Il-Musbieħ No:101 by MaltaUnionofMidwivesandNurses

Il-Musbieœ

MALTA NURSING AND MIDWIFERY JOURNAL Malta Union of Midwives and Nurses

Numru 101 - Diċembru 2023

All the best for the festive Season! to all MUMN Members

the heartbeat of healthcare

www.mumn.org Tel: 2144 8542 E-mail: administrator@mumn.org

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Il-Musbieħ - NUMRU 101

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˄ˢ˥ˠ˜ ʞʦʨʩ ʪʪʣʧʣʪʧʪ

ˀˤ˔˕˕˔ ʞʦʨʩ ʪʪʨʦʣʨʫʪ ˪˪˪ʡˠ˔˥˜˔ˡˢʡ˖˟˨˕

contents

Ħarġa nru 101 - Editorial - President’s message

pages 4-5

- From our diary

pages 20-21

- World Heart Day 2023

pages 26-27

Diċembru 2023 Group Committees - Chairpersons & Secretaries Mater Dei Hospital: Emily Galea, Chairperson: 77440050; Glen Camilleri, Secretary: 79205674 SVP: Therese Decelis, Chairperson: 79809080; Mario Galdes, Secretary: 79449324 RHKG: Graziella Buttigieg, Chairperson: 79275872 Health Centres: Roseanne Bajada, Chairperson: 79671910 MCH: Angelo Abela, Chairperson: 79594326; Malcolm Bezzina, Secretary: 77822561 SAMOC: Charles Galea: 79651430; Mark Mifsud: 99868033 GGH: Joseph Camilleri: 79485693; Anthony Zammit: 79617531; Jennifer Vella: 79277030 ECG Technicians: Alex Genovese, Chairperson: 79860571; Paul Caruana, Secretary: 79604338 Physiotherapists: Pauline Fenech, Chairperson: 79491366; Daren Stilato, Secretary: 77222999 Midwives Group Committee: Luciana Xuereb, Chairperson: 79538562; Marie Claire, Secretary: 99827852 MUMN Council Members Paul Pace - President: 79033033 Colin Galea - General Secretary: 79425718 Alex Manche’ - Vice-President: 77678038 George Saliba - Financial Secretary: 79231283 Alexander Lautier: 99478982 Geoffrey Axiak: 99822288 William Grech: 79011981 Claire Zerafa: 99217063 Joseph Aquilina: 99467687 Alexandra Abela Fiorentino: 79642163 MUMN Office: 21448542 Editorial Board Joseph Camilleri (Editor) CN M1 MDH William Grech: 79011981 Alexander Lautier: 99478982

Pubblikat: Malta Union of Midwives and Nurses Warner Complex, MUMN, Triq il-Vitorja, Qormi QRM 2508 • Tel/Fax: 2144 8542 • Website: www.mumn.org • E-mail: administrator@mumn.org Il-fehmiet li jidhru f’dan il-æurnal mhux neçessarjament jirriflettu l-fehma jew il-policy tal-MUMN. L-MUMN ma tistax tinÿamm responsabbli gœal xi œsara jew konsegwenzi oœra li jiæu kkawÿati meta tintuÿa informazzjoni minn dan il-æurnal.

Il-Musbieœ jiæi ppubblikat 4 darbiet f’sena. Dan il-æurnal jitqassam b’xejn lill-membri kollha u lill-entitajiet oœra, li l-bord editorjali flimkien mad-direzzjoni tal-MUMN jiddeçiedi fuqhom. Il-bord editorjali jiggarantixxi d-dritt tar-riservatezza fuq l-indirizzi ta’ kull min jirçievi dan il-æurnal.

L-ebda parti mill-æurnal ma tista’ tiæi riprodotta mingœajr il-permess bil-miktub tal-MUMN.

Kull bdil fl-indirizzi gœandu jiæi kkomunikat mas-Segretarja mill-aktar fis possibbli.

Çirkulazzjoni: 5,000 kopja.

