The Year of The Nurse & Midwife – The Innovative Pathway.

The Year of The Nurse & Midwife – The Innovative Pathway.
Ayinla Daniel, RN.
(Care City).

“Nurses are better placed/positioned by virtue of their professional roles to make more lasting impacts through health care innovation, this is so because of their proximity to the patient and their mandatory interaction with other health care professionals in the health team; they serve as a compulsory link between the patient/client and the health care team.” – Ayinla Daniel, RN.

“Modern nursing may be unrecognisable from the work of Florence Nightingale, but she would burst with pride at how far our profession has come. Marking two hundred years since her birth with this dedication is extremely fitting.

Dame Donna Kinnair, the Royal College of Nursing’s Acting Chief Executive and General Secretary.

I love this theme, it evokes a form of excitement, its energy, the simple but deep message it tries to pass across to us, yes us, Nurses.

It’s her 200th birthday, if she was still alive, I wonder how she will feel about Nursing today. Nightingale, a true leader, full of inspiration. Geneva decided to celebrate her throughout the year 2020, what an awesome move, and an inspiring one.

The coming year should inspire nurses to do more, more for their profession and more for their worlds. The decision of the World Health Organisation to tag next year the year of the Nurse and Midwife is a brilliant move.

It’s all about universal health coverage, the caption; “Nursing Now!” Invokes a sense of urgency, that the time is always now.

It’s going to be an exciting year for us all, as we delve into the world of health care innovation; learning together and working hard to make impacts on our world!

I believe it is everyone’s responsibility to think of ways to improve life on earth – it should be a daily exercise, just spending time thinking of various ways in which life on earth can be made better.

Efforts towards improving universal health coverage is what has birthed the nursing now campaign, which to me is a lifetime campaign that has no end.

We may not do complex brain surgeries or earn super salaries, but we are stationed closer to the heart of health care – the patient/client, without who there is no health to take care of. We are amazing.

In the coming year, there are vital questions we must all ask our selves and the answers to these questions will build a foundation upon which we can begin to operate.

Photo credit: Unsplash

Let’s Start Asking Some Questions.

What is innovation? Do Nurses really understand the concept of health care innovation? Especially Nurses in Africa. What are the clinical roles of the registered nurse? How can technology improve the role of the registered nurse – making healthcare delivery effective and efficient. What are the new techniques for solving clinical problems? Remember that no problem-solving technique is 100% efficient, so this lack or deficiency creates ample room for improvements.

We all must take deeper inquisitive looks at the professional roles of Registered Nurses from all specialities, study these roles, fully understand them, in so doing we are getting familiar with our responsibilities, which arms us with the necessary knowledge to launch forth into innovation!

Through innovation, we can preserve our professional roles as Registered Nurses, as we work tirelessly to improve on what we do, as we develop and get better, discovering novel methods and ways, our profession is preserved, we become responsible, showing the health team that we are here for serious business.

The New Trends.

In this new year, it is paramount that Nurses begin to get familiar with Artificial Intelligence and other new health care technologies.

Care City is determined to expose Registered Nurses in Nigeria to the realities of health care innovations that are arising from developed countries. We want to understand these technologies, imitate them, improve on them and articulate them into real-life practice! This is among our biggest goals and we believe we can do it!

Ranging from artificial blood to robotic surgeries and mechanical nurses, nanotechnology, Gene engineering, organ transplant, the utilisation of blockchain in health care, the list is endless, enormous are the technological opportunities that abound, that it will be abnormal for anyone to remain bored or jobless, there’s a whole lot to do.

It’s all about universal health coverage.

This is the ultimate goal! How more people can get access to better health care services. What do you think?

Ready to work

As we step into the year of the Nurse and Midwife, I hope your hearts are ready to work! It’s time to put those minds to work. Look around you, look deeply and you will definitely see a problem that needs the innovative touch.

Innovation is creativity! It seeks to reveal to us the inner capabilities that lie dormant within our hearts. I believe you are ready to show the world the ingenuity that resides in you, the problem-solving skills, the critical thinking ability and above all your love for what you do.

It is inspiring what the World Health Organization, headed by Dr. Tedros Adhanom Ghebreyesus, the International Council of Nurses headed by Annette Kennedy are doing through the Nursing Now Campaign to improve the image of the nursing profession, it sure is working, we only need to be more deliberate, especially in Africa, where there are still areas that need urgent attention, in respite to the level of health care services available there and nurses are the most important tools that can ensure universal health coverage.

Let’s Innovate!

Yours In the school of Innovation, Learning and Excellence.

Ayinla Daniel, RN, Rctn.

(Team Care City).

© Care City. 2019

Health Technology News Today: Nanotechnology, what it holds for the future of health care.

On Health Technology News Today, we will enjoy news about Nanotechnology. This featured article has a whole lot of relevant information about nanotechnology.

In it, you are bound to discover enough up to date information about nanotechnology and its possible uses in health care. You had be amazed at how much nanotechnology can contribute to health care.

Ayinla Daniel, RN.

Source: medicalnewstoday.

Nanotechnology, the manipulation of matter at the atomic and molecular scale to create materials with remarkably varied and new properties, is a rapidly expanding area of research with huge potential in many sectors, ranging from healthcare to construction and electronics. In medicine, it promises to revolutionize drug delivery, gene therapy, diagnostics, and many areas of research, development and clinical application.

This article does not attempt to cover the whole field, but offers, by means of some examples, a few insights into how nanotechnology has the potential to change medicine, both in the research lab and clinically, while touching on some of the challenges and concerns that it raises.

What is Nanotechnology?

The prefix “nano” stems from the ancient Greek for “dwarf”. In science it means one billionth (10 to the minus 9) of something, thus a nanometer (nm) is is one billionth of a meter, or 0.000000001 meters. A nanometer is about three to five atoms wide, or some 40,000 times smaller than the thickness of human hair. A virus is typically 100 nm in size.

The ability to manipulate structures and properties at the nanoscale in medicine is like having a sub-microscopic lab bench on which you can handle cell components, viruses or pieces of DNA, using a range of tiny tools, robots and tubes.

