Lack of Sleep Hormone Linked To Diabetes Risk

Low levels of melatonin, the hormone that regulates sleep, more than doubles the risk of diabetes in women, a study has found.

Researchers made the connection after analysing data on 740 women with and without the disease.

Melatonin, a popular remedy for jet lag, is best known for its role in helping to control the body’s sleep-wake cycle. But it also has many other biological functions, including some linked to the blood sugar hormone insulin.

None of the women taking part in the study had diabetes at the start. Over a 12-year period, researchers identified 370 who developed Type-2 diabetes and compared them with a matched 370 who did not.

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24 Ways To Loose Weight Without Dieting (Part II)

Here is the second part of the 24 ways to loose weight without dieting.

11: Limit Alcohol

When an occasion includes alcohol, follow the first drink with a non-alcoholic, low-calorie beverage like sparkling water instead of moving directly to another cocktail, beer, or glass of wine. Alcohol has more calories per gram (7) than carbohydrates (4) or protein (4). It can also loosen your resolve, leading you to mindlessly inhale chips, nuts, and other foods you'd normally limit.

12: Go for Green Tea

Drinking green tea may also be a good weight loss strategy. Some studies suggest that it can rev up the body's calorie-burning engine temporarily, possibly through the action of phytochemicals called catechins. At the very least, you'll get a refreshing drink without tons of calories.

13: Go Yoga - The State of Mind

Women who do yoga tend to weigh less than others, according to a study in the Journal of the American Dietetic Association. What is the connection? The yoga regulars reported a more "mindful" approach to eating. For example, they tend to notice the large portions in restaurants but eat only enough to feel full. Researchers think the calm self-awareness developed through yoga may help people resist overeating.

14: Prefer Home Cook 

Eat home-cooked meals at least five days a week to live like a thin person. A Consumer Reports survey found this was a top habit of "successful losers." Sound daunting? Cooking may be easier than you think. Short cut foods can make for quick meals, such as pre-chopped lean beef for fajitas, washed lettuce, pre-cut veggies, canned beans, cooked chicken strips, or grilled deli salmon.

15: Catch the "Eating Pause"

Most people have a natural "eating pause," when they drop the fork for a couple of minutes. Watch for this moment and don't take another bite. Clear your plate and enjoy the conversation. This is the quiet signal that you're full, but not stuffed. Most people miss it.

to be continued...Part III

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24 Ways To Loose Weight Without Dieting (Part I)

Do you want to loose weight but having problems with dieting? Try these ways and see whether you can cope it.

1: Time Your Meals

Set a timer for 20 minutes and reinvent yourself as a slow eater. This is one of the top habits for slimming down without a complicated diet plan. Savour each bite and make it last until the bell chimes. Paced meals offer great pleasure from smaller portions and trigger the body's fullness hormones. Wolfing your food down in a hurry blocks those signals and causes overeating.

2: Sleep More, Weigh Less

Sleeping an extra hour a night could help a person drop 14 pounds in a year, according to a University of Michigan researcher who ran the numbers for a 2,500 calorie per day intake. His scenario shows that when sleep replaces idle activities – and the usual mindless snacking – you can effortlessly cut calories by 6%. Results would vary for each person, but sleep may help in another way, too. There's evidence that getting too little sleep revs up your appetite, making you uncommonly hungry.

3: Serve More, Eat More Veggies. 

Serve three vegetables with dinner tonight, instead of just one, and you'll eat more without really trying. Greater variety tricks people into eating more food – and eating more fruits and vegetables is a great way to lose weight. The high fibre and water content fills you up with fewer calories. Cook them without added fat. And season with lemon juice and herbs rather than drowning their goodness in high-fat sauces or dressings.

4: When Soup's On, Weight Comes Off

Add a broth-based soup to your day and you'll fill up on fewer calories. Think minestrone, tortilla soup, or Chinese won-ton. Soup's especially handy at the beginning of a meal because it slows your eating and curbs your appetite. Start with a low-sodium broth or canned soup, add fresh or frozen vegetables and simmer. Beware of creamy soups, which can be high in fat and calories.

