means fluid volume deficit.But a low urine volume and a low specific gravity means Renal disease. Diabetic patients will have high urine volume, also patients on high protein tube feedings and fever.Rapid changes in weight reflect on urine output.A rapid difference in weight will likely reflect on the body fluid volume.

3. Skin Turgor: Pinch the skin and release check for skin Turgor. In a patient with a volume deficits ,skin will take its time slowly to return. But if there is no volume deficits when you pinch and release the skin will quickly return to its normal level. Remember that there is reduced skin Turgor in people over 55years and up.Why?.This is due to reduced in skin elasticity.

NB: Severe malnourishment especially in infants can cause depressed skin Turgor even when there is no fluid depletion.

4.Dry mouth: One of the side effects of fluid volume deficits is dry mouth or breathing through the mouth. Dryness of where the gum and the check meet is indicative of fluid volume deficits. There are other factors such neuromuscular irritability ,neck veins and central venous pressure (CVP)

CASE SCENARIO NUMBER 1.

An eighty years old female with stage 111 coccyx pressure ulcer, she is incontinent alert and oriented ×2.Braden scale 11.This patient urine must be monitored .How do you monitor her urine ,you place the female urinal(PUREWICK)in her,and you measure every 4hours. Purewick is very good when done right and you connect to suction. (READ ABOUT FEMALE URINAL)You don’t need doctor orders for that.Your patient is clean and free from INFECTION because if the intake and output are not monitored, patient urine keep going into her wound can result in infection which leads to sudden Septic shock. If there is no output notify the doctor immediately.

CASE SCENARIO NUMBER 2.

You received a patient with Brain injury patient is alert and oriented × 2. He is recovering very slowly from head trauma due to fall . You received report from previous shift RN who told you that patient is voding well.You came in to check his vital signs. And patient said to you repeatedly I need to peep,you placed urinal and encouraged him to void.He kept saying the same thing again, I need to peep.You call the doctor. The doctor orders straight catheter now and every 6hours if patient did not void after the third straight catheter leave catheter in place. Bladder scan before each straight catheter if greater than 250ml straight cath. The nurse Bladder scanned, urine greater than 900ml ,straight catheter done over 1000cc of dark amber concentrated urine. Documented and the doctor notified .

CASE SCENARIO NUMBER 3.DIFFICULT PATIENT (Night shift)

You have a difficult patient that feels privileged and doesn’t want to be disturbed from 12midght till 7am.You came at midnight, he refused to talk to you, and refused his midnight vital sign. You asked him if he voided he lied and said yes,you asked how much ,he said 400cc.And at 4am you came and asked him if he voided,he lied again and said yes.

At 07:30am during report he told dayshift RN that he has not voided all night.Yes once in a while you will meet people like that. Don’t argue with patient, simply call and notify the doctor and get order for straight catheter and document your findings notify the day shift so that they can straight catheter the patient.I have refused to communicate with the nurses at night as a patient because I felt that they disturb too much whereas they were only during their job.I voided and recorded it in a piece of paper for them.The nurse did not like it because I am not supposed to get up. When I became a nurse I realized my self centered attitude. I just had a baby and I needed all my rest since I had nobody to help me after hospitalization at home. No allow nurses to do their job. Their jobs are not easy at all.

WHAT IS BURN?.(NURSING)HOW MANY TYPES OF BURNS.

A burn can be simply described as the destruction of the tissue from excessive exposure to flame, chemical, radioactive agent, electricity, or thermal.That is when an area of the body suck up so much heat that it force the skin to dispel. The dermis and epidermis can be destroyed.

What causes burn?.

A burn is usually caused by fire.It can also be caused by hot solids,hot liquids, electricity, or radiation. Burns are classified as first degree burns, second degree burns, third degree burns and fourth degree. The fourth degree is life- threatening and the most severe and deepest burns.But in Medical profession burns are categorized as full thickness and partial thickness. An average exposure of burn of 130degree in three seconds can result in third degree burns. The electrical burns are difficult to define because they causes damage beneath the skin (that is internal injuries).