Scientist's hand holding molecular model of graphite sphere

Manipulating DNA:
Therapies that involve the manipulation of individual genes, or the molecular pathways that influence their expression, are increasingly being investigated as an option for treating diseases. One highly sought goal in this field is the ability to tailor treatments according to the genetic make-up of individual patients.

This creates a need for tools that help scientists experiment and develop such treatments.

Imagine, for example, being able to stretch out a section of DNA like a strand of spaghetti, so you can examine or operate on it, or building nanorobots that can “walk” and carry out repairs inside cell components. Nanotechnology is bringing that scientific dream closer to reality.

For instance, scientists at the Australian National University have managed to attach coated latex beads to the ends of modified DNA, and then using an “optical trap” comprising a focused beam of light to hold the beads in place, they have stretched out the DNA strand in order to study the interactions of specific binding proteins.

Nanobots and Nanostars

Meanwhile chemists at New York University (NYU) have created a nanoscale robot from DNA fragments that walks on two legs just 10 nm long. In a 2004 paper published in the journal Nano Letters, they describe how their “nanowalker”, with the help of psoralen molecules attached to the ends of its feet, takes its first baby steps: two forward and two back.

One of the researchers, Ned Seeman, said he envisages it will be possible to create a molecule-scale production line, where you move a molecule along till the right location is reached, and a nanobot does a bit chemisty on it, rather like “spot-welding” on a car assembly line. Seeman’s lab at NYU is also looking to use DNA nanotechnology to make a biochip computer, and to find out how biological molecules crystallize, an area that is currently fraught with challenges.

The work that Seeman and colleagues are doing is a good example of “biomimetics”, where with nanotechnology they can imitate some of the biological processes in nature, such as the behavior of DNA, to engineer new methods and perhaps even improve them.

DNA-based nanobots are also being created to target cancer cells. For instance, researchers at Harvard Medical School in the US reported recently in Science how they made an “origami nanorobot” out of DNA
to transport a molecular payload. The barrel-shaped nanobot can carry molecules containing instructions that make cells behave in a particular way. In their study, the team successfully demonstrates how it delivered molecules that trigger cell suicide in leukemia and lymphoma cells.

Nanobots made from other materials are also in development. In a recent paper in the journal ACS Nano, they describe how drug-loaded nanostars behave like tiny hitchhikers, that after being attracted to an over-expressed protein on the surface of human cervical and ovarian cancer cells, deposit their payload right into the nuclei of those cells.

The researchers found giving their nanobot the shape of a star helped to overcome one of the challenges of using nanoparticles to deliver drugs: how to release the drugs precisely. They say the shape helps to concentrate the light pulses used to release the drugs precisely at the points of the star.

Nanofactories that Make Drugs In Situ

Scientists are discovering that protein-based drugs are very useful because they can be programmed to deliver specific signals to cells. But the problem with conventional delivery of such drugs is that the body breaks most of them down before they reach their destination.

But what if it were possible to produce such drugs in situ, right at the target site? Well, in a recent issue of Nano Letters, researchers at Massachusetts Institute of Technology (MIT) in the US show how it may be possible to do just that. In their proof of principle study, they demonstrate the feasibility of self-assembling “nanofactories” that make protein compounds, on demand, at target sites. So far they have tested the idea in mice, by creating nanoparticles programmed to produce either green fluorescent protein (GFP) or luciferase exposed to UV light.

The MIT team came up with the idea while trying to find a way to attack metastatic tumors, those that grow from cancer cells that have migrated from the original site to other parts of the body. Over 90% of cancer deaths are due to metastatic cancer. They are now working on nanoparticles that can synthesize potential cancer drugs, and also on other ways to switch them on.

Researcher working with optical instrument in a nanotechnology laboratory.


Nanofibers are fibers with diameters of less than 1,000 nm. Medical applications include special materials for wound dressings and surgical textiles, materials used in implants, tissue engineering and artificial organ components.

Nanofibers made of carbon also hold promise for medical imaging and precise scientific measurement tools. But there are huge challenges to overcome, one of the main ones being how to make them consistently of the correct size. Historically, this has been costly and time-consuming.

But last year, researchers from North Carolina State University, revealed how they had developed a new method for making carbon nanofibers of specific sizes. Writing in ACS Applied Materials & Interfaces in March 2011, they describe how they managed to grow carbon nanofibers uniform in diameter, by using nickel nanoparticles coated with a shell made of ligands, small organic molecules with functional parts that bond directly to metals.

Nickel nanoparticles are particularly interesting because at high temperatures they help grow carbon nanofibers. The researchers also found there was another benefit in using these nanoparticles, they could define where the nanofibers grew and by correct placement of the nanoparticles they could grow the nanofibers in a desired specific pattern: an important feature for useful nanoscale materials.

Lead is another substance that is finding use as a nanofiber, so much so that neurosurgeon-to-be Matthew MacEwan, who is studying at Washington University School of Medicine in St. Louis, started his own nanomedicine company aimed at revolutionizing the surgical mesh that is used in operating theatres worldwide.

The lead product is a synthetic polymer comprising individual strands of nanofibers, and was developed to repair brain and spinal cord injuries, but MacEwan thinks it could also be used to mend hernias fistulas and other injuries.

Currently, the surgical meshes used to repair the protective membrane that covers the brain and spinal cord are made of thick and stiff material, which is difficult to work with. The lead nanofiber mesh is thinner, more flexible and more likely to integrate with the body’s own tissues, says MacEwan. Every thread of the nanofiber mesh is thousands of times smaller than the diameter of a single cell. The idea is to use the nanofiber material not only to make operations easier for surgeons to carry out, but also so there are fewer post-op complications for patients, because it breaks down naturally over time.

Researchers at the Polytechnic Institute of New York University (NYU-Poly) have recently demonstrated a new way to make nanofibers out of proteins. Writing recently in the journal Advanced Functional Materials, the researchers say they came across their finding almost by chance: they were studying certain cylinder-shaped proteins derived from cartilage, when they noticed that in high concentrations, some of the proteins spontaneously came together and self-assembled into nanofibers.

They carried out further experiments, such as adding metal-recognizing amino acids and different metals, and found they could control fiber formation, alter its shape, and how it bound to small molecules. For instance, adding nickel transformed the fibers into clumped mats, which could be used to trigger the release of an attached drug molecule.

