Memory is the power or process of remembering what has been learned. It can be bunches of information that you’ve learned from school, internet, and experiences, either good or bad. Memory is like a very big storage in our head. You yourself will be shocked from the things that are in store with it. When we remember or recall something, our memory is involved to it. Our memory is an essential in our daily lives, because once our memory failed to function, we will experience difficulties in remembering faces, numbers, and even directions. Won’t it be a burden for us and for others too?

As we get older, the capability of our memory fades away. As a human being, our memory will be needed for a lifetime in every simple ways we do. Our memory is very important in order for us to get into school, university, and get a career or profession that we want. The job of our memory does in remembering wholly depends on our actions. Daily intake of healthy foods will make our memory function properly. We don’t just eat to fill our stomach. We must consider the nutrients that we get from it to become physically healthy, and mind healthy. Food isn’t just enough. It requires teamwork with vitamins that will further make us healthy. Memory also needs energy to work. Aside from food, enough sleep after a long tiring day is a must. Just like our body, it also gets tired if overused. Physical and mental exercises also contribute to a good memory. Our memory also needs to be trained so it will be in good condition. We socialize every day, every hour, and every minute. Having an active interaction with the same or opposite gender will pro-long the stored memories in our mind.

Memory is very important yet, losing it is common these days. Humans are careless about their food intake. They just eat whatever they want or whatever satisfies their tummies. They’ll stay in front of computer and manipulate their accounts in social networking sites for such a long time and forget to have an active lifestyle outside. Humans don’t mind if they sleep or not. Some don’t like analyzing or mind challenge because they are too bored to think. They don’t socialize that much because it will only be a hindrance on what they do. If this cycle continues, it wouldn’t be shocking that most of us can’t remember a single thing anymore. Before it become worse, we must enhance our memory as early as we can. Enhancing it will be a good prevention for memory loss. It will benefit not just us, but also the other people around us. Enhancing our memory will help us in every simple way as much as possible.

Memory enhancement might not matter now, but we will realize later that it is a great investment for future. Considering the factors of memory enhancement like eating healthy foods and regular intake of vitamins, doing exercises, implementing good sleeping habits, and even socializing will result to a healthy remembering. When we take an examination, we think carefully of the answers. We know the answer a while ago but we forgot it just now. We need to take down notes or a memo but the pen went missing. We keep looking for it but it is just behind our ear. Isn’t it frustrating to experience these situations? It won’t be impossible to happen if we don’t enhance our memory, now.

Review of Literature

Memory plays an important part in our daily lives. It is involve in remembering faces, numbers, directions, facts and a lot of information we gather. Just like our body, our memory also have needs in order to live and do its purpose. Memory loss is so common these days. In order to improve our memory’s performance, we must consider taking care of our health, implementing good habits and often socializing. If it is used, it will continue to improve throughout your lifetime (Buzan T., 1991).

According to (Eastway R., 1991), one thing that is fundamental to a good memory is the health of the brain in which it sits. If our body needs good diet, so does our brain. There are kinds of food that will help us in improving our memory. One example of that is fish. Oily fish is the top scorer in foods that contain Omega-3. Fish also contains a fatty acid called DHA, which increases the levels of acetylcholine, a vital carrier involved in the memory’s function. Another one is food that contains anti-oxidants. Some people are unaware of what they take. There are some toxics that we unconsciously eat that can cause fundamental damage in our bodies, including our brain which is mainly responsible for our memory. Carbohydrates from bread and cereals can help to improve alertness, and the ability to form new memories and to retrieve the old ones. We are physiology different from each other, and what benefits in one person will not necessarily be the same for each one of us. Fish, anti-oxidants and carbohydrates will boost an average memory performance. The newest or the modern way to enhance our memory nowadays is taking up drugs. It can help but we must be careful in differentiating memory boosting drug and drugs that don’t retrieve old memories.

If we were really good thinkers, (


Gordon B. & Berger L., 2003) states that we won’t neglect mental workouts. Jigsaws, crosswords and Sudoku are can be seen in the newspaper every day to entertain us. Behind those sheets are ways for an alert and smart mind. Regular mental exercises build ups the brain, same as how physical exercise builds muscles and strengthens the heart. Treating your body well can enhance your ability to process and recall information. Physical exercises reduce the risks of memory loss. Try to give your memory a workout, training it to keep it sharp (Harp T., 2003). After a long tiring day in school or office, a sleep is a must. When we sleep, we boost the capability of our brain in problem-solving and critical thinking skills. It is also an essential in learning new information.

We find it hard to remember something especially if we need to input too much information. Socializing can be one of the simplest memory techniques. According to Oscar Ybarra, a psychologist at the U-M Institute for Social Research (ISR), socializing was just as effective as more traditional kinds of mental exercise in

improving memory

and intellectual performance. Interacting with others can sharpen your memory because social interaction itself is challenging already because you have to deal with variety of people. If socializing isn’t your habit, it can’t affect you now but it will in the future.

One of the horrors of growing older is the certainty that you will lose memory and that the loss of vocabulary or incident or imagery is going to diminish your imagination (Eastway R., 2004). Memory is like a shadow. It will be always after us, but as soon as the darkness rose, it will fade away. Memory is a lifetime machine. It will continue to work for a lifetime as long as we take good care of it. Just like an ordinary machine, it needs to be maintained to function properly.

According to Matlin (2005), memory is the process of maintaining information over time

.

“Memory” came from the Latin word memorariandmemor, meaning “mindful” or “remembering”. Memory is our ability to encode, store, and recall information or past experiences with the help of the human brain. It is like a filing cabinet with a limitless capacity and speed. The work that our memory does widely depends on the owner: the humans. Scientific research has shown that the human brain starts remembering things 20 weeks after conception. In order to form new memories, information must be changed into a usable form through the process known asencoding

.

Once the information has been successfully encoded, it must bestoredin memory for later use. Most of this stored memory lies out of our awareness most of the time, except when we really need to use it. The retrieval orrecalling process allows us to bring stored memories into conscious awareness and use it in the present.

Memory relies largely on the cells in our brain, and as we get older, brain cells (neurons) die, and don’t get replaced. The number of connections between the calls (synapses) also tends to disappear with age. We typically have 100 billion neurons at the age of eighteen, but then proceed to lose them every day thereafter. Forgetting is a normal and inevitable part of the way that the brain works at any age. One benefit of forgetting is that it helps to remove unnecessary information from our minds. The brain is good at knowing how to forget information that it no longer needs. It is hard to know which would be worse- never being able to remember, or never being able to forget. Forgetting may be a natural part of how the brain works, but not all forgetting is beneficial. It’s frustrating not being able to remember all those things that you actually do want to remember. Forgetting happens most of the time for office workers, students, teacher or anyone, even those who don’t have a profession. No one wants it, but just like what is stated above, it is inevitable. Many people wish to improve it, but some of us become unconsciously careless. One thing that is important to a good memory is the health of the brain in which it sits. We want to keep our memory alive but we are the ones who are killing it. There are some factors on killing your memory. Trauma to the head can permanently damage brain cells. Players that involve their heads on a physical game are more prone to brain diseases. Another step is intoxication. Alcohol is the most available substance for this. It slows down the brain’s function when it is in the blood. The third way to decline the brain is to ignore it. The phrase ‘use it or lose it’ really does apply to the brain. Lastly, the food that you eat is very important for the brain. A diet of burgers and highly salted chips is probably the best combination for brain decay, because it avoids feeding the brain the nutrients that help it to function.