Ritratti tal-faççata: MUMN

Il-Musbieħ - DIĊEMBRU 2023

Editorial

Mental Health Services

Mental Health Services In 2018, Mount Carmel Hospital’s structure had to be improved with regards safety, and ambience. Some improvement has been noticed with regards resources, as well as reduction in staff shortages. The mental health strategy has been a big step towards drastically reducing the number of in-patients at MCH. MHS community services are doing a great job, but staff complement must surely be improved because it is far from ideal. Community Mental Health services provide community-based care for better quality of life and social inclusion. Another issue is the inadequate bed space of MCH with the lack of individual privacy. In 2015, a new hospital was announced to be built at Smart City. Then in 2022 the Government identified a tract of land in Swatar for the building of a psychiatric hospital, close enough to Mater Dei Hospital and linked with a tunnel. EU funds had to be the primary source of funding for this facility which had to provide acute care for patients with mental health issues. MUMN said that this year’s Budget failed to address the refurbishment of Mount Carmel Hospital whilst the building of the new hospital is nowhere in sight. According to The National Audit Office (NAO) with regards to the condition of wards at the Mount Carmel mental health facility, some wards have been refurbished. The Auditor General did notice some progress in 2022 whilst last month new wards have been refurbished to an optimum level but up till now some wards are in a ‘questionable state’. This impacts the patients’ and staff’s overall wellbeing and morale.

Unsocial hours of works, long hours of work, night duties, Sunday and feast shifts add pressures to the already ‘burned out’ nursing staff that must face the music. Ideally the nurse-patient ration should be 1:4 but it is not rare that that this would be 3:18. Nurses also face challenges of patients who feel they are ‘locked’ in an institution like Mount Carmel Hospital therefore manifesting aggressive behaviour. In other psychological instances patients feel they are in some form of dangers and therefore lack trust towards staff. Here is when the job of staff working in MCH becomes dangerous, apart that they continuously must combat the issue of stigma. Another setback related with these issues was the removal of psychiatric short stay services from Mater Dei Hospital to be used as a Covid ward and ultimately a surgical ward. One could understand that this decision was an urgent one during the Covid19 pandemic, but this is long overdue now. The Mental Health Association had said that there was a spike in mental health issues, including self-

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harm brought about by the COVID-19 pandemic itself. The closure of the psychiatric shortstay unit at Mater Dei Hospital severely reduced mental health presence at the only general hospital in Malta. This is against the National Mental Health Strategy, and being an essential service, left families in difficulties. Mater Dei Hospital should reconsider to provide a service of a short-stay psychiatric unit that provides specialised personcentred care in time of crisis, were there is therapeutic space for stabilisation and assessment. Psychiatric units are an essential part of the healthcare system, because they provide a safe and supportive environment for patients who need intensive treatment for mental health issues. All this is in a scenario that 5.3% of Maltese report suffering from depression, while 7.9% say they suffer from chronic anxiety. Psychosis in Malta within the general population has been estimated to be 26 per 100,000 with urbanisation, low socioeconomic status and immigration being identified as potential risk factors. One must keep in mind that depression is thought to be the second leading cause of disability worldwide and a major contributor to the burden of suicide and ischaemic heart disease. Furthermore, political commitment through increased budgets in this sector to safeguard the mental wellness of Maltese Society is required.

President’s message

Another year over and a new one just begun…these are the famous words of John Lennon in his famous Christmas song. The year over is 2023 and for us at MUMN, it will be remembered for the sectorial agreement of the nurses/midwives and the ECG technicians. Both important sectorial agreements like all other previous sectorial agreements since such agreements address the shortages within the professions and installs a breath of fresh air into the respective professions. The financial aspect of both agreements being that of the nurses/midwives and that of the ECG technicians will not start and finish in 2023 but will continue in the coming years including 2024. New allowances will commence in 2024 such as new allowances for the nurses and the Senior Staff nurses which will commence on the 1st January 2024. 2024, will be a year where the discussions of the Public Service sectorial agreement will commence. To be exact, due to the COLA which this year was 12.80 euro, a 6.41 euro increase will be given from 1st January 2024 to everyone …in all scales irrespective of the grade or scale. The 6.41 euro and with the increase of the Public Service Sectorial Agreement according to the scale will increase the basic salary of all workers working with the Government as from 1st January 2024. The Government has committed that in the first quarter of this year the discussions for the new Public Service agreement will start since the current Public Service Collective Agreement will expire by the end 2024. Health services have always been changing but these last few years, the changes have become very significant and quite permanent.