The researchers hope this new method will greatly improve the delivery of drugs to treat cancer, heart disorders and Alzheimer’s disease. They can also see applications in regeneration of human tissue, bone and cartilage, and even as a way to develop tinier and more powerful microprocessors for use in computers and consumer electronics.


A schematic illustration showing how nanoparticles or other cancer drugs might be used to treat cancer. This illustration was made for the Opensource Handbook of Nanoscience and Nanotechnology

What of the Future and Concerns Surrounding Nanomaterials?

Recent years have seen an explosion in the number of studies showing the variety of medical applications of nanotechnology and nanomaterials. In this article we have glimpsed just a small cross-section of this vast field. However, across the range, there exist considerable challenges, the greatest of which appear to be how to scale up production of materials and tools, and how to bring down costs and timescales.

But another challenge is how to quickly secure public confidence that this rapidly expanding technology is safe. And so far, it is not clear whether that is being done.

There are those who suggest concerns about nanotechnology may be over-exaggerated. They point to the fact that just because a material is nanosized, it does not mean it is dangerous, indeed nanoparticles have been around since the Earth was born, occurring naturally in volcanic ash and sea-spray, for example. As byproducts of human activity, they have been present since the Stone Age, in smoke and soot.

Of attempts to investigate the safety of nanomaterials, the National Cancer Institute in the US says there are so many nanoparticles naturally present in the environment that they are “often at order-of-magnitude higher levels than the engineered particles being evaluated”. In many respects, they point out, “most engineered nanoparticles are far less toxic than household cleaning products, insecticides used on family pets, and over-the-counter dandruff remedies,” and that for instance, in their use as carriers of chemotherapeutics in cancer treatment, they are much less toxic than the drugs they carry.

It is perhaps more in the food sector that we have seen some of the greatest expansion of nanomaterials on a commercial level. Although the number of foods that contain nanomaterials is still small, it appears set to change over the next few years as the technology develops. Nanomaterials are already used to lower levels of fat and sugar without altering taste, or to improve packaging to keep food fresher for longer, or to tell consumers if the food is spoiled. They are also being used to increase the bioavailablity of nutrients (for instance in food supplements).

But, there are also concerned parties, who highlight that while the pace of research quickens, and the market for nanomaterials expands, it appears not enough is being done to discover their toxicological consequences.

This was the view of a science and technology committee of the House of Lords of the British Parliament, who in a recent report on nanotechnology and food, raise several concerns about nanomaterials and human health, particularly the risk posed by ingested nanomaterials.

For instance, one area that concerns the committee is the size and exceptional mobility of nanoparticles: they are small enough, if ingested, to penetrate cell membranes of the lining of the gut, with the potential to access the brain and other parts of the body, and even inside the nuclei of cells.

Another is the solubility and persistence of nanomaterials. What happens, for instance, to insoluble nanoparticles? If they can’t be broken down and digested or degraded, is there a danger they will accumulate and damage organs? Nanomaterials comprising inorganic metal oxides and metals are thought to be the ones most likely to pose a risk in this area.

Also, because of their high surface area to mass ratio, nanoparticles are highly reactive, and may for instance, trigger as yet unknown chemical reactions, or by bonding with toxins, allow them to enter cells that they would otherwise have no access to.

For instance, with their large surface area, reactivity and electrical charge, nanomaterials create the conditions for what is described as “particle aggregation” due to physical forces and “particle agglomoration” due to chemical forces, so that individual nanoparticles come together to form larger ones. This may lead not only to dramatically larger particles, for instance in the gut and inside cells, but could also result in disaggregation of clumps of nanoparticles, which could radically alter their physicochemical properties and chemical reactivity.

“Such reversible phenomena add to the difficulty in understanding the behaviour and toxicology of nanomaterials,” says the committee, whose overall conclusion is that neither Government nor the Research Councils are giving enough priority to researching the safety of nanotechnology, especially “considering the timescale within which products containing nanomaterials may be developed”.

They recommend much more research is needed to “ensure that regulatory agencies can effectively assess the safety of products before they are allowed onto the market”.

It would appear, therefore, whether actual or perceived, the potential risk that nanotechnology poses to human health must be investigated, and be seen to be investigated. Most nanomaterials, as the NCI suggests, will likely prove to be harmless.

But when a technology advances rapidly, knowledge and communication about its safety needs to keep pace in order for it to benefit, especially if it is also to secure public confidence. We only have to look at what happened, and to some extent is still happening, with genetically modified food to see how that can go badly wrong.



Catharine Paddock, PhD.

Source: medicalnewstoday

Any medical information published on this blogsite is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.

Let’s Talk About Your First Nursing Job, Other Things and a little Dose of Motivation. 2 – 4 minutes read.

“Let’s Talk About Your First Nursing Job, Other Things and a Little Bit of Motivation,” Is a personal note to my brothers and sisters who are just leaving Nursing School. I decided to share it in bits so that it is easier for you to read and understand.

Photo credit

The feeling of finishing. At last, the end of the tunnel has embraced your weary shoulders. You have just finished your Basic Nursing Studies, (either you went through the diploma route or the degree).

The horrors of assignments, projects, seminars and presentations, the labours and sleepless nights during exam periods and the many times you have to wash your uniforms or scrubs (this one is for me), have all come to a temporal end (you will surely encounter more rigours when you start climbing the ladder of professional development; higher degrees, and the higher you go the more complex things get around you, but this basic foundation that your basic nursing studies give you is very pivotal to your career.

For those who went through the degree pathway, you are required to have a one-year internship programme, which introduces you to the “Weird world of Nursing.” While for those who went through the diploma path (like I did), you don’t have to go through another season of training, the structure of the 3 year R.N programme is practical intensive, so you are little bit more conversant with the world of Nursing, which I call weird for a reason (don’t ask me why).

Working on a job is very different from working in a school. In school, you were still a student, so you had supervisors, little responsibilities, and boundaries i.e, you were not qualified to do certain things ‘unsupervised,’ but now you are out of school, and you will work with less supervision, you will have more responsibilities to shoulder and in some settings, almost no boundaries. Welcome, my fellow colleagues to the wild! Yeah, I call it wild for a reason. (don’t ask me why).
In school, you were told a whole lot of stuff about working. A lot of good stuff, and in the little lab of your mind, you had already conducted a whole lot of experiments. You also had your expectations, glorious expectations. Well, sorry to tell you, buddies, you will be very disappointed by the time you start working, and for those of my friends in Nigeria, you guys will be “triply disappointed.” Well, this article is mainly for my friends in developing economies like ours, here in Nigeria.