Memory improvement is significant on someone’s lifetime. What’s the use of a happy event if you can’t recall? What’s the use of reviewing for exams if you have poor memory? As we grow older, we worry about how we will remember a particular thing, if there’s something we can do to prolong it. Well, worry no more! There are plenty of things we can do to improve our ability to remember things, but of course it requires effort from the people who wants it. There are some particular foods and vitamins that are helpful for memory improvement. The nutrients we get from it are responsible for the health of our brain. Exercises, physical or mental, will train our memory to be sharp. Lastly, as we socialize, the effect it gives in our memory is positive. Most of it was done in our daily lives. Enhancing our memory is very simple right?

Eating well is good for your physical as well as your mental health. The brain requires nutrients just like your heart, lungs or muscles do. Like everything else in your body, the brain cannot work without energy. But which foods are particularly important to keep our memory happy and healthy? There’s no doubt that diet plays a major role in brain health. Omega-3 fats that can be found on oily fish as DHA (if you have higher levels of DHA in the blood, then the brain will operate more efficiently), which enables the body to use it easily. If you’re allergic to fish, you don’t need to worry because there’s a good alternative like linseed (flaxseed) oil, soya bean oil, pumpkin seeds, walnut oil and soya beans. They are good for healthy brain function, the heart, joints and general well-being. Nuts and seeds are also on the list. They all contain another important antioxidant: vitamin E. In one study, researchers found that people who consumed moderate amounts vitamin E—from food, not supplements—lowered their risk of Alzheimer’s Disease by 67%. Here’s for all the sweet lovers- chocolate. Sweeten your brain-boosting diet with the dark kind (at least 70% cocoa); it contains flavonoids, another class of antioxidants that some research links to brain health. Let us all become healthy by eating veggies. Vegetables don’t just help our body to become healthy, but also our minds. Getting adequate amount of vegetables, especially broccoli, cabbage and dark leafy greens, may help improve memory. Can your diet make you smarter? You bet. Research shows that what you eat is one of the most powerful influences on everyday brain skills. So why don’t we try switching into a good diet? You’ve become healthy not just by body, but also by mind.

Some people wonder if a tablet can really help boost a memory. Whether you suffer from Alzheimer’s disease or you just have memory problems, it’s been said that certain vitamins can help or prevent memory loss. There is no miracle cure for a bad memory, but there is still a way to improve it while it’s not yet bad. Research shows that B vitamins improve memory by creating a protective shield for the neurons in the brain. B vitamins break down homocysteine, which is an amino acid that poisons nerve cells. This vitamin also aid in the production of red blood cells, which carry oxygen, an important brain nutrient. Known for its ability to cross the blood-brain barrier, this amino acid, Acetyl L-Carnatine (also known as ALCAR) helps with energy production necessary for optimal brain function. Another thing is Gingko Biloba. This herb has been shown to improve blood flow to your organs including your brain. Research concerning its effectiveness is mixed, though some studies indicated it may improve concentration. Unfortunately, much of the evidence for the popular cures isn’t very strong.

Leaving the foods and vitamins aside, let’s check how our habits can help nor destroy our memory condition. Physical fitness and mental fitness go well together. People who get regular exercise also tend to stay mentally sharp in their 70s and 80s. A study from Case Western Reserve University School of Medicine concluded that individuals who exercised – by walking or by engaging in physically active hobbies had a lower risk for Alzheimer’s disease. So experts recommend that you build physical activity into your daily routine. Exercising in the morning before going to work not only spikes brain activity and prepares you for mental stresses for the rest of the day, but also produces increase of retention of new information, and better reaction to complex situations. Let’s just consider exercise as a drug. It can be good if is intake moderately. Most of the people believe that memory fades with age. Well, newsflash: it’s just partly true. Memory fades away because as we age, because we lower the activities in involving it. Increase our brainpower by doing mental exercises. Crosswords and Sudoku and variety of board games are proven to improve our memory’s condition. As we play these games, we’re like settling our memory in a battle field to train, and be strong. As long as we live, we must not stop learning. Although people vary widely in their individual sleep needs, research suggests that six to eight hours of sleep a night is ideal to improve our memory. Our memory gets tired too. Findings suggest that getting an average amount of sleep, may help maintain memory in later life. Both too much and too little aren’t good. Aim for the right amount.

Social interaction is a key ingredient—along with proper nutrition,

physical exercise

,

brain training

, and

lifelong learning

—in the recipe for cognitive sharpness. Socializing can be a challenge for people who live alone, but everyone must have a social life no matter where they live or how they feel. You don’t have to have numerous social events on the calendar or go to a party just to socialize. Simply talking to them is. Being with other people is good for your health and also for your memory. We’re not meant to survive alone. Relationships stimulate our brains—in fact, interacting with others may be the best kind of brain exercise. In one recent study from the Harvard School of Public Health, for example, researchers found that people with the most active social lives had the slowest rate of memory decline. This won’t be a hard thing to do since we’re talking in our everyday lives. Isn’t it simple?

“Explain And Evaluate Whether Or Not Infection Control Can Ever Be Manageable”

This assignment will explore the importance of infection control within nursing. In order to do this, it is first necessary to determine the term ‘infection’ and ‘infection control’. Then a discussion of the chain of infection will be highlighted, making links and referring back to recent clinical practice. There are six links to the chain of infection; the infectious agent, the reservoir (the altering environment), portals of exit (wounds and bodily fluids), means of transmission (different surfaces and airborne), the portal of entry (wounds) and the susceptible host of infection (Horton & Parker, 2006). If at any stage, the chain of infection is interrupted by an opposing agent such as alcohol hang gel, the chain will become broken.

“Infection occurs when an infectious agent multiplies within the body tissues causing adverse affects” (Walsh, 1997, p.102). When an individual has an infection, micro-organisms enter the body through a susceptible host, meaning that the infection will manifest within the body.

“A pathogen is a disease producing microorganism. These organisms which cause infections in humans include bacteria, viruses, fungi, protozoa and parasitic worms” (Brettle and Thompsom, 198, p6).

A human body continuously functions throughout life. Unfortunately, it is often only noticed when it fails. The defences start at the point of contact with our environment through which organisms may invade, for example the skin. Perry states that “The first line of the immune response is protection against invasion from micro-organisms. This is achieved by the skin, mucous membranes, secretions and excretions” (Perry, 2007, p 33).. These microorganisms must overcome any resistance mounted by the host’s defences in order for them to multiply and develop. “The human body is protected from infection by an immune system that have non-specific responses, which includes a number of mechanisms that provide general protection against infection” (Perry, 2007, p 32).

