Test bahasa Inggris seperti TOEFL telah menjadi suatu kegiatan yang wajib bagi sebagian kalangan seperti mahasiswa, pencari kerja dan beasiswa. Dengan memiliki sertifikat TOEFL yang valid maka banyak orang berharap akan memiliki banyak kemudahan untuk meraih sebuah kesempatan emas seperti pekerjaan dan beasiswa. Di Indonesia, TOEFL telah menjadi ladang bisnis yang menggiurkan. Lihat saja banyak institusi yang menawarkan kursus TOEFL dan selalu ramai dikunjungi peminat. Di kalangan perguruan tinggi memiliki skor TOEFL tertentu sebagai prasyarat untuk lulus atau wisuda telah menjadi hal yang biasa. Contoh-contoh tersebut telah menunjukan arti penting dari TOEFL. Nah, pertanyaan saya, seberapa bagus kita mengenal TOEFL tersebut?

TOEFL di selenggarakan oleh suatu lembaga yang bernama Educational Testing Service. Informasi ini terdapat di website ETS, silahkan klik LINK berikut ini atau jika anda terkendala dengan akses internet berikut cuplikan tentang ETS:

About ETS
At nonprofit ETS, we advance quality and equity in education for people worldwide by creating assessments based on rigorous research. Founded in 1947, ETS develops, administers and scores more than 50 million tests annually — including the TOEFL® and TOEIC® tests, the GRE® General and Subject Tests and The Praxis Series™ assessments — in more than 180 countries, and at over 9,000 locations worldwide.

In addition to assessments, we conduct educational research, analysis and policy studies, and we develop a variety of customized services and products for

* teacher certification
* English-language learning
* elementary, secondary and post-secondary education

ETS serves individual students, their parents, educational institutions and government agencies. We help teachers teach, students learn, and parents measure the educational and intellectual progress of their children by

* Listening to educators, parents and critics
* Learning what students and their institutions need
* Leading in the development of new and innovative products and services

Our Mission: To advance quality and equity in education by providing fair and valid assessments, research and related services. Our products and services measure knowledge and skills, promote learning and educational performance, and support education and professional development for all people worldwide.
Our Vision: To be recognized as the global leader in providing fair and valid assessments, research and related products and services to help individuals, parents, teachers, educational institutions, businesses, governments, countries, states and school districts, as well as measurement specialists and researchers.
Our Values: Social responsibility, equity, opportunity, and quality. We practice these values by listening to educators, parents and critics. We learn what students and the institutions they attend need. We lead in the development of products and services to help teachers teach, students learn and parents measure the intellectual progress of their children.

Reputasi test bahasa Inggris TOEFL telah diakui di mana-mana. Dengan membawa sebuah sertifikit TOEFL resmi berstandar internasional, maka kita bisa gunakan diseluruh dunia dari mencari kerja sampai mencari sekolah. Test TOEFL mencakup 4 kemampuan bahasa Reading, Listening, Speaking dan Writing. Format ujian ini berbeda antara Paper Based Test dan Internet Based Test. Silahkan klik LINK berikut ini untuk membaca lebih lanjut tentang TOEFL. (LINK) atau link berikut ini ETS.

Nah sekarang apa yang perlu kita siapkan supaya sukses dengan test TOEFL dan mendapatkan skor tinggi:
1. Test TOEFL adalah test kemampuan bahasa. Dalam pemikiran saya, karena ini kemampuan bahasa maka, diperlukan kemampuan bahasa yang prima untuk mendapatkan skore TOEFL yang tinggi. Test TOEFL memiliki validitas dan reliabilitas yang bagus sehingga akan mampu mendiskripsikan kemampuan bahasa Inggris kita. Sangat sulit untuk mendapatkan skor TOEFL tinggi jika memang kemampuan bahasa Inggris kita rendah.

Solusinya adalah kita harus mulai dari sekarang secara-secara perlahan tetapi pasti dan berkomitmen untuk meluangkan waktu belajar bahasa Inggris. Bahasa Inggris memiliki banyak rumus seperti grammar dan kosakata yang sangat susah dikuasai dalam waktu pendek misal 1 minggu atau 1 hari.