Now, one of the first things that will and can definitely break your heart as a young graduate is “Your salary.” Yes, back in school you thought you would come out and get a very good job, that will immediately take care of your needs, and maybe the needs of a few relatives, but alas! Your first job may be nothing to write home about, except if you are lucky enough to get a very good job, which seldom happens that way. Many who do not have sponsors to help with further studies, have to really sit down and work hard. Your first salary might want to make you shed some tears, just take it easy, it all gets better (LOL!).

So, my first tip for you, don’t dream of “Big money.” {except you came into the profession with the only desire of making money} Instead think out of the box. Think of ways of improving your self. Get a skill if possible, try and learn new areas that many have not ventured into. Take your eyes away from money, horn your nursing skills, for the private sector in Nigeria, nurses who really survive are those that have been able to adapt to their new environment. Just keep improving, preparation meeting opportunity always begets success. Cherish your exposures and your experiences. Nursing in Nigeria is not encouraging, I must tell you, but that does not mean we should also sit down, enjoying the music of the pity party.

Another thing I would love to draw your young minds to is the issue of “Practice boundaries.” In school, you were definitely taught about “Nurses procedures” And “Doctors procedure.” Well, welcome to the wild, where nobody cares if you are a nurse or doctor, especially in Nigeria’s private health sector, these policies may survive in Government institutions, but out there, they don’t hold. Employers want to know what you can do. They want to pay less for more services. So, most of the time, you will find out that you are forced to learn basic medical skills, that are useful, and very important. But may I still caution you here my friends, whenever you do anything, always be very careful, still know your boundaries. Nursing Nigeria is still very young to allow Nurses practice independently, unlike some advanced countries that have Nurse practitioners who practice unhindered, either under the supervision of an experienced Physician or independently, this gives them more autonomy, allowing safe advance medical services to reach more people.

You must learn how to save. This takes us to another dimension of your first job, how to save. You are still very young (Maybe not all of us), and one lifesaving skill you must develop is the ability to save, no matter how little it is. Get financial applications that help you save, by deducting a particular specified amount of money from your account every month or at certain intervals. Many families today have very poor saving habits, and this deficiency is the major cause of financial struggles in many young families today.

You need to start learning good saving habits right from school. It is difficult, but I tell you, it surely worth’s it.
Aside from developing good saving habits, learn investment. Yes my friends, learn how to invest. Don’t just let the money sit there, begin learning how to invest, study investment packages, for those who have not started families yet, this period of your life is one that goes a long way to determine how the first phase of raising your family will look like.

Look for a partner. Well, maybe you were not expecting me to mention this, but this is very important. Guys, look for a woman who fits you, who suites your vision. Ladies, look for a man who knows you, who knows your virtue, a man who knows how to nurture you, you don’t want to end up with just anybody as a wife or husband, that is if you want to get married (LOL!).

This period is the time you begin to start considering your friends, begin to build relationships, cut away toxic ones and stick to healthy ones.

Read! I won’t forgive my self if I left this point out. You must stick to reading. Reading is one quality that has the single ability to stand you out. Nurses don’t read! They are amongst the most occupied human beings on earth. But that should not be a deterrent for you not to cultivate a good reading habit. Read stuff outside your profession, don’t be insular. Be eager to learn something new regularly, follow your local news and politics, be abreast with trends, don’t just remain stagnant.

Be involved in politics! Friends, we are poorly represented in the political climes of our countries national politics and other levels of leadership. Jump into politics, vie for leadership positions. Don’t allow anyone tell you “You are a woman.” No! “You are going to be actively involved in politics because you are a woman.” Many of us guys in nursing (I greet you all), and some fellow ladies, sing the anthem that nursing in Nigeria is not making giant strides, because of the ratio of men to women in the profession, well, this has an atom of truth in it but is not sufficient reason.

Women are built to respond to external motivation, and the women in Nursing today in Nigeria who are making waves are women who were able to motivate themselves, they defied every external limitation and went further.

Let us all come together as one body and motivate our selves. Those who are in positions of power should look for ways of introducing young active minds into leadership, people who know what to do when power is in their hands, and the young minds, don’t wait for external motivation before you make things happen, do it!

Well, there are other things you will definitely encounter when you start working, but these points are powerful enough to guide you through.

Okay then, let me end here today, if I have something else to tell you, you will definitely hear from me. (There is still a lot I would like to write about your first job as a registered nurse but will include it in the next part).

Together we can build the Nursing of our dreams.

Yours in the school of excellence.

Ayinla Daniel, RN.
(Team Care City)

Send us a mail @, we would love to hear from you.

Haemorrhoids and Its Management – A Short Review.


Haemorrhoids are swellings containing enlarged blood vessels found inside or around the rectum and anus (Lawrence A. 2018).

Haemorrhoid is an abnormal mass of dilated and engorged blood vessels in swollen tissue that occurs internally in the anal canal or externally around the anus that may be marked by bleeding, pain or itching and that when it occurs internally often protrude through the outer sphincter of the anus and when occurring externally may lead to thrombosis.( Webster M .2018).

Haemorrhoid are defined as the symptomatic enlargement and distal displacement of the normal anal cushions (Lohsiriwat V. 2017)

Haemorrhoid are dilated (enlarged) veins in the walls of anus and sometimes around the rectum usually caused by untreated constipation but occasionally associated with chronic diarrhoea (Shiel W.C 2016).

They are vascular structures in the anal canal in their normal state. They are cushions that help with stool control. They become a disease when swollen or inflamed.

According to (David B, 2011), the exact cause of hemorrhoid remains unknown. A number of factors which increase the pressure of abdomen are believed to be involved thus:
Constipation, diarrhea and sitting on the toilet for a long time, Pregnancy – increased pressure in the hemorrhoid tissue due to pregnancy may initiate hemorrhoid or aggravate existing ones, Chronic cough, pelvic floor dysfunction, obesity, genetics, absence of valve within the hemorrhoid angina etc.