Infection control is “evolving rapidly, with the quality as the main focus of the service”. (Horton and Parker,2001, p 6). In light of this, it is also important to understand how “prevention and control of infections are important concerns for all types of healthcare agencies” (Craven & Hirnle, 2009, p 465). As health care professionals, working within environments which are highly prone to infectious diseases makes us highly sustainable to contracting a number of illnesses. Whilst on clinical placements, it is important that all ongoing policies and procedures are adhered to in order to minimise the number of infectious agents contracted by patients and health care workers. With a current epidemic outbreak of the influenza A H1N1 bug, also publically known as ‘swine flu’, the department of health established a campaign called ‘catch it, bin it, kill it’. It is a campaign which aims to prevent the spread of infection by making individuals aware of what to do if they cough or sneeze in public “Always ensure everyone washes their hands regularly with soap and water, clean surfaces regularly to get rid of germs, use tissues to cover your mouth and nose when you cough or sneeze and place used tissues in a bin as soon as possible” (NHS Choices, 2009).

Perry stated that “Standard infection control principles should be applied to the care of all patients, regardless of their infection status. These principles are aimed at preventing infection both to patients and to health care workers” (Perry, 2007, p66). A way this could be successfully achieved is to use universal precautions within health care settings.

There is a possibility to intervene and break the infection cycle through infection control procedures and lessen the likelihood of a patient’s susceptibility. It is cited that “a thorough understanding of the chain of infection helps health care professionals to deliver safe care and in turn enables appropriate measures to be taken in order to prevent transmission of infection” (Wilson, 2001, p70).

As previously stated there are six links to the chain of infection. The first two, being the infectious agent and the reservoir (the source of organisms) are closely related to each other because depending on what the environment is like, an infectious agent will always be able to survive in such conditions. The next three stages of the chain of infection can also be grouped together; these are the portals of exit (source of exit for the micro-organisms), the means of transmission (how the organism is carried from the portals of exit) and the portal of entry (gaining entrance into the host). An example of these working together within a hospitalised environment would be if a patient sneezed, the organisms would be transported either on hard surfaces or airborne to a patient who has an open wound. The final stage of the chain of infection is the susceptible host (Horton & Parker, 2006). If at any stage, the chain of infection is interrupted by an opposing agent such as alcohol hang gel, the chain will become broken.

To understand the first stage of the cycle, the infectious agent, it is very important to understand about microorganisms, their microbial virulence, their transmissibility, their growth requirement and most importantly, their effects on the human body (Wilson 2001). Bacteria are usually unicellular organisms and can survive for long periods of time in certain environments. Their main responsibility is to reproduce and survive as long as possible. “Viruses are different from any other organisms in that they consist of a core of one type of nucleic acid surrounded by a protein shell called a capsid. Unlike bacteria, they don’t last very long outside of the environment. Once inside the cell, the virus takes over the nuclear control” (Horton & Parker, 2006).Infections develop because microorganisms capable of initiating an infectious reaction have found a favourable host.

After understanding the infectious cycle, the “reservoir” stage occurs. Hospitals are not the only place where groups of susceptible people congregate to receive care. Individuals in places such as nursing homes are equally compromised. Microbes are able to survive in almost every environment, meaning that these microbes can also live on the human body. This section looks at how people conduct their own hygiene routines, the cleanliness and storage of equipment and finally the water used for cleaning. “In order to break the reservoir link, routine cleaning is an integral part of hospital practice and helps to maintain a high standard of care. Not only does this mean routine cleaning of the environment, e.g. patients lockers, beds, baths and showers, but the cleaning, disinfection and sterilization of the hospital equipment” (Wright et al, 1995, cited in Horton and Parker, 2006). Relating this to clinical practice, patients should always try to conduct their own hygiene routines and if unable to, the health care professionals will do so for them. An example of this would be a patient who needed to be shaved. “Assisting your patient with shaving is an important element of caring for an individual’s personal hygiene needs” (Iggulden, 2009, p134).

If there is still no break in the chain at this stage, the chain will progress on to the ‘portals of exit’. Clinical waste could be disposed of in yellow bags, with all sharps disposed in the allocated sharps bin. “Disposal of used sharps in inappropriate places causes risks to others. These sharps should be disposed immediately, without re-sheathing. Once 75% full, these should be closed and secures off “(Wilson, 2001,p42).

The removal of urine, faeces and other bodily fluids also has to be conducted with great care. The use of linen could also cause a potential infection epidemic. Local laundering facilities are often encountered in many community elderly care units and some specialist wards usually for patients own clothes (Horton and Parker, 2006). Relating this to clinical practice, if a patient has a soiled bed, it is important to change and remove all linen appropriately in order to stop the spread of infection. “Every workplace has written policies on all aspects of waste disposal including special waste, segregation of waste and audit trails. A system of colour coding to identify segregation also exists” (Iggulden, 2009,p66).

The state of transmission (also known as direct contact acquired infections) refers to a susceptible host coming into contact with a person’s body surface or fluids who is infected. Some organisms can be transmitted by more than one route, either directly or indirectly. Direct contact involves proximity between the susceptible host and the infected person or a carrier such as touching, kissing or sexual intercourse. The indirect route requires personal contact with an intimate object, such as a contaminated instrument. Contaminated blood, food, water or inanimate objects are vehicle routes of transmission. With the use of alcohol hand gel on entrance into the ward, on walls throughout the hospital, in all of the toilets and shower rooms and at the end of the patients bed, this is one infection control step which most mobile individuals can carry out. There are also posters above every sink demonstrating the appropriate way to wash and dry hands. These posters are also placed throughout the hospital, along with informative leaflets describing all of the different types of infectious diseases that are likely to be contaminated. “In 2004, the NPSA launched the ‘clean your hands’ campaign across England and Wales. This campaign helps provide practical support to health care organisations. It also involves education and development of an organisational culture where individuals take personal responsibility for delivery of safe, clean care”. (Iggulden et al, 2009, p65).

“Hand creams are another way of preventing infection. Frequent hand washing, especially with antiseptic solutions or if hands are not properly dried, can cause damage to the skin. Cracked skin may harbour more bacteria and increase the risk of cross-infection” (Berman et al, 2009,p222).

“Protective clothing is also a key to preventing the spread of infections. Many excretions and secretions of the body are a major source of pathogenic microorganisms associated with hospital acquired infection (urine, faeces, vomit, sputum, saliva, vaginal secretion, semen, blood, blood stained body fluids, tissues and cerebrospinal fluid)” (Perry, 2007, p33). Aprons or gowns should be worn for procedures anticipated to cause significant contamination of skin or clothing with blood or body fluid. “This will protect the skin of the healthcare worker from contamination by potentially infected body fluid and reduce the risk of cross-contamination of microorganisms to other patients on the clothing.” (Wilson, 2001, p142).