Ubah mindset kita tentang kiat sukses TOEFL dalam hitungan jam yang sering di tawarkan di mana-mana. Kiat-kita atau tips-tips akan bekerja baik bagi mereka yang memang sudah menguasai bahasa Inggris tetapi relatif susah bagi yang memiliki bahasa Inggris rendah. Jika ada saran rumus praktis untuk menebak jawaban, dengan benar tanpa berfikir saya pesimis kita akan bisa menebak dengan benar. Saya kira kita sendiri akan pusing, karena soal TOEFL memiliki tingkat kesulitan yang cukup tinggi dan harus disertai dengan analisa. Dalam option pilihan terdapat jawaban yang memiliki kemiripan sangat tinggi. Nah disinilah arti penting memiliki kemampuan dan pemahaman yang baik jadi bisa membedakan jawaban secara cerdas di antara pilihan dengan banyak kemiripan.

2. Luangkan waktu untuk latihan soal. Di website ETS sendiri terdapat contoh atau sample soal (LINK). Luagkan waktu untuk mempelejarinya, jika memiliki dana lebih bisa pergi ke toko buku untuk membeli panduan atau ikuti pelatihan. Jika ikut pelatihan saya sarankan cari lembaga yang memiliki kualitas dan reputasi baik dan tidak hanya menawarkan sesuatu yang bombastis. Jangan-jangan pengajarnya sendiri belum pernah ikut test TOEFL yang beneran (Institutional/Internatiaonal) bukan yang prediksi. Jika memiliki akses internet bisa mengunjugi situs yang menawarkan belajar TOEFL Online secara gratis. Contonhnya: LINK

3. Luangkan waktu untuk membaca panduan ujian TOEFL yang disediakan oleh ETS untuk mempelajari kisi-kisi soal dan semua yang berkenaan dengan test seperti waktu test, alokasi waktu untuk setiap test. Dengan mempelajari dengan baik anda akan tahu kapan test TOEFL akan diadakan jadi bisa jauh-jauh hari mempersiapkan diri.

4. Time Management
Dalam point ini pengaturan waktu yang bagus saat mengerjakan soal menjadi solusi yang tepat. Setiap ujian dibatasi dengan waktu. Sudah banyak peserta test yang gagal karena tidak bisa mengatur waktu. Anda pelajari setiap test kemampuan memerlukan waktu berapa menit, terus pelajari komposisi test tersebut seperti butir soal dll. Anda harus pikirkan baik-baik berapa menit akan dialokasikan untuk mengerjakan setiap soal, berapa menit untuk review jika jawaban sudah selesai semua sehingga anda yakin dengan jawaban yang telah anda pilih. Rata-rata peserta ujian/test bermasalah dengan waktu. Solusi yang paling tepat adalah anda mengikuti ujian latihan TOEFL baik secara individu atau mandiri atau bersama-sama. Amati baik-baik kemampuan anda. Dengan memiliki pengalaman pernah latihan mengerjakan TOEFL maka penampilan anda pada saat test yang sebenarnya akan jauh lebih baik.

5. Persiapan Mental
Saat yang menegangkan terjadi dalam waktu-waktu menjelang test berlangsung. Setiap peserta memiliki tingkat persiapan mental yang berbeda. Peserta test harus memiliki tingkat percaya diri (PD) yang tinggi. Dari sekian banyak peserta test kebanyakan memiliki tingkat stres yang tinggi yang biasanya ditandai dengan sering pergi ke toilet/WC, keluar keringan dingin dan sakit perut. Hal ini perlu diantisipasi. Jangan sampai penampilan anda menurun gara-gara stress yang berlebihan sehingga persiapan-persiapan yang telah anda lakukan jauh-jauh hari tidak akan banyak bermanfaat. Persiapan mental ini terkesan sederhana tetapi memiliki efek yang besar. Bagi kita kaum religius maka diharapkan untuk selalu berdoa bahwa Tuhan pasti akan membantu kita sehingga rasa PD anda akan semakin meningkat.