Other types of burns are friction burns,cold burns etc.

Minor burns can be treated at home but other severe burns that causes damage to the skin should be treated in hospitals in burn unit. Each facility have burn unit. They understand burns and stabilize the patients before transferring to regular floor.

First Degree burns are superficial. This include mild sunburn. It is painful and the skin color changes to pink depending on skin tone. In this case scenario only part of the dermis is destroyed. No possibility of scaring.

Second Degree burns also known as partial thickness,most of the time moist blisters will develop. Skin surface will turn from pink to red.The cause is usually from hot liquids, solids, chemicals or flames.

Third degree burns or full thickness burns can result from electricity, hot flames, chemicals,hot liquids or solid.They required skingrafting.There is no pain because the nerves endings are dead.Skin surface is dry and leathery.

Fourth degree burns will destroy all the layers of your skin.This is life threatening ,most layers of the skin,joints and bone may be affected.

Burns can lead to so many complications which include infection, joint problems, difficulty with recovery, bone problems. Sterile dressing change and keeping the skin clean is very important. Review burns in details.

Questions.

1.How many types of burns?.

A.Only one type.

B.Burn is a burn.

C. Three types of burns.

D.There are four types of burns.

Correct answer D.

2.Mr Lopez came to the hospital after he sustains burns. He develop a blister, what category of burns is that?.

A.Second degree burns.

B.First Degree burns.

C.Third degree burns.

D.Fourth Degree burns.

Correct answer A.

Questions/Answers/Rationale on Surgery. (Nursing)

Surgery is always a very difficult and stressful situations for patients and families. Creating a physical and psychological problems for patients and families. Providing support is always important, listen to their fear and anxiety. Do your best without jeopardizing their concerns.

The time before surgery is called PERIOPERATIVE PERIOD.

The time in the surgery is called INTRAOPERATIVE(from the time in operating room until after surgery and transported out of operation room)And the time after surgery is called POSTOPERATIVE(from recovery to the floor)Postoperative teaching continues. So it is divided into three phases.There are patient teaching in each phase.

Patient will agree to surgery and sign the consent after the doctor has explained the surgical intervention to patient.

Anesthesia is general or local(regional anesthesia)

(1).An older adult had a surgical intervention. Which action if taken by the nurse demonstrate understanding of normal physiological changes of older adult.

(A).Encourage patient to eat three balanced meal a day.

(B).Monitor vital signs Q4hours.

(C).Turn ,reposition, cough and deep breath every 4hours.Use incentive Spirometry.

(D). Monitor intake and output.

Correct answer C.

Rationale: Having the patient to turn, cough and deep breathing every 4 hours will help to prevent increased risk of respiratory complications including pneumonia and atelectasis.The use of incentive Spirometry inflates alveoli and promotes venous return. It is done 10 times while awake for the first 5 days postoperatively .

(2). Jenifer is scheduled for surgery but she is so worried and afraid. She said tell me daughter that I love her.But nurse what if I did not make it alive with this surgery?. What will be the best response for this patient by her nurse.

A.Tell me how you are feeling. Let us talk about how are are feeling.

B. Your doctor is a miracle worker. So don’t worry or be afraid.

C. My grandmother is 98years old.She woke up from surgery and you are only 45years old.

D.You will be glad that you did this surgery. What kind of insurance do you have?.

Correct answer A.

Rationale: It is therapeutic to allow the patient to talk about her fears and feelings. It is important to understand patient concerns and fears,and to provide correct information and emotional support.

(3).One of the common symptoms of postoperative discomfort is gas pain.What will be the best action taken by the nurse to help patient relieve gas pains?.

(A).Encourage early and frequent ambulation.

(B).Patient to call frequently for pain medication.

(C).Maintain normal vital signs.

(D). Encourage adequate fluid intake.

Correct answer A.