According to Chen and Herbert (2010) approximately 50% to 66% of people have problems with hemorrhoids at some point in their lives, males and females are both affected with about equal frequency. Haemorrhoids affect people most often between 45 and 65 years of age. It is more common among the wealthy and outcomes are usually good.

The first known mention of the disease is from a 1700BC Egyptian papyrus

The signs and symptoms of haemorrhoids depends on the type present. Internal haemorrhoid often result in painless, bright red rectal bleeding when defecating.

External haemorrhoids often result in pain and swelling in the area of the anus. If bleeding occurs it is usually darker, symptoms frequently get better after a few days (David B, 2011).

Hemorrhoid can be diagnosed using physical examination, digital rectal examination, anoscopy, sigmoidoscopy etc (Chen and Herbert 2010).

Treatment of haemorrhoids can often relieve the mild pain, swelling and inflammation. Haemorrhoids can also be managed with home treatments such as: eating high fiber foods, use topical treatments, soak regularly in a warm bath or sitz bath, keep the anal area clean, do not use dry toilet paper, apply cold and take oral pain relievers.

Complications from hemorrhoids are rare, but can include; blood clots, bleeding, iron deficiency anemia (Webster M .2018).

Surgical removal of hemorrhoids is known as haemorrhoidectomy.

Classification of Hemorrhoids
Hemorrhoid are classified into two types according to David B. (2011).
•Internal hemorrhoid.
•External hemorrhoid.
•Internal Hemorrhoid.

Those that appear above internal sphincter (they originate above the pectinate line) are called internal hemorrhoid. This type lies within the rectum. It usually present with painless, bright red rectal bleeding during or following a bowel movement. The blood typically cover the stool (hematochezia) is on the toilet paper or drip into the toilet bowl (Brunner and Suddarths, 2014).

The stool itself is usually normally coloured. Other symptoms include mucus discharge, a perineal mass if they prolapsed through the anus, itchness and fecal incontinence.
Internal hemorrhoids are usually only painful if they become thrombosed or necrotic, if not they are usually painless.

According to Chen, Herbert (2010) internal hemorrhoids were classified into four grades based on the degree of prolapse.
• Grade I: No prolapse, just prominent blood vessels.
Grade II: Prolapse upon bearing down, but spontaneous reduction.
Grade III: Prolapse upon bearing down, requiring manual reduction.
Grade IV: Prolapse with inability to be manually reduced.

External Hemorrhoid: This type of hemorrhoid lies outside the external sphincter (Brunner and Suddarth, 2014).
If not thrombosed external hemorrhoids may cause few problems. However, when thrombosed, hemorrhoid may be very painful. Nevertheless, this pain typically resolves in two to three days.
The swelling may however, take a few weeks to disappear. A skin tag may remain after healing if hemorrhoids are large and cause issues with hygiene, they may produce irritation of the surrounding skin and thus itchiness around the anus (Dayton, Peter and Lawrence, 2016).

Haemorrhoids are vascular structures in the anal canal (Chen& Herbert, 2010). In their normal state, they are cushions that help with stool control. They become a disease when swollen or inflamed; the unqualified term “hemorrhoid” is often used to refer to the disease (Chen, Herbert, 2010).
According to Brunner and Suddarth’s (2014), hemorrhoids are dilated portions of veins in the anal canal.
Hemorrhoids are very common; nearby three out of four adults (50 years of age) will have hemorrhoids from time to time (Brunner and Suddarths, 2014).
Male and female are both affected with about equal frequency (between 45 – 60 years age).
It is mor e common among the wealthy.
Approximately 50% to 66% of people have problems with hemorrhoids at some point in their life (Lorenzo Rivero, 2019).
According to David B (2011), the exact cause of hemorrhoid remain unknown. A number of factors which increase the pressure of abdomen are believed to be involved thus:
Constipation, diarrhea and sitting on the toilet for a long time.
Pregnancy – increased pressure in the hemorrhoid tissue due to pregnancy may initiate hemorrhoid or aggravate existing ones.
Chronic cough, pelvic floor dysfunction, obesity, genetics, absence of valve within the hemorrhoid angina etc.
The signs and symptoms of hemorrhoid defers on the type present.
Painless bleeding during bowel movements you might notice small amounts of bright red 1“1blood on your toilet or in the toilet.
Itching or irritation in your anal region.
Pain (external hemorrhoid) or discomfort.
Swelling around the anus.
A lump near the anus, which may be sensitive or painful (may be a thrombosed hemorrhoid, Brunner and Suddarths, 2014).

Hemorrhoid cushions are a part of normal human anatomy and become a pathological disease only when they experience abnormal changes. There are three main cushions present in the normal anal canal.

These are located classically at left lateral right anterior, and right posterior positions. They are composed of neither arteries nor veins, but blood vessels called sinusoids connective tissue and smooth muscle (Dayton et al, 2016).

Sinusoids do not have muscle tissue in their walls as veins do. This set of blood vessels is known as hemorrhoidal plexus. Hemorrhoid cushions are important for continence. They contribute to 15 – 20% of anal closure pressure at rest and protect the internal and external anal sphincter muscles during the passage of stool. When the person bears down, the intra abdominal pressure grows and hemorrhoid cushions increase in size, helping maintain anal closure. Hemorrhoid symptoms are believed to result when this vascular structure slide downwards or when venous pressure is excessively increased.

Increased internal and external anal sphincter pressure may also be involved in hemorrhoid symptoms. Two types of hemorrhoids may occur: internal from the superior hemorrhoidal plexus and externals from the inferior hemorrhoidal. The pectinate line divides the two regions (David B. 2014).

Investigations To Aid Diagnosis
Physical Examination: A visual examination of the anus and surrounding area may diagnose external or prolapsed hemorrhoids.
Rectal Examination: A rectal examination may be performed to detect possible rectal tumors, polyps an enlarged prostate or abscesses.
Anoscopy: Visual confirmation of internal hemorrhoids may require anoscopy, insertion of a hallow tube device with a light attached at one end.
The two types of hemorrhoids are external and internal which are differentiated by their position with respect to the pectinate line. Some persons may concurrently have symptomatic versions of both. If pain is present, the condition is more likely to be an anal fissure or an external hemorrhoid rather than an internal hemorrhoid (Chen& Herbert, 2010).

