Reproductive Health Nursing | Reflection

Reproductive Health Nursing | Reflection One of the important domains of nursing care is to counsel the clients to promote their health and well-being. Counseling can be done for different purposes including personal hygiene antenatal care, and Family planning. Counseling about family planning is a challenging skill which is learnt by nurses during their training period and later on they use their skill as one of the essential parts of their job to ensure that client’s reproductive health is maintained. During my reproductive health community rotation, I came a cross with a 33 year old female, having 3 children and was living with her husband and in laws. I started my interview by greeting her and her family members and started doing family assessment by asking her about health status of the family members. During the interview, I came to know that the lady has one son and two daughters with the gap of hardly one year. Due to such little space between the children, the mother was not able to breast feed her children in an appropriate way. As I moved further during the interview and tried to explore the reason of least gap between her children. She explained this phenomenon by saying that however she used the contaceptive pills and injections to space her upcomimg pregnancy but the usage was not appropriate and she could not continue the pills and injections due to side effects. Due to this interrupted usage of short term contarceptive methods, she ended up with a preganncy without a n appropriate gap. Moreover, based on literature it has been found that shor term methods like condoms, injections and pills are prone to failure during typical usage and due to incorrect usage (Kost, Singh, Vaughan, Trussell, Bankole, 2008), while failure of long term methods like depot preparations or intrauterine devices is less and these methods are safe, with few side-effects and have with high continuation rate (Searle, 2014). There are multiple reasons for method failure including incorrect or inconsistent usage or uncertain effectiveness of the chosen method (Trussell Portman, 2013). When I asked her future plans about the usage of family planning methods, she was found to be very willing and ambitious for using appropriate methods for planning her next pregnancy with an appropriate gap. However, I got confused for a moment and became hesitant about discussion on such sensitive topic with my client but I advised her to use male method (condom) and she said her husband had been using this method but it was also not that much effective. As she said this sentence, my level of confidence went down and I got diverted from the actual topic of interest and started asking her about other health problems. In this way, the interview with client ended and I recognized that I was unable to help my client. After coming back from this community rotation, on one hand, I was happy to found a cooperative client who helped me to complete the assessment form and on the other hand, I was dissatisfied as I wasn’t able to ease my client to resolve her concern. Although, I was aware about family planning methods that might had helped my client but my counseling skills were not up to mark, therefore I could not help my client to develop insight for her problems. Furthermore, I could not prove to be a helpful person for her family as I could not address the needs of the family despite knowing that the client was supposed to be counseled for family planning in an appropriate way. Although, the concept of holistic approach for a client is comprehensible from theoretical aspect but sometimes it becomes difficult to apply the same concept in real life. This meeting with my client helped me to reflect on my limitations to assess the needs and counsel the family in an appropriate way. When I reflected , I identified several reasons of inappropriate counseling. The important and foremost reason was that it was my first experience therefore I wasn’t enough confident about the appropriate way of counseling particularly for such sensitive topics like Family Planning. In addition to this, I also found that before counseling the clients on such sensitive topics, one need to have appropriate skills and mastery which were lacking in me during the time of interview. I also realized that I had advised mother to use a family planning method which was not basically counseling rather a suggestion which was not enough to develop insight in my client about her problem. Secondly, I was not aware about different types of family planning methods, therefore I could not convince my client to use the methods which were suitable for her as I had not learned much about family planning and nor I have visited any family planning center at that point in time. Moreover, being a stude nt I was not comfortable to discuss such issues with my client which was related to reproductive and sexual health. In addition to this, I should have built strong rapport with my client that would have definitely assisted me to resolve the concern of my client. Apart from this, I should have allowed my client to deal with her feelings and make her own informed choices. This could have been supported by in-depth assessment of my client regarding the use of short term methods like pills, condoms and injections. This could have helped me to do a root cause analysis of method failure and which in turn would have helped me to come up with suitable solutions for her. I could have taken support from my theory class content regarding family planning before setting time with the client in the community. Moreover, I should have involved the husband during the counseling because pregnancy planning is not entire responsibility of woman herself but it is the joint responsibility of husband and wife. The support