Gloves are also vital in order to constrict any infections from spreading. Disposable gloves for direct contact with body fluids and moist body sites provide a reliable method of reducing the acquisition on hands of microorganisms from these sources. “Gloves should be worn for any activity where body fluid may contaminate the hands”. ( Paterson et al, 1991, cited in Walsh 1997, p101). Gloves must always be changed between patients, even if they are being used for routine procedures such as emptying urine drainage bags. “Washing gloves between patients is also not recommended; the gloves may be damaged by the soap solution and if they become punctured unknowingly, may cause body fluid to remain in direct contact with the skin for prolonged periods of time” (Olsen et al,1993 cited in Wilson, 2001, p139).

Another preventative step, although commonly not used within the health care setting, is for individuals to wear masks and eye protection. Close fitting masks are recommended for some aspects of care of patients with open tuberculosis. Eye protection and masks should be worn for any activity where there is risk of bodily fluids splashing into the face. Tolkars et al (1995) found that contact between bloods or other infective fluids and the eyes or mouth of surgical staff occurred in 2% of surgical procedures, particularly orthopaedic and gynaecology (cited in Wilson,2001, p141-42).

In order to avoid these examples being contained by patients, it is sometimes necessary to put the patient into an isolation room. To avoid such contamination, it is absolutely crucial that all equipment is sterilized.

If there is still no break in the chain, the portal of entry stage arises. This is the entry route which organisms find their access into the body. This entrance is often the same as the exit route. Some common entry routes are the urinary, respiratory and gastrointestinal tracts (Taylor et al, p504, 1993).

Intact skin protects tissue from invasion by microorganisms. Damaged skin may become infected superficially by bacteria or fungi and blood borne viruses which may enter the body through damaged skin, hence why cuts on the skins surface need to be covered.

In order to avoid organisms getting into wounds, it is essential that the correct safety equipment is used. (Horton and Parker, 2006). Whilst on a recent placement, a sterile pack including sterilized gloves, scissors and swabs were used to change a head dressing. This was to ensure that no organisms could enter the patient’s most vulnerable sight causing infection.“The susceptibility of the host is influenced by various different factors including normal PH levels of gastric secretions, age, sex, race, hereditary factors, immunization, fatigue and high stress levels’ (Taylor, Ellis et al,1992). Wilson added “the sustainable host can essentially be anyone, depending on their health and well being at that one time, whether they are patients, visitors, other health care professionals, friends or family members. It is also essential as a health care professional, to recognise that certain microbes may not be harmful to a healthy individual, but may overwhelm someone who is unwell and that the susceptibility of the host varies, depending on their immune defences” (Wilson,2001, p65). When a chemotherapy patients has treatment, their immune system lowers, making them more susceptible to infection. The immune system of a baby would be immature of that compared to an adult; similarly, an elderly patient’s immune system would be significantly lower in efficiency. “Adequate nutrition is also essential to encourage rapid wound healing and thereby reduce the possibility of wound infection” (Wilson, 2001, p191). Within a clinical placement, assisting a patient with a good nutritional intake would boost their immune system by giving the body all of the additional vitamins needed to recover from its trauma.

To conclude, everything which was touched upon in the introduction was explored throughout the text, with the main focus of the assignment exploring the chain of infection. I discovered how the six stages of the chain of infection may be applied to individuals who are susceptible to infection. In order for me to do this successfully, I related each of the stages back to clinical practice. This allowed me to develop a greater depth of knowledge as to how infection can be eradicated within hospitalised environments. In clinical areas, cross infection will always be an issue for any hospital, regardless of how many policies and procedures there are in place. It is impossible for any trust to ensure that each individual who walks into a clinical area follows the preventative measures to eradicate infection. Wilson summarises “infection is a common, but largely avoidable complication of healthcare” (Wilson, 2001, p131). With patients, health care workers and domestics all having different levels of knowledge concerning infection control, the way people conduct themselves in certain environments will always differ. Health care workers can ensure they practice professionally, for example partaking in the NHS campaign “Bare below the elbow”, and is good practice to make sure that all workers in hospitals use all forms of prevention such washing their hands correctly, and using alcohol gel.

References:

• A.Berman, C. Jackson, S. Snyder, 2009, Skills in clinical nursing, 6th edition, New Jersey, Pearson Hall
• C.Hirnle, R. Craven, 2009, Fundamentals of nursing, 6th edition, United States, Lippincott Williams and Wilkens
• C. Lillis, P. Lemone, C. Taylor, 1993, fundamentals of nursing the art and science of nursing care, JB Company
• C.Perry, 2007, Infection prevention and control, Oxford, Blackwell
• H. Iggulden, C. MacDonald, K. Staniland, 2009, Clinical skills the essence of caring, London, Open University
• J. Wilson, 2001, Infection control in clinical practice 3rd edition, London, Bailliere Tindall
• L. Parker, R. Horton, 2006, informed infection control practice, London, Churchhill Livingstone
• M. Thompson, R. Brettle, 1984, Infection and communicable disease, London, Heinemann
• M. Walsh, 1997. Watson’s Clinical Nursing and Related Sciences 5th edition. London. Baillere Tindall
• NHS UK [Online] [accessed 08/01/09] world wide web: < http://www.npsa.nhs.uk/cleanyourhands/the-campaign/whoglobalchallenge/>
• NHS CHOICES UK [Online] [accessed 03/08/09] world wide web: < http://www.nhs.uk/AlertsEmergencies/Pages/Pandemicflualert.aspx>

The Art of Midwifery

Midwifery places the woman and the midwife at the centre of midwifery care. It is said that midwifery is an art that uses the heart, the hands and the mind. In relation to working with woman in childbearing this essay will discuss this statement. The essay will look at these three essential elements of midwifery, the heart, the hands and the mind, showing detail of how each are related and the importance of each element when working with women in childbearing. The ‘heart’ looks at the key values of compassion, respect for the women, the baby and oneself, and the importance of women centred care. The ‘hands’ focus on the skills, techniques and therapeutic touch of the midwife and the ‘mind’ highlights reflective and ethical practice, and the knowledge required to practice safely and competently.

The Heart

At the heart of midwifery practice is the relationship between the midwife and the woman. This involves a relationship of trust. The women, relies on the midwife to give her confidence. The midwife is trusted by the woman to know what is best for herself and her body. The midwife benefits the childbearing woman with clinical knowledge, skills and recommendations, forming a relationship of mutual trust and respect (Alef Thorstenson, 2004). The mother and the baby are the central focus for the midwife.