According to Dayton et al. (2016), management of hemorrhoid is divided: into

Conservative management

Surgical management
Conservative Management
Hemorrhoid symptom and discomfort: can be relieved by good personal hygiene and by avoiding excessive straining during defecation.
High fiber diet/fiber supplements: A high fiber diet or high residue diet that contains fruit and bran along with increased fluid intake may be necessary to enhance the passage of soft bulky stool and prevent straining.
Warm compresses, sitz bath, analgesic ointments and supporistories, astringents (e.g witch hazel) and bed rest reduce engorgement.
Use of barrier cream: such as petroleum jelly or Zinc oxide, an analgesic agent such as Lidocaine and a vasoconstrictor such as epinephrine (David B. 2011).
Pregnancy: Hemorrhoid occurs as a result of pregnancy pressure, usually result following pregnancy but if such fails active treatments is often delayed until after delivery.
Other conservative managements are:
Rubber and ligation: This is typically recommended as the first line treatment in those with grade 1 to 3 diseases. It is a procedure in which elastic bands are applied on to an internal hemorrhoid, at least 1cm above the pectinate line to cut off its blood supply within 5 – 7 days, the withered hemorrhoid falls off.
If the band is placed close to the pectinate line intense pain results immediately afterwards (Chen& Herbert, 2010).
Sclerotherapy: This involves the injection of a sclerosing agent such as phenol into the hemorrhoid. This causes the vein walls to collapse and the hemorrhoids shrivel up (Chen& Herbert, 2010).

Surgical Management
The surgical removal of varicosities of veins or prolapsed mucosa of the anus and rectum that do not respond to conservative treatment is called hemorrhoidectomy (Philips, 2017).
Hemorrhoidectomy can be done as a day case especially if it is a stapled hemorrhoidectomy which is usually less painful and associated with faster healing compared to complete removal of hemorrhoid. In such case, the patient may be booked as a day case. In severe case of hemorrhoid which excisional hemorrhoidectomy can be applied, the patient will be admitted to the ward a day before the surgery.
Excisional hemorrhoidectomy is a surgical excision of the hemorrhoid used primarily in severe cases. It is associated with pain and usually requires 2 – 4 weeks for recovery. However, the long term benefit is greater in those with grade 3 hemorrhoids as compared to rubber band ligation. It is the recommended treatment in those with a thrombosed external hemorrhoid if carried out within 24 – 72 hours. Glyceryl trinitrate ointment after the procedure helps both with pain and healing (Lorenzo, 2019).
Doppler – guided, transanal hemorrhoidal dearterialization is a minimally invasive treatment using an ultrasound Doppler to accurately locate the arterial blood flow. These arteries are then tied off and the prolapsed tissue is sutured back to its normal position. It has a slightly higher recurrence rate but fewer complications compared to a hemorrhoidectomy.

Cauterization Methods: A number of cauterization methods have been shown to be effective for hemorrhoids, but are usually only used when other methods fail. This procedure can be done using electrocautery, infrared radiation, laser surgery or cryosurgery.
Infrared cauterization may be an option for grade 1 or 2 diseases in those with grade 3 or 4 diseases, reoccurrence rates are high.
Stapled hemorrhoidectomy, also known as stapled hemorrhoidoplexy, involves the removal of much of the abnormally enlarged hemorrhoidal tissue followed by a repositioning of the remaining hemorrhoidal tissue back to its normal anatomical position. It is generally loss painful and is associated with faster healing compared to complete removal of hemorrhoids. However, the chance of symptomatic hemorrhoids returning is greater than for conventional hemorrhoidectomy. So it is typically only recommended for grade 2 or 3 disease (Dayton et al, 2016).

Preventions of Hemorrhoid
According to Chen &Herbert,(2010) haemorrhoids can be prevented through the following measures:
Avoiding excessive straining during defecation, avoid constipation and diarrhoeaea, either by eating a high fiber diet and increase a fluid intake or by taking fiber supplement.
Sufficient exercise
Spending less time attending to defecate, avoiding reading while on the toilet
Avoid lifting of heavy object
Weight control or losing weight for overweight person

Complications of Hemorrhoids
Anal fistula or tissue
Excessive bleeding
Excessive discharge of fluid from the rectum
Inability to urinate or have a bowel movement
Severe pain, especially when having a bowel movement (David B.2014)

Brunner & Suddarth (2014). A text book of Medical surgical nursing; 12th edition; Baltime publisher, New York.

Chen & Herbert (2010). Text Book on Medical Surgical Nursing 15th Ed. J. B. L. Princott Company Philadelphia USA.

David B.(2011). Definition of hemorrhoid retrived December 2, 2019 from http://www.davidb .

Lohsiriwat V.(2017).Hemorrhoid Definition retrived May 7, 2017 from

Lorenzo R. (2019) Hemorrhoids. Mosby’s Dictionary of Medicine, nursing & health
professions. 9th edition. St Louis ml; Elsevier Mosby.

Shield W.C (2016) Hemorrhoid Definition Retrieved January 24, 2016 from

Waugh A. & Graunt A.(2015), Anatomy and physiology in health and illness.12th edition; USA. Churchill livingstone.

Webster M. (2018) M. W. Definining Hemorrhoid retrieved October 7, 2018 from http://www.merriam-webster

About the author.

Health Technology News Today – Robotic Surgical Technology: Successful trial on pig.

I chanced upon this interesting information, about robots and surgeries. Awesome information I must tell you. I made comments and did a little curating.

An unmanned robot has been used to stitch together a pig’s bowel, moving science a step closer to automated surgery, say experts.