Also in: http://www.subekti-blogpendidikan.blogspot.com

Communication?
A process of transferring information
Interactions between at least two agents
Share a repertoire of signs
Interchange of thoughts, opinions, or information by speech, writing, or signs
Better as a two-way process

What’s Communication made up?
Words – 10 per cent
Paralinguistic (the way in which the words are spoken) – 40 per cent
Non-verbal features (body language) – 50 per cent

Basic Information Processing Modes
Visual processors think in pictures
Auditory ones think in sound and dialogue
Kinesthetic processors need motion and gesture to understand.

How to communicate effectively with patients?
Get to know the patients and their circumstances
Listen to the patient
Use a variety of teaching materials and methods
Recognize that people are often resistant to change
Keep message clear and simple

Instructions/ orders?
What is the difference?
Which one is best?

How to Give Instructions in English

Sequencers are the words that help order your instructions
Instructions, do one of three things
Tell people what is necessary, what is wrong, what is not necessary

Giving a Good Instructions
Mission
Destination
Procedure
Time
Anticipation
Failure

How To Give Verbal Instructions
Avoid unclear, ambiguous instructions that can easily be misinterpreted
Choose words with the fewest syllables to avoid misconceptions of meaning
Speak clearly and intelligibly

How To Give Verbal Instructions
Maintain focus to remain on instructional track
Use a speaking voice that is pleasant but confident
Ask for questions before the instructions begin and after they are given
Make sure the instructions present a specific goal.

How to Give Effective Instructions to Children
Stop and decide what you want your child to do
Get the child’s attention
Tell him what to do directly and firmly
Don’t end your instruction with “OK?”
Praise him when he does the task quickly and well
“What did I tell you to do?”

How to Give Effective Instructions to Children
Decide the consequence you will impose and go to the child to warn him of the consequence
Move closer to him than normal, conversational distance. Make direct prolonged eye contact and tell him the consequence of not doing what you asked.

How to Give Effective Instructions to Children
Give him the opportunity to complete the task now
If he still doesn’t comply, give the consequence
Go to him and tell that the consequence you stated earlier is now in effect

Giving Good Instructions to Children 
Be clear and concise
Give one instruction at a time
Be realistic
Be positive
Don’t ask, tell
Reward compliance

Examples of Good Instructions
Bintang, go wash your hands
Nita, open your mouth
Shinta, walk next to me
Adhi, get the syrup now

Examples of Bad Instructions
Be careful
Can you put your toys away?
Go upstairs, wash your face, brush your teeth and go to bed
Okay, I think it is time for you to go to bed
Don’t run in here

How To Give Better Instructions
Give instructions in the ways that work best for your subordinate
Give your directions in more than one way
Check for understanding

Don’ts
Do not allow the other person any latitude to think about what to do or how to do it
Do not give patient the freedom to come up with their best way of getting the task done
Do not give orders, give instructions

A Challenge???
It is much easier to give a pill, put a dressing on a wound, take vital signs, or change a catheter, than to teach a patient to care for himself
present information and instructions to patients, then step back and allow them to make informed choices about their lives

Dear students of 2007,
The next lecture of Family Nursing will be about Complementary Therapy and Management of Post surgical Patients at Home, which is will be conducted on Monday, October 19th 2009 at 3 pm – 5 pm.

You might take these books as literature:
1. Complementary Therapy for Health Care Providers by Merrily A. Kuhn chapter 1 & 2.
2. Home Care Nursing Practices 3rd edition by Robyn Rice chapter 4 & 14

These following links are also suggested:
1. http://hivinsite.ucsf.edu
2. http://www.catie.ca
3. http://nccam.nih.gov
4. http://www.homecareohio.org/pdf
5. http://www.ncbi.nlm.nih.gov

Other references are welcomed.
The lectures’ out line could be accessed through:
1. www.diahnita.blogspot.com
2. www.diahnita.wordpress.com

Please prepare for the PRE TEST since this is considered as the addition mark. There is no extended time of PRE TEST for whom who LATE.