5: Go for Whole Grains

Whole grains such as brown rice, barley, oats, buckwheat, and whole wheat also belong in your stealthy weight loss strategy. They help fill you up with fewer calories and may improve your cholesterol profile, too. Whole grains are now in many products including waffles, pizza crust, English muffins, pasta, and soft "white" whole-wheat bread.

6: Eyeball Your Skinny Clothes

Hang an old favourite dress, skirt, or a smokin' pair of jeans where you'll see them every day. This keeps

 your eyes on the prize. Choose an item that's just a little too snug, so you reach this reward in a relatively short time. Then pull out last year's cocktail dress for your next small, attainable goal.

7: Skip the Bacon

Pass on those two strips of bacon at breakfast or in your sandwich at lunch time. This simple move saves about 100 calories, which can add up to a 10 pound weight loss over a year. Other sandwich fixings can replace the flavour with fewer calories. Think about tomato slices, banana peppers, roasted red bell peppers, grainy mustard, or a light spread of herbed goat cheese.

8: Build a Better Slice of Pizza

Choose vegetable toppings for pizza instead of meat and you'll shave 100 calories from your meal. Other skinny pizza tricks: go light on the cheese or use reduced-fat cheese and choose a thin, bread-like crust made with just a touch of olive oil.

9: Sip Smart: Cut Back on Sugar

Replace one sugary drink like regular soda with water or a zero-calorie seltzer and you'll avoid 10 teaspoons of sugar. Add lemon, mint or frozen strawberries for flavour and fun.

The liquid sugar in soda appears to bypass the body's normal fullness cues. One study compared an extra 450 calories per day from jelly beans vs. soda. The candy eaters unconsciously ate fewer calories overall, but not so the soda drinkers. They gained 2.5 pounds in four weeks.

10: Sip Smart: Use a Tall, Thin Glass

Use a tall, skinny glass instead of a short, wide tumbler to cut liquid calories — and your weight — without dieting. You'll drink 25-30% less juice, soda, wine, or any other beverage.

How can this work? Brian Wansink, PhD, says visual cues can trick us into consuming more or less. His tests at Cornell University found all kinds of people poured more into a short, wide glass — even experienced bartenders.

(More tips on Part II - next posting...)

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Learn The 9 Best Diet Tips

Are you looking for the best diet tips online? Well, here the 9 simple but best diet tips i have ever found.  Apply it and see for yourself.

1:  Drink plenty of water or other calorie-free beverages.

Before you tear into that bag of potato chips, drink a glass of water first. People sometimes confuse thirst with hunger, so you can end up eating extra calories when an ice-cold glass of water is really all you needed. If plain water doesn't cut it, try drinking flavoured sparkling water or brewing a cup of fruit-infused herbal tea.

2:  Be choosy about night time snacks.

Mindless eating occurs most frequently after dinner, when you finally sit down and relax. Snacking in front of the TV is one of the easiest ways to throw your diet off course. Either close down the kitchen after a certain hour, or allow yourself a low-calorie snack, like a 100-calorie pack of cookies or a half-cup scoop of low-fat ice cream.

3: Enjoy your favourite foods.

Instead of cutting out your favourite foods altogether, be a slim shopper. Buy one fresh bakery cookie instead of a box, or a small portion of candy from the bulk bins instead of a whole bag. You can still enjoy your favourite foods - the key is moderation.

4: Eat several mini-meals during the day.

If you eat fewer calories than you burn, you'll lose weight. But when you're hungry all the time, eating fewer calories can be a challenge. "Studies show people who eat 4-5 meals or snacks per day are better able to control their appetite and weight," says obesity researcher Rebecca Reeves, DrPH, RD. She recommends dividing your daily calories into smaller meals or snacks and enjoying most of them earlier in the day - dinner should be the last time you eat.

5: Eat protein at every meal.

Protein is the ultimate fill-me-up food - it's more satisfying than carbs or fats and keeps you feeling full for longer. It also helps preserve muscle mass and encourages fat burning. So be sure to incorporate healthy proteins like lean meat, yogurt, cheese, nuts, or beans into your meals and snacks.

6: Spice it up.

Add spices or chiles to your food for a flavor boost that can help you feel satisfied. "Food that is loaded with flavour will stimulate your taste buds and be more satisfying, so you won't eat as much," says American Dietetic Association spokeswoman Malena Perdomo, RD. When you need something sweet, suck on a red-hot fireball candy. It's sweet, spicy, and low in calories.