from partner is very important for adapting any contraceptive method. Quality of couple’s relationship and inter-spousal communication and its effect on contraceptive use has also been supported by literature (Akanbi,et al., 2011). Moreover spousal communication has been identified as a good predictor of contraceptive use and fertility preferences (Link, 2011). Secondly, the involvement of expert counselor of family planning would have become an excellent approach and I should have taken some ideas or skills from my reproductive health faculty before visiting the client herself. Besides this, integrated counseling frameworks of family planning such as GATHER or REDA frameworks could have applied practically in the community (The Acquire Project, 2008). These frameworks guide the health care providers to explore the problems of client systematically without breeching their confidentiality. Moreover, it also helps clients to make informed choices for themselves after having the in-depth knowledge about the suitable family planning methods. Due to my insufficient knowledge and experience, I could not apply these frameworks practically. Moreover, I should’ve done a mock exercise of counseling by taking help from my faculty who must have helped me by providing a platform for mock before going to community. For future, I would try to do the in depth assessment of the needs of a client by involving spouse as well. Moreover, I would try to get the expert opinion regarding family planning counseling by integrating different approaches of family planning counseling. This would enhance my knowledge about family planning counseling skills. Additionally, I would try to discuss such sensitive issues with the client by having enough knowledge about the family planning methods. I would also try to build a strong rapport with the client in order to discuss the issues related to sexual and reproductive health very openly and freely. In conclusion, I was very much satisfied because I was able to reflect on the whole event and also identified my limitations. This whole reflection and critical thinking helped me to develop future plan which would assist me in future to counsel the women regarding family planning methods in an appropriate way. Skilled Labour: Types and Shortage in Malaysia Construction Skilled Labour: Types and Shortage in Malaysia Construction The skilled labour in the construction industry generally refers to those who were being trained within a long period and they have brought some specialized technical industry skills in advancing the construction projects. Normally the works requiring the labour who has high degree of manual skill. The labour can be considered as a skilled labour if they are able to fulfill the requirement. Types of Skilled Labour According to the Construction Industry Skill Standards, CIDB (1998), there are many types of skilled labour. The following types are: Concretor Plasterer Bar Bender Carpenter Tiler Bricklayer Scalffolder Mobile Crane Operator Tower Crane Operator Earthwork Plant Operator Concretor A concretor builds the concrete structures parts such as columns, beams, floors and walls. The concrete can be mixed by hand or in concrete mixer or utilize ready-mixed concrete. The duties shall include the following: Identify materials for concrete mixture Pour concrete into formwork Mix concrete Place and compact concrete Perform curing of concrete Plasterer The duties of a plasterer at level 1 are to apply one coat of various kinds of plaster to walls as a finishes. The other duties include the following: Apply cement plaster to flat wall Apply cement render finish coat to flat walls Apply cement plaster to internal and external angles Apply finish coat to internal and external angles At level 2, they are necessary to apply a protective and decorative covering of plaster or render to the surfaces of building. The other duties include the following: Prepare overhead surfaces of plastering Fixing wire mesh to exterior surfaces before plastering Install plaster cornice and mouldings Plastering to overhead surfaces Apply granolithic or textured finish Bar Bender After cut and bend the reinforcement bars then bar benders are try to fix them into the forms of concrete. They also have to combine the bars together with wires or fasteners or by welding. After that, place the bars in forms and fixes them in position of reinforces concrete with wire mesh. The others duties include the following: Prepare tools and materials Fabrication of steel Install steel bars and wire mesh Carpenter The works include cutting, notching, boring, sinking, pelleting, fitting, trimming, mitreing, halving, morticing, tenoning, dovetailing, scarfing and wedging and for all ends, splayed edges, short lengths and temporary supports. The others duties include the following: Prefabricated the forms and fixes them into the right position Set out the correct position for fixing the forms Prepare any temporary support for the forms Dismantle the forms Tiler A tiler at level 1 has to place tiles to surface walls and floors according to specified designs which may include the process of applying plaster coat and cement mortar layer. The tiles shall be laid in rows and tapped them into place. Next, align the rows of tiles by using the spirit level. He also requires lying paving stones, bricks, and wood blocks. The others duties include the following: Apply finish coat to floor rendering Apply screed to receive tile Prepare vertical backing surface for wall tiling Set out and lay tiles on walls and floors Perform rendering and apply backing surface to lay the floor tiles Set out and lay paving on base During level 2, the tasks of a tiler will be more complicated. The tiler has to set more complex mosaic panels on walls, prepare and sets marble blocks, installs and repairs