Pelvin (2006) describes the midwife’s role as one of privilege. The intimate relationship between the midwife and the women exists, through a personal and momentous event in the life of a woman. The physiological procedure of birth and the post natal relationship between mother and baby is facilitated by the midwife however the midwife’s influence does not end there, the role attempts to assist the women to have a deeper understanding of herself and of her family relationships. A fundamental value of midwives as stated in the (Australian Nursing and Midwifery council [ANMC] Code of ethics, 2005) is the value of kindness and compassion to others and self, by respecting the fundamental rights and choices of the mother and ensuring that practice is ethically and culturally appropriate. Acts of kindness such as being gentle, considerate and caring should be a constant approach to midwifery care.

The art of midwifery involves achieving a balance between being competent and professional whilst showing heart by still demonstrating emotion. Hunter (as quoted in Jacob and Lavender, 2008, p. 78), says that “…expressing emotion and sharing feelings with others is immensely valuable, both for enhancing relationships and also for developing a type of practice that is open-hearted and genuine.” This relationship is extremely valuable with pregnancy outcomes which may involve unexpected miscarriage, where supporting women and their families can be difficult.

The Hands

The ‘hands’ in the art of midwifery looks at the benefit of therapeutic touch. Therapeutic touch can reassure the woman of her safety with the knowledge that her midwife is confident in her actions and sensitive to her needs. When situations do not allow words, the hands can convey reassurance and express confidence, compassion and care (Ernst, 2009). Touch can be used in many forms including close contact for physical support, helping the women to maintain her posture or just being there as a shoulder to lean on. Touch can provoke different responses by different women. While massage can be good for relieving pain for some, others find a simple light touch to the forehead is all that’s needed to reassure a woman she is not alone and that the midwife is there for her (Page & McCandish, 2007).

Another important ‘hands on’ skill for the Midwife is the ability to use palpitation and touch examination of the mother’s abdomen to assess and determine the baby’s growth, position, size and wellbeing (Grigg, C. 2006). Other skills utilizing the hands can include, teaching breastfeeding, blood pressure measurement, supporting the women through labour and birth, baby assessments and supporting the newborn infant and the use of interventions such as epidurals.

The (Australian Nursing and Midwifery council [ANMC], Code of Professional Conduct for Midwives in Australia, 2006) describes many other midwifery skills not only relating to the care of the woman but also her family and the community. It is the duty of the midwife to provide antenatal and parenthood education. The midwife is committed to working with the women, providing support and advice during her pregnancy/birth and through the postpartum period. The midwives responsibilities also extend to preventative care, detections of complications, promotion of normal birth and accessing the need for medical intervention and the carrying out of emergency procedures should an emergency occur.

Creating a positive atmosphere and environment for the birth is an important factor for many women. Most women have their babies in the unfamiliar and unwelcoming environment of the hospital, a positive attitude assists in reducing anxiety and stress, allays fears and allows the woman to feel secure in her surroundings. Page & McCandish (2007) suggest that simply by making more space and moving furniture in the room offers the woman more area to move and by providing different props such as benches, pillows, and cushions give the women more choices so as for example she can lean or rock when experiencing the intense pain of contractions. The skills of the midwife are many and varied and the hands are vital in conveying messages to the woman.

The Mind

As the Australian College of Midwives, ACM Philosophy for Midwifery (2004) states midwifery is informed by scientific evidence, by intuition and by experiences. This involves the midwife using knowledge gained from research evidence, individual values and preferences, seeking out evidence to support decisions and discussions with the woman to decide on her individual birthing plan. Page & McCandish, (2007) describe evidence based clinical practice as “the judicious use of the best evidence available, so that the clinician and the patient arrive at the best decision, taking into account the needs and values of the individual patient.”(p.205)

Birth is a normal life event and not a disease process thus making health promotion the basis for midwifery care. Health promotion and education involves more than the provision of information to woman in antenatal classes lead by a midwife, where the midwife discusses topics the professional deems relevant. Education needs to move to a more client-led agenda (Beldon & Crozier, 2005).

When working with women it is important to always focus on women centred language and effective communication. Thinking and imagining how the woman is feeling assists in providing comfort and reassurance to the woman. Giving women information about the progress of the labour in positive terms that the woman will understand is most valuable. Knowing when to be quiet is also important. The midwife has to be mindful of her own facial expressions as these can have a huge impact on the woman’s feelings, a smile conveys reassurance that everything is ok and going well (Page & McCandish, 2007).

The midwife’s mind needs to be aware of the changes occurring in maternity care and know that the traditional medical model that once served the doctors and the hospital, is antiquated. As we move towards emerging midwifery models of care which favour continuity of mother and baby care by the same midwife throughout the women’s pregnancy, birth and beyond (Barlow, 2008). A midwife’s autonomy is increasing in maternity care. The Australian Nursing and Midwifery Council, Code of Ethics for Midwives in Australia (2005) also states midwifery care includes the promotion of ‘normal’ birth, prevention and detection of complications in the mother and baby, medical care access and the carrying out of emergency measures as important responsibilities of the midwife.

Conclusion

The heart, hands and the mind all play important roles in the midwifery model of care. Each area can be difficult to explain as separate components of midwifery as the three areas are intertwined and each just as valuable as the other in providing women with women centred care throughout the life changing experience of childbirth. It is evident from research into the art and science of midwifery that midwives are essential in providing care to the childbearing women that supports and guides women through healthy pregnancy, labour and the postpartum period. Midwifery care involves the promotion of ‘normal’ birth, prevention and detection of complications in the mother and baby, medical care access and the carrying out of emergency measures. Our role is to work in partnerships with women and their families by helping them to explore their options and make informed decisions.

WORD COUNT: 1440 words with in-text referencing.

The definition of occupational therapy as gradually metamorphosis from its genesis till date, yet it has gradually evolved from its first definition in 1914 by George Barton who stated that ‘if there is an occupational disease, why not an occupational therapy’. While in 1919, he further postulated that ‘occupational therapy is the science of instructing and encouraging the sick in such labours as will involve those energies and activities producing a beneficial therapeutic effect. Over the years, the definition of occupational therapy had transited and in 1923, Herbert J. Hall define occupational therapy as that which provide light work under medical; supervision for the benefit of patients convalescing in hospital and homes, using handicraft not with the aim of making craftsmen of the patients but for the purpose of developing physics and mental effectiveness. American occupational therapy Association (AOTA) proposed the definition that occupational therapy is the ‘art and science of directing man’s involvement in selected task to reinstate, reinforce and enhance performance, to facilitate learning of the skills and functions essential for adaptation and productivity, diminish or correct pathology and to promote and maintain health. In 1994 AOTA mmrevised the definition and stated that occupational therapy is the use of purposeful activity or interventions to promote health and achieve functional out come to develop, improve or restore the highest possible level of independence with person who is limited by a physical injury or illness.

The goal of occupational therapy is to assist the individual in achieving an independent, productive and satisfying life style. Occupational therapist use adaptive activities to increase the individual’s functioning and productivity in view of achieving independence and satisfaction.