7: Stock your kitchen with healthy convenience foods.

Having ready-to-eat snacks and meals-in-minutes on hand sets you up for success. You'll be less likely to hit the drive-through or call in a pizza order if you can throw together a healthy meal in five or 10 minutes. Here are some essentials to keep on hand: frozen vegetables, whole-grain pasta, reduced-fat cheese, canned tomatoes, canned beans, pre-cooked grilled chicken breast, whole grain tortillas or pitas, and bags of salad greens.

8: Order children's portions at restaurants.

Ordering a child-size entree is a great way to cut calories and keep your portions reasonable. This has become such a popular trend that most servers won't bat an eye when you order off the kids' menu. Another trick is to use smaller plates. This helps the portions look like more, and if your mind is satisfied, your stomach likely will be, too.

9: Swap a cup of pasta for a cup of vegetables.

Simply by eating less pasta or bread and more veggies, you could lose a dress or pants size in a year. "You can save from 100-200 calories if you reduce the portion of starch on your plate and increase the amount of vegetables," says Cynthia Sass, RD, a spokeswoman for the American Dietetic Association.

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Nursing Care Plan for Acute Lymphocytic Leukemia (ALL)

NCP for Acute Lymphocytic Leukemia

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Nursing Care Plan for Pleural Effusion

A sample of nursing care plan for pleural effusion with actual and potential problems.

Ncp for Pleural Effusion

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Case Study on Acute Lymphocytic Leukemia

Here is another case study on Acute Lymphocytic or Lymphoblastic Leukemia.

Case Study on Acute Lymphocytic/Lymphoblastic Leukemia

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Case Study on Pleural Effusion

Our group was divided into 9 groups where each and every group must come up 2 different case studies either about respiratory, GIT, cardiovascular and hematopoietic system disorders.  Our group chose respiratory and hematopoietic system.  It was conducted on January 2011 at the General Hospital of Malacca, Malacca, Malaysia. 

Pleural Effusion - Case Study

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Roles and Functions of a Professional Nurse

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all setting. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. With these nurses work in a large variety of specialties where they work independently and as part of a team to assess, plan, implement and evaluate care.

These nursing practices have been influenced by the nursing leaders in the past. Among the few of them were Clara Barton, Lavinia Dock, Lillian Wald, Margaret Sanger, Florence Nightingale and Virginia Henderson. Florence Nightingale, often considered as the first theorist, earned her title as “The Lady of Lamp” and was the Founder of Nursing while Virginia Henderson is considered as the “First Modern Nurse”.

In this paper, we are going to discuss what is nursing, nurses’ roles and functions and the two visionary leaders and their contributions to nursing.

Nursing and its Definition.

According to Virginia Henderson, “the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge”.

She emphasized that nurses should be concerned on both healthy and ill individuals and interacts with clients even when recovery may not be feasible. She also mentioned that nurses may act as a client advocate and should provide education about the client’s health condition and nursing activities to be performed to improve client’s health condition.

The nurses’ goal is to assist the sick and healthy individual to gain independence as rapidly as possible in performing nursing activities. Moreover, nurses can either be a substitutive (work for the person) to the fully dependent patient, supplementary (helping the person) to the partially-able patient and complementary (working with the person) to the able patient.

Roles and Functions of a Professional Nurse.

Nurses are expected to perform a variety of roles in health care institutions whenever care is provided to the clients. They maybe carried out simultaneously depending on the need of the client in a particular situation and case.