the parquet flooring and applies terrazzo finish to floors. The others duties include the following: Set out and lay tiles to soffit Set out and lay parquet and polyvinyl chloride tiles Set out and lay cast in-situ terrazzo Fix tiles to a curved wall Spreading and levelling of mortar mix Cutting and trimming units Perform polishing and grinding Bricklayer A bricklayer is responsible to lay bricks and blocks (except stones) by using various kinds of bonds in order to form the walls, partitions, arches and other structures at level 1. The others duties include the following: Worksite preparation Construct opening of brick wall Construct concrete masonry structures Construct attached and isolated pier They also work for more complex decorative structures at level 2 which may include repair to existing brickwork. The others duties include the following: Construct brick steps Construct glass block panel Construct curved wall Construct hollow block reinforced wall and column Construct complex arch Scaffolder A general scaffolder performs his basic skills and techniques for level 1. A scaffolder is to erect and dismantle various types of metal scaffolding such as platforms, upright and horizontal members. The others duties include the following: Selection and inspection of equipments Erection and dismantling of scaffold Maintenance of scaffold A tube and coupler scaffolder at level 2 is to erects and dismantle metal scaffolding which also include the following: Cantilevered and spurred scaffolds Cantilevered crane loading platforms Mast climbers Additional remarks: This standard applies to every metal tube scaffolding not exceeding 40 m in height and prefabricated scaffolding not exceeding 15 m in height. A Professional Engineers verification is requiring for the design and construction of scaffolding beyond those heights. Competency as general Scaffolder is an additional requirement in order to comply with these standards Mobile Crane Operator A mobile crane operator operates crane mounted on wheel or tracks which can be driven under his own control. The others duties include the following: Pre-operational check Post operational check Maintain the operation and maintenance of crane Tower Crane Operator As a tower crane operator needs to operate the crane that consists of a turning metal tower which moves on rails and equips at the top with a mobile or fixed jib. Normally the crane is supported the hoisting equipment. The others duties include the following: Pre-operational check Post operational check Operation and maintenance of the crane Earthwork Plant Operator An earthwork plant operator has to carry out the power driven machine mounted on wheels or crawler tracks equipped with all the movable shovel, grad bucket and etc. This machine is used during the excavation and motion of the earth, rock, and sand. The others duties include the following: Pre-operational check on machinery Ensure the operation of the equipment Factors that caused the Labour Shortage Problem Introduction The problem of labour shortage has being existed since 1970s. According to the Master Builders Association Malaysia (MBAM), with the implementation of 9th Malaysia Plan (9MP) and the letters of intent has been awarded to get projects under way, Malaysian construction industry has began to surface problem of labour shortage. We must pay more attention on the serious impacts that caused by this problems and appropriate actions must be taken at once in order to solve this problem effectively. Factors There are several factors that influence to the poor participation of labour in construction industry. The strong growth of the economy, poor image, lack of training system, large number of foreign labour were contribute to the shortage of labour in construction industry. Those factors are being listed below and adopted from the MBAM report, previous newspaper and the articles. Working Conditions and environment Most of the labours in the construction industry are worked in full time, and sometimes the working hours are more than 40 hours in a week. In 2008, there are about 18% of labour have worked 45 hours or more per week. They have to work until midnight if there are under special condition. They have no rest day in weekends or even public holiday. The construction labour usually does not get paid if they are unable to work due to the inclement weather. There are less people willing to participate in the construction works because of the working environment and the condition. According to MBAM report, the working environment for the skilled labour in the construction industry can be considered as not good enough. For instance, the location of the construction site is unstable and many of the buildings are only use for temporary purpose. So, they have to often move their dwelling place once the construction project has been completed. Therefore, the environment of the site is getting the severe air pollution and it will affect our health. In addition, some of the construction site is located at undeveloped area that lack of basic amenities. Other than that, majority of labour are work direct expose to the sun in the construction site. There are not so many people that capable work under this environment. Poor Welfare in Construction Industry Poor welfare is one of the factors that caused problem of labour shortage. This problem will occur when there are irresponsible contractors omitted to take out welfare such as SOCSO or EPF. Basically, welfare shall provide to the labour in accordance with the requirements. For example, contractors should provide comfortable temporary accommodations for the labour who works at outstation, but the contractors never fulfil their obligations and thus provide them a dirty and small place. Most of the people will take care what are the welfare they can