Occupational therapy is a health discipline concerned with enabling function and well-being (Baum, 1997)

Occupation in Occupational Therapy

(Polatakjo 2007, Wilcock 2000), states that the ultimate impact of occupational therapy in multidisciplinary health care service must be a profound understanding of enabling occupation (Pollock and McColl 2003) also stresses that the knowledge of occupation is employed as a means to enhance the development of health in people. Occupational therapists also aspire to the goal of facilitating occupational engagement and performance as the end or outcome of therapy. Occupation is “the purposeful or meaningful activities in which human beings engage as part of their normal daily lives…… all aspects of daily living that contribute to health and fulfilment for an individual”(McColl 2003 p1)

Schwammle (1996) encourage occupational therapists to focus on enabling clients achieve a sense of well being via occupation.

In contrast, (Wilcock 2006) de-emphasises occupation in favour of established concepts that are more consistent with a medical model. He also stressed that medical focus, rather than an occupational focused may have resulted in therapists looking at remedying performance components rather than addressing occupation itself, but (Molineux, 2004) said it will be highly problematic as it will lead to issues of role blurring, role overlap and role ambiguity.

A different dimension to core philosophy of occupational therapy is functional independence or activity of daily living as the ultimate goal of occupational therapy (Thornton and Rennie 1998). Chavalier (1997) concurred that occupational therapists experience difficulty agreeing on what occupational therapy is, and also that the diverse opinion is a strength to the occupational therapy profession.

There seems to be an overall conclusion by occupational therapy experts that occupational therapy as a profession should mainly focus and emphasis on occupation as the core centre of the profession.

(Baum and Baptiste 2007, Law et al 2002, Wilcock 2000, Asmundsottir and Kaplan 2001) all stress that occupation should be central in occupational practices. Various authors also gave reasons why occupation should be the epicentre of occupational therapy:

It will provide an exclusive perspective that will ensure the professional survival of OT in health service (Pierce 2001)

It will unite OT and ensure its continued survival (Nelson 1996).

It will enable OT to achieve its full potential (Crabtree 2000)

Occupation-focused practice may result in more satisfying practice for individual occupational therapists (Molineux 2004, Wilding 2008)

Occupation focused may assist therapists’ intervention s to be more meaningful when dealing with complex issues (Persson et al 2001)

It makes OT to be a true, self-defining profession.

Metamorphosis Of Occupational Therapy

Right from the inception of occupational therapy. the concepts of occupation is the foundation upon which the profession is built. The founders of occupational therapy the likes of George Barton, Fleanor Clarke Slage, Adolph Meyer etc based the new profession on their own personal experiences of the health enhancing effects of engagement in purposeful and meaningful activities (Peloquin, 1991a), Kielhofner (1992) noted for the early part of twentieth century how occupation is seen to play an essential role in human life and lack of it could result in poor health and dysfunction, occupation is also seen as the link between the mind and soul. Occupational therapy

There was a shift of focus to mechanistic paradigm in the (1960s). These emphases the ability to perform depend on the integrity of body systems, and functional performance can be restored by improving or compensating for system limitations.

KIELHOFNER (1992) saw a growing dissatisfaction among occupational therapist with the mechanistic approach whiled Reilly (1992) called for therapist in the early 1960s to focus on occupational nature of humans and also the ability of the profession to emphasize on the occupation needs of people contemporary paradigm (1980- present day).(Molineux 2009)

Relationship between professional philosophy and occupational therapy

A professional philosophy helps set values, beliefs truths and focuses the therapist on the principles that governs his actions. It gives credence to the profession existence and substantiates reasons for practitioner’s therapeutics processes.

In studying the philosophical basis of a profession, it is essential to look at it from its three components as it relates to occupational therapy

Metaphysical component. This bothers on what the nature of humankind is. -active being, occupation performance, Reductive approach and Holistic approach.

Epistemology component. This relates to the development of a professional philosophy. It analyse the nature, origin and limits of human knowledge.(Adaptation, Thinking, feeling and doing)

Axiology component. It concerns with the values of the profession. Quality of life, client catered approach, code of ethics

Man is an active being whose development is influenced by the use of purposeful activities, using their capacity for intrinsic motivation; human beings are able to influence the physical and mental health and their physical environments through purposeful activity. Adaptation is a change in function that promotes survival and self-actualisation, it is also described as the satisfactory adjustment of individual s within their environment over time. . Dysfunction may occur when adaptation is impaired, while purposeful activity enhances the adaptive process.

Health care system has been developed from a reductionistic approach where man is viewed as separate body function and each part treated separately and focuses on specific problem for greater efficiency. However, medicine has metamorphosis into addressing all the bodily functions of the client, this is a holistic approach by occupational therapy traced to Adolf Meyer. He sees the human body as a live organism acting. The holistic approach emphasises organic and fundamental relationship between the parts and the whole being, an interaction of biological, psychological, socio-cultural and spiritual elements. Occupational therapy trend is shifting away from holistic practice to specialised (reductionistic) approach again. For example, occupational therapy practitioners working in hand rehabilitation refers to themselves as hand therapists or those in psychiatry call themselves psychiatric therapists.

Critical analysis of model and frame of reference

MODEL AND FOR

In advancing the theoretical foundation of occupational therapy, a model is defined as a theoretical simplification of a complex reality (Frolitch, 1993) and consists of several explicitly defined concepts. Conceptual models are schematic or graphic representation of concepts and assumptions that act as a guide for theory development.

The frame of reference is based on philosophy or a paradigm and attempts to describe or explain what we believe or value. Models are developed within a frame of reference. Hence, FOR are viewpoints, beliefs or values. FOR are connected sets of ideas that form the basis for action. (Duncan, 2006)

Reed and Sanderson (1999) states that no perfect or ideal model for health, functioning and disability exists for occupational therapists. Rather, they suggest that occupational therapists should select the aspects from those health models that most closely fit the belief and values of occupational therapy.

According to Townsend (2002), Occupational performance is defined as the result of the dynamic relationship between the person, the environment and the occupation. It refers to the ability to choose and satisfactorily perform meaningful occupations that are culturally defined and appropriate for looking after one’s self, enjoying life and contributing to the social and economic fabric in the community. Occupations are groups of activities and tasks of everyday life.

Activities of Daily Living (ADL)

The initial process of occupational therapy assessment involves interviews with the patient and the carer to establish previously held life roles and the tasks and activities that were completed within these roles. Observational assessment is undertaken of personal self-care tasks, including showering, dressing, toileting, grooming, and eating, and domestic or instrumental tasks, including meal preparation, shopping, cleaning, laundry, and management of finances and medications. Standardized measures may include the Functional Independence Measure (FIM), [6

MODELS

Model of human occupation (MOHO)

The model emphasis that occupational behaviour is a result of the human system, the

subsystem, the habitation subsystem and the environment.

MOHO is a behavioural model. He defines occupational performance from a behavioural perspective. The model sees occupational performance as a result of mind-brain-body performance subsystem.