1. Caregiver.  As a caregiver, nurses are expected to assist the client’s physical, psychological, developmental, cultural and spiritual needs. It involves a full care to a completely dependent client, partial care for the partially dependent client and supportive-educative care, in order to attain the highest possible level of health and wellness.
2. Communicator. Communication is very important in nursing roles. It is vital to establish nurse-client relationship. Nurses who communicate effectively get better information about the client’s problem either from the client itself or from his family. With better information nurses will be able to identify and implement better interventions and or nursing care that promotes fast recovery, health and wellness. 
3. Teacher. Being a teacher is an important role for a nurse. It is her duty to give health education to the clients, families and community. However, the nurse must be able to assess the knowledge level, learning needs and readiness of the clients, families and community to give appropriate and necessary health care education they need to restore and maintain their health. 
4. Client Advocate. A nurse may act as an advocator. An advocator is the one who expresses and defends the cause of another or acts as representative. Some people who are ill maybe too weak to do on his own and or even to know hi rights to health care. In this instance, the nurse may convey is client’s wish like change of physician, change of food, upgrade his room or even to refuse a particular type of treatment. 
5. Counselor.  A nurse may act as a Counselor. She provides emotional, intellectual and psychological support. She helps a client to recognize with stressful psychological or social problems, to develop and improved interpersonal relationship and to promote personal growth.
6. Change Agent.  As a change agent, oftentimes a nurse change or modify nursing care plan based on her assessment on the client’s health condition. This change and modification will only happen when the intervention/s does not help and improve a client’s health.
7. Leader.  Nurse often assumes the role of leader. Not all nurses have the ability and capacity to become a leader. As a leader it allows you to participate in and guide teams that assess the effectiveness of care, implement-based practices, and construct process improvement strategies. You may hold a variety of positions like shift team leader, ward in-charge, board of directors, etc.
8. Manager. As a Manager, a nurse has the authority, power, and responsibility for planning, organizing, coordinating and directing work of others. She is responsible for setting goals, make decisions, and solve problems that the organization may encounter. It is also her responsibility to supervise and evaluate the performance of
9. her subordinates. The manager always ensures that nursing care for individuals, families and communities are met.
10. Case Manager.  In some hospitals, a case manager is a primary nurse who provides direct care to the client or family e.g. case manager for diabetic client, she has the responsibility to give health education, measure the effectiveness of the nursing care plan and monitor the outcomes of intervention whether effective or not.
11. Research Consumer. Nurses often do research to improve nursing care, define and expand nursing knowledge.

Biography and Contribution of Florence Nightingale and Virginia Henderson in Nursing.

Florence Nightingale (1820 - 1910)

She was the younger daughter of William Edward Nightingale of Embley Park, Hampshire, and Lea Hurst, Derbyshire, was born at Florence on the 15th of May 1820, and named after that city, but her childhood was spent in England, chiefly in Derbyshire. 

Born to a comfortable family, Florence Nightingale was educated by governesses and then by her father, with her older sister, Panthenope. She was familiar with the Greek and Latin classical languages, and modern languages of French, German, and Italian. She also studied history, grammar, philosophy and mathematics.

By 1844, over parental objections, Florence Nightingale chose a different path than the social life and marriage expected of her by her parents -- she chose to work in nursing, which was then not quite a respectable profession for women. She went to Kaiserwerth, Prussia in 1847, where she received 3 months training in nursing. In 1853 she studied in Paris with Sisters of Charity, after which she return to England to assume the position of superintendent of London's Institution for the Care of Sick Gentlewomen.

She came to prominence during the Crimean War for her pioneering work in nursing, and was dubbed "The Lady with the Lamp" after her habit of making rounds at night to tend injured soldiers. Nightingale laid the foundation stone of professional nursing with the principles summarized in the book Notes on Nursing.  The Nightingale Pledge taken by new nurses was named in her honor, and the annual International Nurses Day is celebrated around the world on her birthday (wikipedia).

In later life Florence Nightingale suffered from poor health and in 1895 went blind. Soon afterwards, the loss of other faculties meant she had to receive full-time nursing. Although a complete invalid she lived another fifteen years before her death in London on 13th August, 1910 (John Simkin).

Her Contributions

Her improvements in improving the standards for the care of war casualties in the Crimean earned her the title “Lady with the Lamp”. Her efforts in reforming hospitals and producing and implementing public health policies also made her an accomplished political nurse: She was the first nurse to exert political pressure on government.

She is recognized as the first nursing’s scientist-theorist for her work on “Notes on Nursing: What It Is and What It Is

Not” and “Notes on Hopitals”. She published these books in 1859 with the support of wealthy friends and John Delane at The Times and was able to raise £59,000 to improve the quality of nursing.

In 1860, she founded the Nightingale School & Home for Nurses at St. Thomas's Hospital. The school served as a model for other training schools. Its graduates traveled to other countries to manage hospitals and institute nurse-training programs. 