The increase of TCNs and European nurses within the Health and Elderly services have been on the ongoing for quite a number of years. It is more than evident that the Health Service and elderly Services has become totally reliant on the foreign nurses as to maintain the current and even future Health Services. This is not a new phenomenon but a phenomenon which shape the Health Division and the Active Aging Division beyond recognition since it is envisaged that more services in the future will be reliant on the foreign nurses. It is important to adjust in these new settings which will bring certain new challenges. One of the complaints MUMN is receiving is that new nurses are not being exposed to any orientation courses and that new nurses acting as relievers, with day-to-day placements hinders proper continuity of care since such nurses have never worked in MDH let along in a speciality. All wards in MDH, MCH, SVP, GGH and KGH specialized in their own way and therefore having nurses on the ward who are continuously changing will affect nursing care. All Hospital managements are striving to maintain continuity of care by deploying the same nurses on the same wards, but this is becoming challenging especially with the huge shortages of nurses and new areas which need to be opened in MDH when a huge influx of patients are admitted. Well Christmas is a time for family, but it is also a time for those who live alone, loneliness is more greatly felt. So we need to make sure that no one is left behind. MUMN would like to thank all its members for their continuous support and dedication to MUMN. From MUMN Executive Committee, we would like to wish you a Blessed Christmas and a Happy New Year.

Il-Musbieħ - DIĊEMBRU 2023

Paul Pace President

Kelmtejn

mis-Segretarju Ġenerali Reġa’ wasal tmiem ta’ sena oħra. Sena li kienet mimlija kuluri. Sena ta’ ħidma favur il-membri tagħna ﬂ-interess ta’ kulħadd. L-aktar fattur importanti kien l-ifﬁrmar ta’ żewġ Ftehim li jittrattaw in-nurses u l-midwives u l-ieħor dwar l-ECG Technicians. Issa qed inœarsu ’l quddiem biex kmieni s-sena d-dieœla nibdew in-negozjati flimkien ma’ seba’ unions oœra biex nilœqu ftehim dwar il-Ftehim Kollettiv tas-Servizz Pubbliku kollu. Dan mhux ser ikun eÿerçizzju façli peress li f’dan il-Ftehim Kollettiv ser nirsistu biex indaœœlu kunçetti li jitrattaw materji sensittivi u li permezz tagœhom inkunu qed naææornaw ruœna maÿ-ÿminijiet ta’ llum. Ma’ dan hemm ukoll l-aspett finanzjarju li huwa importanti wkoll u li se joffri sfida lil min se jkun madwar il-mejda tad-diskussjoni. Nispera li sal-œaræa tal-Musbieœ li jmiss, ikollna xi œaæa soda u tajba f’idejna. Però s-sinjali jidhru poÿittivi. Infatti minn Jannar li æej, apparti ÿ-ÿidiet li gœandna stipulati fil-Ftehim Kollettiv (madwar ¢14 fil-æimgœa), ilGvern aççetta li jtina wkoll ÿieda oœra ta’ ¢6.41 oœra biex b’kollox se jkollna madwar ¢80 kull erba’ æimgœat, kulœadd skont l-iskala ta’ salarju tiegœu. Dawn huma laqgœat delikati œafna gœaliex ma nkunux waœedna imma nkunu ma seba’ unions oœra fosthom il-GWU, UHM, MUT, MAM, Unions tal-Pulizija etç. Nistennew u naraw.

5,000 membru. Il-post huwa çentrali u jaqdi kull esiæenza anki gœall-fatt li barra s-sala l-kbira tal-konferenzi, gœandna wkoll Training Center fissular ta’ taœt li huwa addattat gœal kull min irid jorganizza seminars u jaqsam f’workshops. Kull xahar qed norganizzaw seminars b’suææetti differenti fejn l-attendenzi qed ikunu dejjem sorprendenti. Dawn is-seminars qed iservu wkoll ta’ taœriæ personali lil min jippreÿenthom gœaliex permezz tagœhom qed isaœœaœ il-œiliet talpreÿentazzjoni kif ukoll public speaking. Kif tista’ tapprezza dawn il-premises swew sold mhux œaÿin u gœalhekk issa qed inœallsu lura l-loan. Nixtiequ li dan il-piÿ ma nœalluhx gœall-Kunsill li æej u nœallsuh f’dawn it-tlett snin li æejjien. Din kienet ir-raæuni li ÿidna ftit ilmembership fee. Nirringrazzjakom tal-

F’Jannar li æej nagœlqu sentejn filpremises il-æodda, premises li kull ma jgœaddi ÿmien nindunaw kemm kien pass gœaqli gœal raæunijiet differenti. Dawn il-premises jixirqu lil union bœal tagœna li llum tœaddan aktar minn