Haglund and Kjellberg (1999) argue that the MOHO lacks the influence of the environment on human behaviour. Though it includes the environmental factor, he does not explain the interaction and relationship between the person and the environment.

Canadian Model of Occupational Performance (CMOP).

See in occupational performance terms of dynamic relation between occupation, environment and a person, the key elements of environment are cultural, institutional, physical and social. While the purpose of occupation can be leisure, productivity or self-care. The CMOP presents the person as an integrated whole, incorporates spiritual, affective, cognitive and physical need (Townsend, 2002) The CMOP defines occupational performance as the result of dynamic relationship between the person, the environment and the occupation.

OCCUPATIONAL PERFORMANCE MODEL (Australia)

In contrast to the ICF where ‘rest’ is a body function, ‘rest’ has an activity perspective in the OPM.

CORE PROCESS (HAGEDORN 2006)

The first extensive presentation of occupational therapy core competencies was produced by Mosey (1986) she based her domains of concern of the profession as performance components, occupational performances, the life cycle and the environment. While (Neistadt and Crepeau 1998) give a list at entry level to be development of skills, socialization in the expectation related to organisation, peers and the profession, acceptance of responsibility and accountability in relevant active-ties. In 1994,the college of occupational therapist published a position on ‘core skills and conceptual framework for practice’. Core skill is defined as the ‘expert knowledge at the hearth of the Professional’.

The unique core skills of occupational therapy are

Engage in purposeful activity and meaningful occupation as therapeutic tools to enhance health and wellbeing.

Enable people to explore, achieve and maintain balance in their daily living tasks.

Evaluate the effects of manipulate, physical and psycho-social environments, maximise function and social integration.

Ability to analyse, select and apply occupation to focused therapeutic media to enable dysfunction in daily living tasks and occupational roles.

For a therapist to be able to display core professionalism via the above listed core skills. The therapist needs to use four core processes.

Therapeutic Use of Self

In the heart of therapeutic intervention is the ability of the therapist to communicate with the client and establish a therapeutic relationship or alliance. Mosey (1986) described ‘conscience use of self’ as one of the legitimate tools of practice.

ASSESSMENT OF INDIVIDUAL POTENTIAL, ABILITY AND NEEDS

For an effective therapeutic intervention, there must be a clear and accurate evaluation of the potential and abilities of the clients in view of the client’s needs and goals. This is achieved through the array of tests, checklists and other assessment tools. Assessment may require detailed observation, measurement and repeated testing in relation to ADL which the individual engages.

OT is concerned with the whole spectrum of human skills through all ages: past, present and future. Possibilities and probabilities need careful evaluation which requires experience and indepth clinical reasoning.

ANALYSIS AND ADAPTATION OF OCCUPATION

A fundamental assumption of occupational therapy is that engagement in occupation promotes health and well being. Hence, occupational analysis seeks to break down the tasks into smallest units of which performance is composed. The client skill components can be identified and the therapist can map how this can be built into competence. To achieve this, the therapist must observe, record and analyse elements of performance via work, leisure and self care activities. The therapist also employs analytical methods to determine client interaction between occupational role and social life relationships.

ANALYSIS AND ADAPTATION OF ENVIRONMENT

Therapists acknowledge that the environment has an effect on behaviour. It facilitates interaction, reduce stress and promote engagement. Hence, adapting to the environment can enhance occupational performance or impede engagement in task. The analysis of the environment should be at an holistic level and not limited to the physical aspects alone, but also socio-cultural aspects, emotional and financier environment.

CODE OF ETHICS AND PROFESSIONAL CONDUCT COT 2010

On a daily basis, occupational therapists are confronted with situations that requires decisions. Moral and ethics have the potential to affect the clinician’s decision making practice. Ethics are philosophical stands on the rightness or appropriateness of various voluntary actions. The adoption of ethical principles is one characteristic often used to distinguish professions from other occupations (Vollmer & Mills, 1966).

The code of ethics and professional conduct produced by the college of occupational therapists (COT) and NPC are formulated to guide O. T in their professional conduct in terms of competent combination of knowledge, skills and behavior’s.

The code of ethics and professional conduct are sub – divided into major sections:

Service user welfare and autonomy, this includes: Duty of care, welfare, mental capacity and informed consent and confidentiality.

Service provision: Equality, Resourses, the occupational process, risk management and record keeping.

Personal professional integrity: Personal integrity relationships with service users, professional integrity, fitness to practice, substance misuse, personal profit or gain, and information representation.

Professional competence and lifelong learning: professional competence, delegation, collaborative working, combining professional development, and occupational therapy practice education.

Developing and using the profession’s evidence base.

The code of ethics and professional conduct enacted various laws upon which an occupational therapist base his/her practice, these include:

Health Act 1999 ‘Occupational therapist’ is protected by law and can only be used by persons who are registered with the health professions council (HPC)

O.T personnel must respect the right of all people under the Human Right Act 1998.

Mental Capacity Act 2005 code of practice states that: A person must be assumed to have capacity unless it is established otherwise.

Data protection Act 1998: gives individual the right to know what information is held about them and that personal information is handled properly.

Roles of COT and HPC (Code of ethics and professional conduct.COT,2010)

Case Study

B. Trimble

Case Study

P.D. a twenty-three-year-old female presents with symptoms of psoriasis. She has several thick scaly, well defined, erythematous plaques, which are silvery in color. The patient reports that she has just returned from a twelve-day trip to southern Louisiana to work the ecosystem as part of her education as an environmental engineer. During the trip, she had significant solar exposure, although she wore sunscreen. The expanded and prominent plaques cover her elbows and thighs, and there is a patch on her scalp. Her lesions cover about fifteen percent of her body. She occasionally applies moisturizing lotion or witch hazel if it becomes too irritating. All other body systems are normal.

Patient states “I have always had some rashes, although usually not this bad.”

Past Medical History

“Some rashes

,”

otherwise non-contributory

Social History

Recent trip to southern Louisiana for ecosystem work related to studies as an environmental engineer.

Physical Examination

Several thick scaly, well define, erythematous plagues, silver in color.

Expanded plague and prominent plagues cover elbows and thighs, with an area on the scalp. Plague coverage is fifteen percent of the body.

Significant sun exposure

All other body systems are within normal limits.

Reviewing the symptoms, the primary diagnosis is plague psoriasis. Psoriasis is a chronic inflammatory disease of the skin in which the production of epidermal cells occurs at a rate that is faster than normal. The cells in the basal layer of the skin divide too quickly, and the newly formed cells move rapidly to the skin surface and become evident as profuse scales or plagues of epidermal tissue. The psoriatic epidermal cell may travel from the basal cell layer to the stratum corneum and be cast off in three to four days, which is in sharp contrast to the normal twenty-six to twenty-eight days. As a result of the increased number of basal cells and rapid cell passage, the normal events of cell maturation and growth cannot take place. This abnormal process does not allow the formation of the protective layers of the skin (PubMed Health, 2012).