She also became involved in the training of nurses for employment in the workhouses that had been established as a result of the 1834 Poor Law Amendment Act.

Virginia Henderson (1897 - 1996)

She was born in Kansas City, Missouri on Nov. 30, 1897, the fifth of eight children of Daniel B. and Lucy Minor (Abbot) Henderson. Her father was an attorney for Native American Indians. Her mother came from the state of Virginia to which Miss Henderson returned for her early schooling. She was educated at the U.S. Army School of Nursing (1921) and Teachers College, Columbia University where she completed her B.S. (1932) and M.A. (1934), then taught from 1934 until 1948.

Virginia Avenel Henderson died on March 19, 1996 at the age of 98. Her ending had the warmth, style, and graciousness of her life. After partaking chocolate cake and ice cream and saying goodbyes to her family and friends, she passed from one dimension to another. Miss Henderson, and she always preferred Miss to Ms., left behind a quantity of work that is the soul of modern nursing.

Her Contributions:

Virginia Henderson has been called the "first lady of nursing" and the "first truly international nurse." Her writing, presentations and her research and contacts with nurses have profoundly affected nursing and impacted the recipients of care by nurses throughout the world. Among them are as follows:

1. She began her career in public health nursing in the Henry Street Settlement and in the visiting nurse service in Washington, D.C.
2. She was the first full-time instructor in nursing in Virginia when she was at Norfolk Protestant Hospital in Norfolk and was active in the Graduate Nurses Association of Virginia. She designed a plan to create district organizations within the state. She was an early advocate for the inclusion of psychiatric nursing in the curriculum and served on a committee to develop such a course at Eastern State Hospital in Williamsburg, Virginia in 1929.
3. During her years at Teachers College, Columbia University, Henderson was an outstanding teacher and drew students from many countries to study with her. Nurses through the United States studied with her without ever leaving their home schools when her revision of Bertha Harmer's Textbook of the Principles and Practice of Nursing became widely use.
4. Other important publications grew out of Henderson's years at Yale University including Nursing Research a Survey and Assessment in collaboration with Leo Simonds. She also directed a twelve-year project entitled Nursing Studies Index, four volumes recognized as an essential reference for many years.
5. Her book, Nature of Nursing, published in 1966 expressed her belief about the essence of nursing and influenced the hearts and minds of those who read it. 
6. At the age of 75, Henderson directed her career to international teaching and speaking. This enabled another generation to reap the benefits of contact with this quintessential nurse of the twentieth century.
7. In 1953, she joined Yale School of Nursing, a particularly fitting association, since the first dean, Annie Warburton Goodrich, had served as her mentor in her early professional years. The Yale years were a time of great productivity.

Conclusion

Florence Nightingale and Virginia Henderson were among the visionary leaders in the past who have greatly influenced the nursing practice and contributed much to the improvement of nursing status worldwide. Though nursing have a lot of definition, yet it all boils down to caring of the clients as a holistic being. Nurses also assume variety of roles and functions such as caregiver, leader, change agents, teacher, manager, case manager, counselor, client advocate, and consumer research.

References

Berman, Audrey, Erb, Glenora Lea, Kozier, Barbara, and Snyder, Shirlee. 2008. Fundamentals of Nursing: Concepts, Process, and Practice. New Jersey: Pearson Education, Inc., 8th Edition, 460 – 483.

John Simkin. Spactus Educational. Retrieved from http://www.spartacus.schoolnet.co.uk

Florence Nightingale. In Wikipedia. Retrieved from http://en.wikipedia.org

Angela Barron McBride. Virginia Henderson. Retrieved from http://www.nursinglibrary.org

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Nursing Communication

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all setting. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. With these nurses work in a large variety of specialties where they work independently and as part of a team to assess, plan, implement and evaluate care.

These nursing practices have been influenced by the nursing leaders in the past. Among the few of them were Clara Barton, Lavinia Dock, Lillian Wald, Margaret Sanger, Florence Nightingale and Virginia Henderson. Florence Nightingale, often considered as the first theorist, earned her title as “The Lady of Lamp” and was the Founder of Nursing while Virginia Henderson is considered as the “First Modern Nurse”. 