Regards,
Diah Nita

What?
Diverse medical and health care system, practices, and products
Go along with medical therapy (complement)
Alternative therapy, used instead of conventional medicine.
Integrative medicine, a hybrid of complementary and conventional medical treatments

Kinds
Herbal medicine
Diet, nutrition, and lifestyle changes
Mind/body or behavioral interventions
Alternative system of medical practice
Manual healing method
Bioelectromagnetic
Pharmacologic and biologic treatments

Complementary Therapists
Osteopaths
Acupuncturists
Psychotherapist
Hypnotherapies
Pilates teacher
Craniosacral therapists

Chronic Illness & complementary Therapy
PLHIV
Cancer
Diabetes
SLE

Research of Complementary Therapy
50 different research projects being conducted
Provide new opportunity for training researches in complementary therapy
Grants are awarded to universities, clinics, and practitioners.

Research Projects
Antioxidant vitamins to eradicate cancer cells
Guided imagery (visualization) to boost the immune system and help the body fight the disease
Acupuncture as a treatment for women with depression
Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007 by by Patricia M. Barnes, M.A., and Barbara Bloom, M.P.A., Division of Health Interview Statistics, National Center for Health Statistics; and Richard L. Nahin, Ph.D., M.P.H., National Center for Complementary and Alternative Medicine, National Institutes of Health

Health Care Provider’ Responsibilities
Understand the purpose
Identify the symptom of the patient
Identify the contraindications and adverse effect
Determine patient’ reason of seeking complementary therapy
Identify allergies of the patient

Reading Sources
Complementary Therapy for Health Care Providers by Merrily A. Kuhn

http://hivinsite.ucsf.edu

http://www.catie.ca

http://nccam.nih.gov

Family Focused Care
A theoretical approach to FFC
System structure (family unit organization)
System function (family unit defined goals or outcomes of care)

Caring by Family
Assessing the family unit and partinent relationships
Assessing suprasystem support group
Assessing energy, information, and boundaries – APGAR
Using emphatic communication

Caring by Family
Begin with the end in mind
Put first things first
Providing culturally sensitive family care
Assisting decision making for families – ENUFF

Goals of Family Focused Care
Be empowered for self care
Recognize that the illness effect all the family members
Define the problems and identify the solutions
Improve confidence in decision making
Participate in positive self-care activities
Utilize available community resources for care
Achieve maximal balance and home independence
Evaluate progress and modify behaviour as needed
Alternative plans

Home Care Application
Developing the plan of care
Visit frequency
Patient education
Medications
Infection control
Nutrition

Post Op. Infection control
Aseptic technique
Good hand washing
Medical supplies
Wound care solution
Dressing changes

Nutrition
Wound healing diet
Food combination
Blood iron
High protein, iron, vitamin C
Zinc sulfate 220 mg/ day
Fluid requirements

Dear students of 2008,
The next lecture of KDDK II (Nursing Basic Skills II) will be about Drugs Administrations which is will be conducted on:
Class A : Monday, September 7th & 14th 2009 at 01.00 pm
Class B : Tuesday, September 8th & 15th 2009 at the same time.

You might take these books as literature:
1. Clinical Pharmacology 9th Edition by P.N Bennett (page 83-86).
2. Crash Course: Pharmacology by Donald Barnes (page 17-18).
3. Farmakologi untuk keperawatan by Jan Tambayong (page 1-9).
4. Fundamental of Nursing: the Art & Science of Nursing Care by Carol Taylor (page 714-772).
5. Introductory – Clinical Pharmacology 6th Edition by Sallys Roach (page 4-52).
6. Nurse’s Drug Guide by Samantha Venable (page 14-32).
7. Nursing Pharmacology Made Incredibly Easy.! (page 1-22)
8. Nursing Procedures Made Incredibly Easy.! (page 177-225).
9. Pharmacology: A Nursing Process Approach 5th edition by Joyce Lefever Kee (page 14-42).