get from the company. Once they cant get any protection from the company, they are not willing to join the construction industry. Government Policy in restricted the number of foreign labour Moreover, government policy in restricted the numbers of foreign labour join into construction industry is also one of the factors that caused the labour shortage problem happen. According to the Human Resources Minister Datuk Dr Fong Chan Onn said in Star Newspaper on 19 July 2000, the Malaysia planned to reduce the number of foreign labour drastically over the coming next few years. As a government policy that accordance with Berita Harian government policy on 29 February 2000, Deputy Prime Minister, Datuk Seri Abdullah Ahmad Badawi, it stated that one company not allowed hiring foreign labour which more than one third of their total number of company staff and each labour will not require to work more than eight years in Malaysia. So far according to The Sun on 1st July 1999, Prof. Datuk Abdul Rahman Abdullah, chief executive of Construction Industry Development Board (CIDB), there are not much Malaysian are interested to join in construction industry and almost 75% labours are come from other countries. Further to this, according to Deputy Prime Minister Tan Sri Muhyiddin Yassin on 20th May 2010, Malaysia will raise the levy on foreign workers in 2011, after having deferred the implementation last year. He said that the quantum of increase would vary based on the specific sectors which employ the foreign workers. After that, the policy is to reduce our dependency on foreign workers and this will be done in stages in the long run. According to the 2006/2007 Economic Report released on September 2006, Malaysia aims to reduce the number of foreign workers in the country from 1.84 million to 1.5 million by 2010. It is envisaged that by that time, only 200,000 foreign workers will remains in the construction industry. Thus through this government policy, Malaysias construction industry will have a big problem on this labour shortage. Sources: Ministry of Home Affairs Malaysia, personal correspondence. Department of Immigration, Pusat Bandar Damansara, Kota Kinabalu Kuching the Deaprtment of Labour Sarawak (letter from the department to writer dated 14 Mac 2005) Economy of Malaysia The economic that Malaysia has seen for last decade is one of the leading causes of the worker shortage. The economic always play an important role in the need for labour. There are many construction activities will be carried out during the peak period of economy, therefore the need for the labour is relatively become higher. On the contrary, the problem of labour shortage will occur when the economic downturn because the construction works will be delayed and suspended where the client is not capable to complete the progress payments. The labour cannot get the daily income which fixed by the client. Thus many of them will migrate to the other countries where necessary the construction labour work at their construction industry. Furthermore, while the economic is recovered, we may also face the problem in recruiting the workforce in construction industry since majority of them are already adapted their new working environment in other countries. Insufficient training system In Malaysia, the professional basic training is being deficiency. According to the 2005 Labour Shortage Action Plan, it became evident that the labour shortage problem is multilateral and has consequence from a wide range of interlinking factors. In addition, the learning and the training system that introduced by construction industry are not flexible to meet the changes of the progress of construction works at once. There is no opportunity for the unskilked labour being trained so that only the skilled labours are capable to carry out the more complicated works during construction works. According to the research information, it reveals that only 45% of construction companies involve learning and development training after all the major decisions have been made or during the final stages of the project. A further 9% do not involve in learning and development training at all. Other 27% of companies involve learning and developments training at the inception planning stages and in a further 19% of are introduced it at the initial implementation stage. Young Generations unwilling to take part in construction industry The poor image of construction industry can be defined into 3D syndrome attached to the industry. There are dirty, dangerous and difficult. In respect on this 3D syndrome, local youth would rather be unemployed despite working in the construction industry. The construction industry was considered dirty and it is unsatisfactory because most of the construction site is located at the undeveloped area and normally lack of basic amenities or public services. Most of the facilities which located at the construction site do not have well practices and also not comply under the requirements of governing construction activities. In Malaysia, there are minor issues those accidents on construction site. It is not only involve labour, but also cause badly injured and even death to the general public. All of this accident has results on poor participation of labour in construction industry. In certain circumstances, the construction activities can be very complicated due to the differentiation in type of the project as well as the surrounding project environment. Majority of youths are difficult to perform well during construction works. Moreover, it has the difficulties in maintaining the cooperative between the staff and the project team members. The youngsters with high level of educations are prefer to work under a good working condition such as office work rather than to work at site that always exposed to the sun.