Psoriasis, one of the most common skin diseases, affects approximately two percent of the population. There appears to be a hereditary defect that causes overpopulation of keratin. The primary defect is unknown. A combination of specific genetic makeup and environmental stimuli may trigger the onset of the disease. There is evidence that the cell proliferation is mediated by the immune system. Periods of emotional stress and anxiety aggravate the condition, and trauma, infections, and seasonal and hormonal changes are trigger factors. The onset may occur at any age, but is most common between the ages of ten and thirty-five years. Psoriasis has a tendency to improve and then recur throughout life (PubMed Health, 2012).

The clinical manifestation

The lesions appear as red, raised patches of skin covered with silvery scales. The scaly patches are formed by the buildup of living and dead skin that results from the vast increase in the rate of skin-cell growth and turnover. If the scales are scraped away, the dark red base of the lesion is exposed, producing multiple bleeding points. These patches are not moist and may or may not itch. The lesions may remain small, giving rise to the term “guttate psoriasis.” Usually, the lesions enlarge slowly, but after many months they coalesce, forming extensive irregular shaped patches (PubMed Health, 2012). Psoriasis may range from a cosmetic source of annoyance to a physically disabling and disfiguring affliction. Particular sites of the body tend to be affected by this ailment; they include the scalp, the area over the elbows and knees, the lower part of the back, and the genitalia. Psoriasis also appears on the extensor surfaces of the arms and legs, on the scalp and ears, and over the sacrum and intergluteal fold. Bilateral symmetry is a feature of Psoriasis (Brunton, Chabner, & Knollman, 2011). The disease may be associated with arthritis of multiple joints, causing crippling disability. The relationship between arthritis and psoriasis is not understood. Another complication is an exfoliative psoritic state in which the disease progresses to involve the total body surface (Brunton, Chabner, & Knollman, 2011).

Management

The goals of management are to reduce the rapid turnover of the epidermis and to promote resolution of the psoriatic lesions. Thus, the goal is limited to control of the problem, because there is no cure (Brunton, Chabner, & Knollman, 2011).

The therapeutic approach should be one that the patient understands; it should be cosmetically acceptable and not too disruptive of life-style. It will involve a commitment of time and effort by the patient.

First, any precipitating or aggravating factors are removed. Then as assessment is made of life-style, since psoriasis is significantly affected by stress. The patient must also be advised that treatment of severe psoriasis can be time-consuming, expensive, and esthetically unappealing at times. Treatment will begin with Vectical ointment (calcitriol) 3mcg/g, topical use only. Apply twice daily, once in the morning and once in the evening, the maximum weekly dose should not exceed 200 gram (National Institute of Health, 2012). Treatment will extend to eight weeks, with follow up in office at that time. Each gram contains 3 micrograms of calcitriol. Vectical should not be applied to the face, eyes, or lips. It should be used with caution in patients receiving medications known to increase calcium serum levels, such as calcium supplements, vitamin D supplements, and thiazide diuretics. Vectical may cause sunburn more easily, avoid the sun, sunlamps, or tanning beds while using Vectical ointment. Use a sunscreen or wear protective clothing when having to be outside for more than a short time (National Institute of Health, 2012).

Vectical ointment is indicated for the topical treatment of mild to moderate plague psoriasis in adults eighteen years and older. Calcitriol (Vectical) contains 1,25-dihydroxycholecalciferol, the hormone active form of vitamin D3. Calcitriol 3-mcg/g ointment is similar in efficacy to calcipotriene 0.005-% ointment for the treatment of plague type psoriasis on the body and is better tolerated in intertriginous and sensitive areas of the skin (Katzung, Mastes, & Trevor, 2012). Vectical contains calcitriol, which studies have shown to be fetotoxic, and should be used in pregnancy only if the potential benefits justify the potential risk to the fetus. It is not known if calcitriol is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Vectical ointment is used by nursing women. If the patient thinks she may be pregnant, they will need to discuss the benefits and risks of using Vectical ointment while pregnant (Katzung, Mastes, & Trevor, 2012).

Patient Education

Use only as directed, for external use only. Vectical is to be applied only to areas of skin affected by psoriasis.

Vectical should be gently rubbed into the skin so that no medication remains visible. As you may sunburn more easily, avoid the sun, sunlamps, or suntan beds/booths while using Vectical ointment. Use a sunscreen with an SPF of 30 or greater; wear protective clothing when you must be outside for more than a short time (Brunton, Chabner, & Knollman, 2011).

All medications may cause side effects, but many have no, or minor, side effects. Minor skin discomfort at the application site is the most common side effect of Vectical ointment. Notify the medical provider if these side effects occur; rash, hives, itching, difficulty breathing, chest tightness, swelling of the face, mouth or lips, new or worsening skin irritation ( blistering, flushing, burning, severe discomfort, or redness), symptoms of hypercalcemia (weakness, nausea, confusion, constipation, excessive thirst, fast, slow or irregular heartbeat) (National Institute of Health, 2012).

Treatment Plan

Vectical (calcitriol) 3mcg/g, 100 G tube; twice daily.

Follow up appointment in eight weeks.

Laboratory testing to include calcium serum levels and hCG testing now and at followup visit. Additional laboratory testing to include skin biopsy for fungal infection. Patient education on use and precautions of medications, and supplements

.

Referral to psoriasis support group for emotional support and education.

Differential Diagnosis

Review of symptoms and history of working in the environment leads to questioning if the patient presentation is a case of Tine Corporis and Tina Capitis. As the patient was in an environmental area that is subject to large fungal growth and exposure to a wet climate increases the risks for fungal infestation, this is the differential diagnosis (Brunton, Chabner, & Knollman, 2011).

Tina capitis is a contagious fungal infection of the hair shafts. Microsporum and Trichophyton species are dermatophytes that infect hair. Clinically, one or several round patches of redness and scaling are present. Tinea Corporis or Tina circinata begins as an erythematous macule advancing to rings of vesicles with central clearing. The lesions appear in clusters, usually on exposed areas of the body. These may extend to the scalp, hair, or nails. As a rule, there is an elevated border consisting of small papules or vesicles. Coalescence of individual rings may result in large patches with bizarre scalloped borders. Use of a woods lamp will help in the diagnosis. The fungal infection will glow under the light. Skin biopsy will confirm the presence of fungal infestation (Katzung, Mastes, & Trevor, 2012).

References

Brunton, L., Chabner, B., & Knollman, B. (2011).

Goodman & Gilman’s: The pharmacological basis of therapeutics

(12 ed.). McGraw-Hill.

Katzung, B., Mastes, S., & Trevor, A. (2012).

Basic & Clinical Pharmacology

(12 ed.). McGraw-Hill.

National Institute of Health. (2012, January).

Vectical ointment

. Retrieved from U.S. National Library of Medicine:

http://www.dailymed.nlm.nih.gov/dailymed/druginfo.cfm

PubMed Health. (2012, November).

Psoriasis

. Retrieved from PubMed Health:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001470