In this paper, we are going to discuss what is nursing, nurses’ roles and functions and the two visionary leaders and their contributions to nursing.

Communication Process

Communication is the interchange of information, thoughts and ideas between two people or group of people. Communication is the process by which a message or information is exchanged from a sender to a receiver. It can be carried out into two different modes: verbal and non-verbal.

Communication involves a sender, a message, receiver and a response or feedback.

A sender is a person or group of person who wishes to convey a message to another person or group of

person. A sender should see to it that the message she transmitted or conveyed to another person must be clear, simple and easy to understand. It is necessary to use a language that the other person is using to achieve effective communication. It is also important to note that your gesture and or body language is congruent to what you are saying. Timing and tone of voice also play an important role in communication.  It must suit to the mood of the client to obtain accurate information.

A message is the thoughts, ideas or emotions that are transmitted to the other person or group of person which is actually said or written and the body language that accompanies the words and how the message is being transmitted. In transmitting a message, a channel is used either through a face-to-face talk and recorded messages through radio or television. It is important that the channel is appropriate for the message and should serve the purpose.

A receiver is a person who perceives or receives information, ideas and thoughts transmitted by the sender. He can be a listener, observer or attendee. It is important to note that the receiver perceive or understand exactly what the messages he/she is receiving. This way communication is said to be effective.

A feedback/response is the message that the receiver returns to the sender. It can either be verbal or non-verbal or both. If the feedback or response matches to the message being relayed, then it is said that the message is interpreted correctly. This way, the sender becomes the receiver who is required to interpret and respond as well.

Importance of Effective Communication to Nurse-Client Relationship.

Effective communication is very important in nurse-client relationship. Nurse-client relationship is referred to by some as interpersonal relationship, by others as therapeutic relationship and by still others as helping relationship.

The nurse-client relationship is professional and therapeutic. It ensures the client’s needs are first and foremost. It exists to meet the needs of the client, not the needs of the nurse. It is always the nurse who is responsible for establishing and maintaining boundaries with clients, regardless of how the patient behaves (College of Registered Nurses of British Columbia).

Effective communication is used to gather assessment data, to teach and influence, and to express caring and comfort to the clients. Nurses who communicate effectively gets better information about the client’s problem and be able to identify and implement better interventions or nursing care that promotes fast recovery, health and wellness. 

There are five components to the nurse-client relationship: trust, respect, professional intimacy, empathy and power. Regardless of the context, length of interaction and whether a nurse is the primary or secondary care provider, these components are always present. 

1. Trust. Trust is critical in the nurse-client relationship because the client is in a vulnerable position. Initially, trust in a relationship is fragile, so it’s especially important that a nurse keep promises to a client. If trust is breached, it becomes difficult to re-establish.
2. Respect. Respect is the recognition of the inherent dignity, worth and uniqueness of every individual, regardless of socio-economic status, personal attributes and the nature of the health problem. 
3. Professional intimacy. Professional intimacy is inherent in the type of care and services that nurses provide. It may relate to the physical activities, such as bathing, that nurses perform for, and with, the client that creates closeness. Professional intimacy can also involve psychological, spiritual and social elements that are identified in the plan of care. Access to the client’s personal information also contributes to professional intimacy. 
4. Empathy. Empathy is the expression of understanding, validating and resonating with the meaning that the health care experience holds for the client. In nursing, empathy includes appropriate emotional distance from the client to ensure objectivity and an appropriate professional response. 
5. Power. The nurse-client relationship is one of unequal power. Although the nurse may not immediately perceive it, the nurse has more power than the client. The nurse has more authority and influence in the health care system, specialized knowledge, access to privileged information, and the ability to advocate for the client and the client’s significant others. The appropriate use of power, in a caring manner, enables the nurse to partner with the client to meet the client’s needs. A misuse of power is considered abuse.

Barriers of Communication

Barrier of communication is the difficulties faced when people attempt to communicate with each other. There are many types of barriers of communication; among the most common types are language, religion, cultural background, gender, interpersonal, physical, and emotional.

For the past four months in Diploma in Nursing in SEGI College our group has identified few barriers. Though we live in the same country yet we are different with each other in terms of religion, place we live in and we have foreigner classmates.