Other references are welcomed.
The lecture’s out line could be accessed through:
1. www.diahnita.blogspot.com
2. www.diahnita.wordpress.com

Please prepare for the PRE TEST and POST TEST since these are considered as the addition mark. There is no extended time of PRE TEST for whom who LATE.

Regards,
Diah Nita

Drugs Administration
Part II, September 8th & 15th 2009
By Diah Nita

Medication Orders
Parts of medication orders
Medications supply system
Dosage calculations
Safety measures of preparing drugs
Categories of drug orders

Part of the medication order:
Patient’s name
Date and time
Name of drug
Dosage
Route
Frequency
Signature of order writer

Dosage calculations.
System of measurement:
Metric system
Apothecary system
Household system

Safety measures of preparing drugs:
The nurse give the (1) right medication to the (2) right patients in the (3) right dosage through the (4) right route at the (5) right time.

Categories of Drug Orders
Standing orders
One time/ single orders
PRN orders
STAT orders

Nursing Process
Assessment
Diagnosis
Planning
Outcome expected
Implementations
Evaluation

Assessment
Assessment of subjective data:
Current health history
Client symptom
Current medications
Post health history
Clients environment

Assessment of objective data:
Gross and fine motor control
ROM
Muscle strength
Visual impairment
Laboratory test, diagnostic studies & physical assessment.

Diagnosis
Made based on assessment data
May be actual or potential
Facilitates individualized care plan
More than one applicable nursing diagnosis may be generated.
Common nursing diagnosis of drug therapy:
D:\My Documents\N I T A\KDDK II\Nursing diagnosis.odt

Planning
Characterized by goal setting/ expected outcomes
Effective goal setting qualities:
Client centered
Acceptable to both client & nurse
Realistic and m,measurable
Shared with other health care providers
Realistic deadlines
Identifies components for evaluations.

Outcome Identification
Clinical observations will improve
The patient will receive a dosage that reaches the therapeutic level
The patients will demonstrate education regarding their medication.

Implementations
Nursing actions/ interventions
Client education & teaching
Administration of drug
Assessment of drug effectiveness.

Drug Therapy Teaching
Comprehensive drug & health history
Reason for medical therapy
Expected result
Side effect & adverse reactions
When to notify health care provider
Drug interactions
Required changes in activities of daily livings (ADLs)‏
Demonstration of learning
Medications schedule
Recording system
Discussion & monitoring of access to financial resources
Development & support of backup system
Community resources.

Evaluation
Addressed in the evaluation phase of the nursing process
Evaluation time is depend on the time frame in the goal statement
Ongoing & related to process
If failed —> determine the reason & revise the plan accordingly.

Literatures
Clinical Pharmacology 9th Edition by P.N Bennett (page 83-86).
Crash Course: Pharmacology by Donald Barnes (page 17-18).
Farmakologi untuk keperawatan by Jan Tambayong (page 1-9).
Fundamental of Nursing: the Art & Science of Nursing Care by Carol Taylor (page 714-772).
Introductory – Clinical Pharmacology 6th Edition by Sallys Roach (page 4-52).
Nurse’s Drug Guide by Samantha Venable (page 14-32).
Nursing Pharmacology Made Incredibly Easy.! (page 1-22)‏
Nursing Procedures Made Incredibly Easy.! (page 177-225).
Pharmacology: A Nursing Process Approach 5th edition by Joyce Lefever Kee (page 14-42).

Common nursing diagnosis related to drug therapy:
1. Deficient knowledge about drug action, administration, and side effect related to cultural/ language barrier or speech articulation problem.
2. Pain (acute/ chronic) related to hesitancy in taking prescribed pain medications due to fear of addiction.
3. Ineffective individual maintenance related to not having recommended preventive care.
4. Ineffective protection related to effects of anticoagulant medication on clothing mechanism.
5. Ineffective therapeutic regiment management.
6. Noncompliances related to forgetfulness.
7. Risk for injury related to side effects of drug such as dizziness and drowsiness.
8. Ineffective therapeutic regiment management related to lack of finance or health care coverage to purchase medications.