Unlike existing machines, the Star robot is self-controlled – it doesn’t need to be guided by a surgeon’s hands. In tests on pigs, it at least matched trained doctors at mending cut bowel, Science Translational Medicine reports.
But it is very early days and it remains to be seen if people would trust such a “hands-off” approach.
Slippery target
Robots performing surgery are not new. Hospitals in the UK and the US already use robot assistants to help cut out hard-to-reach tumours, such as prostate cancer.
These devices, such as the da Vinci System, are an extension of the surgeon – gadgets that give the operator better sight of the target and more adept tools to get the job done.
Four pigs – had the Star surgery
But scientists are now trying to create a new generation of robots that will work independently, albeit under close supervision, to remove human error. In theory, the medical team could sit back and watch the machine perform, and only get involved if necessary.
Robots are best suited for repetitive, predictable work. Getting them to stitch soft tissue that slips and slides around in the body when it is manipulated is a challenge.
Dr Peter Kim and colleagues at the Children’s National Medical Center, in Washington, say they have found a way to get round this with their Smart Tissue Autonomous Robot or Star.
Fancy sewing machine
Star “reads” fluorescent markers in the soft tissue to know precisely where to plant its stitches on the moving target. Like a regular sewing machine, it can be programmed for things like stitch size, pattern and tension.
And it appears to perform slightly better than skilled humans in terms of stitch positioning to repair a cut in a pig’s intestine.

Dr Kim said: “If you want to throw in 20 stitches, it is not enough that a human being does 19 out of 20 well. You have to do all 20 of them well to have a good outcome.
“This machine will consistently throw in 20 perfect sutures.”
That is not to say the robot is infallible.
In the trial, carried out on live animals in the operating theatre and on tissue samples in the lab, the scientists had to supervise the robot and tweak what it was doing around 40% of the time.
Dr Kim said: “These are minor adjustments, very much like when you see your little baby starting to walk. We were a little nervous about it to make sure it does it the right way.
“It can be fully autonomous for the task we want to do.”
He hopes robots like this could reduce surgical errors, improve outcomes and save lives.
Mr Shafi Ahmed, from the Royal College of Surgeons of England, said it was a radical step to try to replace a surgeon with a machine, but not necessarily a bad one in certain situations.
“All humans make errors. We have emotions and we get tired, whereas robots are objective.
“We need to ask whether machines might be better at doing some parts of surgery.
“Obviously there are issues around the ethics and trust. At what point do you trust a robot? This study suggests autonomous robots can do quite complex processes competently.”
Dr Kim says the technology could be used on patients within the next couple of years. And one day, it may be possible to carry out routine operations, such as gall bladder or appendix removals, from start to finish using robots.

Personal Commentary:

Science is making progress, but most of the time science tends to want to choke ethics or replace flesh and blood [me and you].

This is advancement quiet all right, but the roles of human beings can’t be completely replaced by artificial intelligence. Man has to be on stage, especially in the area of health care where close observation, perfection and above all emotional intelligence are the order of the day.

Well, robots may be perfect, but they can never replace the human softness of a Surgeon or the kind touch of a Nurse.

Commentary by Ayinla Daniel Rn.
Photo credit: @unsplash


Care City News.

Quacks are Our Friends – My Perspectives. Part 1.

Photo credit Graham Ruttan/Unsplash.

Quacks are Our Friends – My Perspectives. Part 1. 1 min read.

Introductory Notes.
Don’t get me wrong, I am not endorsing quackery in this essay, I am only saying that we have to be reasonable and look at the situation from other significant perspectives, feel free to leave comments. These are my views.

You see my friends, these quack nurses we see flooding our private hospitals in Nigeria are not devils nor are they our rivals.

It may surprise you to know that in developed countries, they have more advanced health care systems that create a niche for fellows like these our friends, they call them UAP’s, unlicensed assistive personnel, these guys help with the rather unintelligent responsibilities, which will include bed-making [I don’t really see anything intelligent or scientific about this], providing bed-pans, changing linens and a host of other things that do not require critical thinking or do not pose significant threat to the patients health if neglected.

I believe it’s wise we approach this issue from various perspectives. Some of them [the auxiliary nurses] really have the desire to pursue the nursing profession, but do not have the academic requirement that qualifies them to study nursing, or some who may have the requirements do not have the available resource to carry on with a university degree or as the case may be to study in schools of nursings which as we all know are very expensive.

So what do they do?
Also foiled by the presence of licensed health care practitioners [nurses, doctors, and sometimes pharmacists etc] who are willing to teach nursing as a trade, a vocation, so as to secure cheap and as well unlicensed services.

These lots are abandoned at the mercies of these guys, the quack trainers. If we do not have fellows who train them, we sure may not have them around, but here we are, we have scores of nurses and doctors training them, and allowing them to undertake core nursing responsibilities to the painful detriment of the health care consumer, the patient/client who also is oblivious of the fact that they have the right to know if those given them care are duly qualified and licensed.

They have to be assured of the quality of care given to them, and the process of care which has personnel licensure as a primary element loudly emphasizes the need for proper licensure.

Can we stop looking at them like they are monsters? We teach them, we train them, we accommodate and educate them, we are the first problem and not them, they are only unfortunate to have been the satisfaction for our desire to procure cheap services for our clinics and hospitals.

The next time you see a quack nurse or an auxiliary nurse as we call them here, do not be hesitant to not allow your inbuilt anger for auxiliary nurses control you. Be more civilised, hear their story, understand their motivation and help them if you can.

In the next article, I will place more emphasis on what we can personally do for these fellows and we will also talk a little about the governing bodies fault, the nursing council in this case.

Leave your comments, we really want to enjoy your view.

Ayinla Daniel, RN.
(Team Care City).

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Johnson & Johnson Nurses Innovate QuickFire Award in Peri-operative Care – Lessons on Innovation For Nurses.

Johnson & Johnson Nurses Innovate QuickFire Award in Peri-operative Care – Lessons on Innovation For Nurses.


Ayinla Daniel, Rn.

(Editor Care City).

There is pretty much we can all learn from the novel achievements of these Nurses.

In this article, I will talk briefly on the innovative ideas that saw them becoming nominees for Johnson & Johnson Nurses Innovate QuickFire Awards in Perioperative care, their motivation and little lessons I learnt from the criteria used to choose their ideas, I strongly believe that you are going to find it inspiring.

Debbie Kantor & Chao Hsing Yeh. (Pictured with their inventions)

As a nurse and scientist, I never thought of myself becoming a nurse innovator. I would tell nurses you have to believe and love what you are doing. I often told myself, if I cannot do this, my patient won’t be able to do it. Be passionate about what you do. Find a positive environment and surround with people who will encourage, motivate and support you endlessly. Once you set up your goal, it may need to take a little detour, but your persistence will pay off. Keep trying, do not give up and do not settle.Chao Hsing Yeh, PhD, Rn.