Rationale: Frequent ambulation is necessary because it stimulates peristalsis activity and relieves gas pain.

(4).Bowel elimination is a natural process in which the body excretes the waste products of digestion.

(A) This is essential component of healthy body function.

(B).Excretion is bad for the body.

(C). Elimination is discrimination.

(D).All of the above.

Correct answer A.

Rationale: A is the correct answer B,C,D are all wrong. Problem with the bowel elimination will affect the electrolytes, nutrition and fluid in the body.

(5).What food has a laxative effect.

(A).Chicken and rice.

(B).Cheese.

(C). Prunes.

(D).Hamburger with fries.

Correct answer C.

Rationale: Prunes are natural remedies for constipation.

(6).The PCP known as patient controlled analgesia pump allows the postoperative patient to do what?.

(A). Allow the patient to administer his or her own analgesic.

(B ) Be free and happy without pain.

(C).Happy time patient can over medicate his or herself as much as possible.

(D).Get it when you can.

Correct answer A.

Rationale:Patient controlled analgesics pump will allow the patient to administer his or her own medication. It does not allow the patient to have unlimited access to the narcotic. B,C,D are all wrong.

7. After a car accident mrs Rabbit has a ruptured spleen .The doctor performed a major emergency surgery why?.

A.The surgery must be done immediately to preserve the patient life. This surgery involves a major organ, has tendency for complications and must be done in hospital settings.

(B).Doctors like money. Get money from them.

(C).Patient don’t need that surgery.

(D).It should be a minor surgery.

Correct answer A.

Rationale: A is correct, the spleen is a very important organ in the body. It keeps blood circulation in your body clean and functioning. It will recognize old or damaged blood in your body and remove them. B,C,and D are all wrong.

RESPIRATOR MEDICAL EVALUATION QUESTIONNAIRE.

What is the purpose?.

A respirator Medical evaluation is for a fitted test done to make sure that the mask that you wear to do your job fit your face and well sealed properly around your nose and mouth.Several exercises are done for safety reasons making sure that you are well fitted with the correct mask.All respirator mask including N95 are tested.Be Complaint with OSHA GUIDELINES.

The purpose is to see if you have a Medical condition that can prevent you from wearing a respirator. So medical professionals are tested every year due to the nature of their jobs.Or when there is new model or size of respirator has changed .If you fail test additional questions or more testing are required until you pass the fitness test.

If you have a medical condition don’t hesitate to let them know and it will remain confidential. I believe that you will be provided with alternative that you can use for your safety, patients and others. The test takes a few minutes. Most people don’t like the test but it got to be done for you to continue working.

GIVING GRATITUDE TO PARENTS AND TEACHERS.(Elementary,High School,College Professors @ USC . )

It takes a village to raise a child. It surely does because parents and grandparents then the community which include the elementary school, high school and the university. For me it took more than one village to raise me.Anyway that is another subject matter. Right now my focus is on giving gratitude to all those that made my journey possible. So to all of my parents, teachers, and professors thank you very much. So thank you for the nutrition, the warmth, the bonding, the curdled, doctors visits.The physical, emotional and all the supports.

Birth: I was a full term baby ,delivered after 39weeks ,weighed 5lbs 9oz.It was normal delivery I was told.I was born the day that my age mates were born.It was in a small hospital were delivery was done mainly by midwives. Took me home, I was always sick even with good nutrients. I was nicknamed Ogbanje.In yoruba they call it Abiku.

Nutrition: I was fed every two hours with breast milk and bottled milk alternatively and water.So I thank you.I was curdled, kept warm and my diapers changed. I wish I was able to show my gratitude to my parents when they were alive.I was also taken to the hospital for ear infection Argument liquid ordered and given to me.

Baby starts to walk around lots of support given. My princess is walking around, walk, walk. Remember every child is the parents prince or princess.