1. Language. This the main barrier in communication faced by our foreigner classmates. Most of our classmates does not understand and speaks English so that interaction and communication is less. Students who are able to communicate in English interacts more with each other and likewise students who only speaks in Bahasa Malaysia tends to interact with themselves too and less with non-Malaysian classmates.
2. Cultural. Malaysia is known for being a multiracial country. Chinese, Indian, Malays has their own culture which has been kept and handed down from previous generation. Though we have been living in this country since birth yet we hold our respective culture and in one way or another make us to be clannish not to mention our foreign classmates. Obviously, our foreigner classmates are trying to adapt, adjust and fit in themselves. However, from time to time we all bond each other.
3. Religion. This area is not much of an issue since in this country we highly respect each others religion. Christian, Islam, Hindu and Buddhist are free to practice their respective religious rights.
4. Interpersonal and Attitude. Though this is not included in the question, they would love to add this type of barrier because they feel that this is one of the most top barriers in communication. Each of them has different types of family upbringing, and lifestyle. We have different attitudes, likes and dislikes and some students have prejudices which affect effective communication or interaction within and outside the classroom. Students who show their bad attitudes have fewer friends in class and few only likes to communicate with them.  Others who do not like other classmates do not like to interact and communicate with them too for some other reasons.

Ways to overcome barriers of communication to make communication and interaction more effective. Our group has identified the following ways to overcome the above barriers of communication and use them in order to facilitate effective communication.

1. Work at improving English and Bahasa Malaysia languages. These take knowledge and work. Those students who less speaks English should work out hard on this. Constant reading, improves vocabulary, and or have English tutorial if necessary. Besides English is the medium of instruction in the class so it is very important. Those foreigner students should learn Bahasa Malaysia either through tutorial, seek help from other classmates for translation and or do self help study.
2. Use simple words to convey the message. Make simple sentences that are easy to understand either in writing or speaking.  Everyone hates bombastic words. So keep it simple and easy to understand.
3. Develop the skill of cross-cultural communication. Here are some skills we need to develop to have the skill in cross-cultural communication, to wit:

• Know yourself: Identify your attitudes, your opinions, your likes, your dislikes, your prejudices, your degree of personal ethnocentrism (the tendency to believe that one's ethnic or cultural group is centrally important, and that all other groups are measured in relation to one's own) and the biases that we all carry around.
• Take time: Listen to the other person and allow him or her to accomplish their purpose. Don't jump to conclusions. Some times we finish the thoughts and ideas of the other person before he or she has finished talking.
• Encourage feedback: Feedback allows communicators to correct and adjust messages. Without feedback we cannot have agreement. Don't be afraid of silence. It could be the appropriate feedback at times.
• Develop empathy: The greater the difference between us and others, the harder it is to empathize. To develop empathy we must put ourselves in the other person's place. By becoming more sensitive to the needs, values, and goals of the other person, we overcome our ethnocentric tendencies.
• Seek the commonalities among diverse cultures: Despite our cultural differences we are all alike in many ways. We need to seek that common ground to establish a bond between ourselves and the rest of humanity. Although our own ethnocentrism might have hindered us from getting to know people from other cultures, let us be more than ever committed to help ourselves and others overcome the barrier that culture creates. Let us endeavor to minimize the occurrences of cross-cultural misunderstandings as we develop the attitudes and the skills that are needed to communicate cross-culturally (Dori Kelsey).

REFERENCES

Berman, Audrey, Erb, Glenora Lea, Kozier, Barbara, and Snyder, Shirlee. 2008. Fundamentals of Nursing: Concepts, Process, and Practice. New Jersey: Pearson Education, Inc., 8th Edition, 460 – 483.

College of Registered Nurses of British Columbia. Nurse-Client Relationship. Copyright CRNBC/Nov. 2006. Available online: www.cmbc.ca (accessed November 13, 2009).

Dori Kelsey. Culture as a Barrier to Communicate. Available online: http://ezinearticles.com/?Culture-As-A-Barrier-To-Communication&id=55341 (accessed November 08, 2009).

Bernard L. Erven. Overcoming Barriers To Communication. Department of Agricultural, Environmental, and Development Economics, Ohio State University. 2002. Available online (accessed November 08, 2009).

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