To tread the innovative pathway in any career demands that the elements of true passion, creativity and hard work are secured in the heart of whosoever desires to become an innovator. Stories of great innovators in all fields of endeavour reveal specific characters that can be found in the lives of all those who made an impact in their various fields.

In the Nursing profession, the waves of innovation might not be too prominent today, due to a number of factors, but it steadily gathers momentum that will see the future of nursing practice cocooned by innovative ideas that improve health care practice – ideas developed by Nurses who are actively involved in critical thinking and problem-solving.

Before I begin to talk about some lessons that inspired me, let’s briefly take a look at these innovative ideas, their efficiency/criteria used to choose them and the story behind them.

The Hero Bandage.

Debbie Kantor, APRN, Co-Founder at HERO Medical, created the HERO Bandage, a simple one-piece wound care dressing for the head or limbs designed to improve the self-care and monitoring of chronic wounds. Johnson&johnson.

This bandage is truly a hero. In clinical practice, wound care is a very delicate aspect that requires extra attention by health care practitioners responsible for their management, as improper handling of wounds can greatly increase the risk of the development of complications, which may include infection, haemorrhage, deformity among a host of other physiological complications.
“I couldn’t stop thinking about how there should be a quicker, easier way to stop bleeding more efficiently for both head and leg wounds, and that’s when the idea for the one-piece HERO Bandage came to me. And the name came from my love of Superman, and my belief that this solution can have a super impact on wound care.” – Debbie Kantor.

This brief statement which I extracted from the interview with Debbie succinctly describes how she channeled her passion into solving a problem she discovered. The hero bandage is a standard bandage that surely influences the outcome of wound care, it does this by; making wound dressing more efficient – its design allows flexibility and easy manoeuvrability, it becomes more handy in emergency care when you need to stop bleeding immediately presents itself.

Debbie describes her inventions capacity to influence wound care outcomes, she explained further, saying;

The HERO Bandage is a single, sterile package that has the potential to help health systems be more efficient and lessen the burden for frontline healthcare workers. With fewer pieces and skills required, it provides an easy-to-use bandage that can cover a larger part of a wound in less time than a normal dressing would take. And I think what really makes our product unique is that it can eventually be used for the head, an amputation, a limb or other appendages. Also, current bandages only cover a part of the head while ours provides full coverage, so there really isn’t anything like it currently available.

Brilliant idea there, with more support, from the likes of Johnson & Johnson this idea is surely becoming a reality and this feat is definitely going to be a source of inspiration for nurses who are nurturing the desire to become innovators.

I would also tell myself, and younger nurses just beginning their innovation path, that it’s okay to be scared. Innovation is a journey different for everyone. Keep a journal and write down the good, the bad and the ugly. Fellow nurses of all stages can be a great resource. Find a champion who believes in you and the potential impact of your idea.Debbie Kantor, APRN, Co-founder at Hero Medical.

Wireless Auricular Point Stimulation (APS)© 2019.

Chao Hsing Yeh, PhD, RN, Associate Professor at Johns Hopkins School of Nursing, developed Wireless Auricular Point Stimulation (APS)© 2019, JHU, a treatment based on traditional Chinese medicine acupuncture that aims to provide a non-invasive, self-administered and nonpharmacological treatment for pre-, intra- and postoperative pain. Johnson&Johnson.

Pain management in medical practice is one dimension of care that requires constant research in discovering the most effective methods of alleviating pain without causing harm or too much harm to the body.

Auricular point acupressure is an old Chinese medical practice that uses pressure points of the ear to help relieve pain. The belief is that the ear represents the human body, like a “minisystem,” since it is shaped like a foetus and some points on the ear represent/correspond to the position of body organs that can be massaged and relief of pain achieved.

This may sound odd to those who do not have any idea about Chinese medical practices which have been effectively used for up to 3000 years. Chao Hsing’s method combines the wisdom of ancient medicine with the technicalities of modern technology, this ingenuity is enjoyed when you comprehend her idea of using a smartphone that can be used to stimulate these pressure points on the ear when the device is placed on the ear or auricle.

She describes the device and its benefits :

I believe opioid use has taken an incredible toll on not just patients, but entire health systems. I believe this toll has been physical, emotional and financial. Wireless APS has the potential to broaden the options of pain management and provide an adjunctive option for perioperative care. Moreover, APA could be more widely disseminated than acupuncture, allowing patients to focus on self-care by engaging the therapy daily, anywhere and anytime as a practical tool for pain control. The availability of APA as method of care offers the potential to improve patients’ quality of life in a cost-effective manner.

Now, let us look at the criteria that were used to chose these ideas.

Criteria For Selection.

Their ideas were selected based on the following criteria:

  • Thoroughness of their approach Feasibility and uniqueness of their idea.
  • Identification of key resources
  • Plan to further the idea and
  • The solution’s potential to improve perioperative (pre-, intra- and post) care and health outcomes. Johnson & Johnson

In another article, we will take more time to describe these criteria, to enable nurses who are passionate about innovation understand some requirements.

Be Inspired.

Are you going to sit back and relax, while nurses like you around the world work round the clock trying to discover new and efficient methods of delivering nursing care? No you won’t, you will get inspired and join this army of inventors.

You will awaken the inventor within you, many problems await solutions and you are in the best position to provide solutions. You may say your environment is not helping you, well if you depend on this deficiency as an excuse not to work, then you still have a long way to go. Passion supersedes impossibilities. If you are really passionate about innovating, then you will make up your mind that nothing will hinder you, absolutely nothing.

Project Care

Project care is an interactive programme developed by Care City to help inspire aspiring innovators in the field of nursing in Nigeria and other countries. We know how much you want good company on your way to becoming an inventor, so we decided to be your company.

We will remind you of your dreams, think with you as you plan, support where possible, we will be the thinking team that will inspire you to do more, we will provide you with learning materials and try and secure necessary connections and above all integrate you into a community of nurses, health care practitioners and other professionals who are passionate about innovation.

Send us a mail today:

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