Formulas for computing drug dosages

Adult Dose

Dose on hand dose desired
————————– = ——————————
Quantity on hand X (quantity desired)

Example:

Amoxicillin, 625 mg PO, is ordered. It is supplied as a liquid preparation containing 250 mg in 5 ml. How much does the nurse administer?

250 mg 625 mg
————– = —————
5 ml X ml

3125 = 250 X
X = 12, 5 ml

Another formula

Dose desired
——————— X quantity on hand = desired quantity
Dose on hand

Example:

625 mg
———– X 5 ml = 12,5 ml
250 mg

Pediatric calculations

BSA (child)
—————– X adult dose = child’s dose
BSA (adult)

Another formula (Clark’s rule)

Child’s weight (pound)
——————————— X adult dose = child’s dose
150

Body Surface Area a.k.a BSA available in Fundamental of Nursing by Carol Taylor page 719

Why should we concern to this.,??
Medications errors have been said to cause 150 deaths per day and 1,3 million injuries per year.

Drug’s Name and Label
Chemical name
Generic name (non proprietary)‏
Official name
Trade name (brand name)‏

Drug Classification
Body system
Therapeutic use
Mode or side of action
Molecular structure

Drug Administration Route
Oral (P.O)‏
Intravenous (I.V)‏
Intramuscular (I.M)‏
Subcutaneous (S.C)‏
Topical
Ophthalmic
Rectal (P.R)‏

Drug Administration Route
Buccal
Inhalation
Nasogastric (NG)‏
Otic
Vaginal
Sub lingual (S.L)‏

Drug Reactions
Adverse drug reactions:
Undesirable drug effects
Common/ infrequently
Mild, severe, life-threatening
Occur after first, several, or many doses

Allergic Drug Reactions
Hypersensitivity reaction.
Drug viewed as foreign substances/antigen.
Allergic symptoms.
Anaphylactic shock.
Angioedema (angioneuritic edema).

Drug Idiosyncrasy
Unusual/ abnormal reaction to a drug.
Different response from normally expected.
Over response to a drug.
Genetic deficiency

Drug Tolerance
A decreased response to a drug.
Requiring an increase in dosage to achieve the desired effect.
Takes certain drugs for a long time.
Individual users increases the dose them self.

Cumulative Drug Effects
May seen in those with liver/ kidney disease
Unable to excrete & metabolize drug
Can lead to toxicity
Sometime health provider lowers the dose.

Toxic Reactions
Administered in a large dose
Blood levels exceed the therapeutic level
Reversible/ irreversible
Aware of the signs and symptoms of toxicity of commonly prescribed drugs.

Drug Interactions
Drug-drug reaction :
Additive drug reaction
Synergistic drug reaction
Antagonist drug reaction

Drug Interactions
Drug-food interaction:
Food —> rate + amount of drug absorbed
Tyramine + MAOI = hypertensive
Grapefruit inhibit certain drug + toxic blood levels.

Factors Influencing Drug response
Age
Weight
Gender
Disease
Route of administration

Nursing Implications
Consult appropriate references/ hospital pharmacist
Observe patients for adverse drug reactions, drug idiosyncrasy, drug tolerance.
Record all observations in the patient’s record.

Literatures
Clinical Pharmacology 9th Edition by P.N Bennett (page 83-86).
Crash Course: Pharmacology by Donald Barnes (page 17-18).
Farmakologi untuk keperawatan by Jan Tambayong (page 1-9).
Fundamental of Nursing: the Art & Science of Nursing Care by Carol Taylor (page 714-772).
Introductory – Clinical Pharmacology 6th Edition by Sallys Roach (page 4-52).
Nurse’s Drug Guide by Samantha Venable (page 14-32).
Nursing Pharmacology Made Incredibly Easy.! (page 1-22)‏
Nursing Procedures Made Incredibly Easy.! (page 177-225).
Pharmacology: A Nursing Process Approach 5th edition by Joyce Lefever Kee (page 14-42).

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