Elementary School Teachers: One of my elementary school teacher stood out. He was very good .He flogged me like crazy. If he was in USA he would have been sued for child abuse. But in underdeveloped countries they are held as heroes.He challenged me with mathematics and really helped me in learning mathematics. So when I came to USA I had A in Statistics and A in Algebra mathematics. I thank you late teacher Azor.

Secondary School Teachers: I send my gratitude to all of you.With good foundation in elementary school, secondary school was not bad.I remembered my literature teacher,he was wonderful. He taught me how to finish a novel in two days no matter the size of the novel. When we are going to start a new novel. He starts the song that went like this cridim,cridim,cridim.I didn’t know the meaning of that.

But that really got me tuned in. I remembered that I read ” BEYOND PARDON ” by Bertha M. Clay (391 pages)in two days. It was in the olden days when civilization slapped us on the face.

University of Southern California here I come.

USC Education:I am very grateful to all my professors at the university of Southern California thank you.Their program was wonderful, I learnt so much.

Clinical rotations:Most of our clinical rotations were done in reputable hospitals and clinics such Cedars Sinai hospital, Good Samaritan hospital to mention but a few. It was the best program in those days in the 90s.It was very hectic but really worth every bit of it. I love the dissection, we hard to dissect a cat for the practicum in the community college. It was so perfect.Buy you book on dissection and practice before your class and know every part of it because you will be tested. The practical was great. Thank you again and again.

Research: We did some research studies. It was not intensive but it surely took us to the right direction.

Also I am grateful to my Psychiatric professor.She was the best,very caring and compassionate.

GIVING GRATITUDE.

  1. FREE AIR: We are not as free as the air we breathe because we are constantly in chain. But I want to give gratitude to my maker .For my life and the free air that I breathe.( No charges) For making the most valuable thing like the air we breathe FREE. Can you imagine if we have to pay for the AIR that we breathe.””The insurance companies and the doctors would have step in to place charges.”Imagination is most important than knowledge. Knowledge is limited.But imagination encircles the whole wide world”””(Albert Einstein) just like COVID19 PANDEMIC that encircled the world.So many have lost their lives from COVID19 PANDEMIC . Snatched away AIR from over 500,000 people who died.Without adequate oxygenation of the body, and insufficient oxygen to the brain, death is eminent.

2.LIVE :Airway, breathing and circulation.Most of the time,most of us don’t stop to think and reflect. We only stop when we are too old or are forced to stop.So today I encourage you to stop and look around to appreciate what you have. We always complain of what we don’t have but never complain of what we have.Mahatma Gandhi once said,””Live simply so that others can simply live”.So have you appreciated yourself, the people around you, the birds, trees today?.When was your last annual physical examination?.

3.COMMUNICATE: All the organs of the body communicate with each.The kidney talk to the heart and the heart talk to the kidney. If your lungs is not getting enough blood, it will signal the brain and the brain logs off in 4 to 6minutes. So communicate and appreciate all these miracles in your body. Don’t take them for granted.

4.HEALTH:Have you thought of how the birds and the trees survive?.Have you stop and think about why you are so nauseated?.Why are you anemic?.Why is your abdomen distended?Afterall you are not pregnant. So many of my colleagues ignored warnings signs kept working overtime, only to find out later that they have gastric cancer or breast cancer. Stop and listen to your body. After their diagnosis they were ready to stop and listen but it was too little too late.

5.DON’T WORRY ABOUT THE FUTURE:Tomorrow is pregnant it can give birth to a boy or a girl. You cannot change that.In 2019 we never thought about COVID19 PANDEMIC but 2020,it came and created a devastating blow to so many superpower nations. Be consistent, focus and honest to yourself. The future will take care of itself. Marcus Aurelius once said, “Never let the future disturb you.,you will meet it,if you have to, with the same weapons of reason which currently prepares you against your presence”. Dream big ,stop and acknowledge your surroundings because “the future belongs to those who believe in the beauty of their dreams”. – Eleanor Roosevelt.

6.FORTY SIX: Be grateful and give gratitude for your life. Who knew that our current President will be the 46 President and his first son departed the world at the age of 46years. Tomorrow like I said is a pregnant woman. (Pregnant mama)March on fully loaded with gratitude and appreciation. “And behold, I come quickly, and reward is with me,to give every man to his work. I am the Alpha and Omega,the beginning and end, the first and the last”- Revelation 20:12- 13.

So What Are You Grateful For Today?.

I am grateful for the COVID19 vaccine that I got. Grateful to those who make the vaccine possible.The doctors, scientists, researchers, the Federal government current and previous. I am grateful for the opportunity to get the Pfizer vaccine, grateful that it was painless.

HEALTH PROMOTION AND STRESS REDUCTION AT WORK.

The question that arises is how do you promote good health and reduce stress at work?.

It can be done by the following:

1.Education on the importance of smoking cessation at work.Discourage smoking, limit smoking breaks and smoking designated areas.

2.Nutrition: Encourage balanced nutrition for individuals. Employee canteens must have balanced meal. So the food in the cafeteria and the vending machines should be healthy.

3.Limit stress: Stress can be defined as emotional and physical reactions to threatening behavior from management or the environment. Stress can be very straining to the body. Each individual differences in handling will determine its impact. It is important for the establishment to take preventive measures to prevent the accumulation of stress on individual or the company which will not be cost effective. Continuous stress for a long time can lead to counterproductive behavior, health problems, burnout, poor performance ,tardiness, large turnover rate, and drug abuse. And possible leaving the job for good rather commit suicide because of the job.

4.Back care: It is very important to educate the employees on back care.There are various training programs for employees on back care and how to lift patients. There are many devices now available in hospitals to help nurses and physical therapist take care of their patients.

5.Weight reduction: Facilities should encourage and make provision for weight reduction. Employees are educated on balanced meal plans and the importance of remaining physically active.

6. Conflict resolution:Management should encourage teamwork minimize conflict. Are there role ambiguity or role conflict or role overloaded. Employers should pay attention to minimize stressful situations.

Other factors are personal attempt to control the problem, aggressiveness, impatience, development of self awareness of the job,increase employee participation, job training, skills improvement,improve teamwork, better communication, and health promotion and disease prevention.

HEALTH FAIR,CARING AND COMPASSION.

Health fair here we come.We levied ourselves and made some contributions bought supplies that we needed such as

Accucheck machines,

Blood pressure equipments,

Stethoscopes,

snacks, gloves and some vitamins

In December of 2006 our union decided to have health fair for indigenous people of the rural community in Nigeria. It was a great experience.

We have doctors, nurses and other professionals. It was a two days health fair. Some took their family to show them what Nigeria look like.We flew KLM to Amsterdam then to Abuja. From the Abuja international airport we drove to Nicon Noga Hilton Hotel Abuja,Nigeria. The kids could not believe their eyes. “”Mom this is like USA”.Are you sure that this is Nigeria?.I replied it is Abuja in Nigeria.

It is very interesting and beautiful but I cannot afford to pay for it.It was more expensive than some hotels in USA.We went for a cheaper hotel my children didn’t enjoy it.It was not bad.It cost less than $60.00per night. I like it but I would have preferred nicon Noga Hilton hotel Abuja,Nigeria. Next time that is where I hope to be.

Two days later we took the big bus to the village for the health fair.We stayed in a hotel. Arrangement was made from here through someone that is familiar with the area.

The Health Fair: It went well .The diagnosis were done by the doctors and recommendations were made.

Physical Assessment.

Vital signs done.

Patients Teaching included:

1.Nutrition assessment.

2. Diabetes management. Blood sugar check and complications of diabetes.

3.Hypertension: Teaching on high blood pressure and referrals made.

Snacks distributed and drinks given to all the attendees. Most of the people were very happy. We paid some of their hospital expenses. And the health fair was free.There were noncompliance people that ignored our warnings.