Awguri! 6

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koperazzjoni tagœkom bil-quddiem. Huwa importanti li l-union tagœna ma jkollhiex dejn gœal tul ta’ ÿmien biex tkun f’poÿizzjoni li tibqa’ tiÿviluppa ’l quddiem u tkompli tissaœœaœ. Ma nistax nagœlaq dan l-artiklu mingœajr ma nirringrazzja lillMembri kollha tal-Group Committees tagœna speçjalment liç-Chairpersons u s-Segretarji tagœhom li jaœdmu bla heda fl-interess tal-membri kollha. Prosit u Keep it up Œbieb. Ovvjament inkun qed nonqos jekk ma nuriex l-apprezzament tiegœi lillMembri tal-Kunsill speçjalment lillAmministrazzjoni tal-union li l-œidma tagœhom ma tieqafx matul is-sena kollha. Kelma ta’ apprezzament tmur ukoll lil Office Administrator li tagœmel kull sagrifiççju possibbli. Grazzi talœidma tagœkom matul is-sena kollha. Nagœlaq billi nawgura lilek u lil dawk qrib tiegœek Milied Hieni u Sena mimlija Saœœa. Colin Galea Segretarju Æenerali

Kenneth Abela

Carers Maskili f’pajjiżna

Is-Saga tkompli INTRODUZZJONI Sentejn ilu, f’Settembru 2021, f’’IlMusbieœ’ Numru 92, kien relevat kif l-NCPE kien ikkonkluda li entitajiet m’humiex qed jiddiskriminaw abbaÿi ta’ sess meta fid-deskrezzjoni tagœhom jiddeçiedu li ma jassenjawx carers iræiel ma’ residenti tas-sess feminili. Il-kaÿ kien tressaq kontra Dar gœall-Persuni b’Diÿabilità u f’Dar tal-Anzjani. Opinjoni tal-NCPE riçenti wera li minkejja tibdiliet fil-mentalità u anke liæijiet tal-ugwalajanza, illum, sentejn wara, il-posizzjoni baqgœet l-istess. F’dan il-kaÿ riçenti, waqt li l-Kummissarju (tal-NCPE) “tagœmilha çara li filprinçipju ma taqbel xejn mal-argumenti tal-Fondazzjoni (l-‘employer’)....’. “IlKummissarju (tal-NCPE), anki jekk gœandha riservi dwar ir-raæuni li pprovdiet il-Fondazzjoni, tœossx li aktar iva milli le, dak li qed tgœid il-Fondazzjoni huwa veritier u li r-raæuni gœala l-ilmentatur ma ntagœÿilx ma kienx ibbaÿat fuq issess tiegœu’. Kif ser naraw, entitajiet mhux biss jistgœu ma jagœÿlux carers iræiel sempliçiment gœax huma ræiel, iÿda anka jekk huma anzjani!

IL-KAŸ Il-kaÿ ma kellu jœalli ebda dubju dwar kienx hemm diskriminazzjoni jew le f’gœaÿla ta’ carers maskili. Wara li l-Arçidjoçesi ta’ Malta, li taœtha taqa’ tali Fondazzjoni, ikkonferma bil-miktub li tali Fondazzjoni qegœdin dejjem ‘on the look out’ gœal care workers, u li kull min kien interessat kien imœeææeg japplika, saret applikazzjoni. Fir-rigward ta’ kwalifiki u esperjenza, l-applikant kellu oltrè minn dak mitlub mill-Fondazzjoni. Iÿda biss ftit æranet wara, mingœajr biss interview æiet lura r-risposta. “You have not been selected to proceed further”. Wara talba gœal spjegazzjoni ma æietx imwieæba mill-Fondazzjoni, sar l-ilment lill-NCPE. KIF IÆÆUSTIKA L-EMPLOYER QUDDIEM L-NCPE L-applikant ma æiex shortlisted gœallebda waœda mill-poÿizzjonijiet vakanti.

Skont il-Fondazzjoni, qalu li jimpjegaw iræiel. Mingœajr ma elenkaw dwar f’liema poÿizzjonijiet, qalu li r-ratio ratio hi raæel wieœed (1) gœal kull gœaxar (10) nisa!

l-attivitajiet okkupazzjonali partikolari involuti… œtieæa ta’ okkupazzjoni æenwina u meta dak it-trattament jibqa’ fil-limiti ta’ dak li jkun adatt u meœtieæ fiç-çirkostanzi’.

Li œadu “bis-serjetà œafna” in konsiderazzjoni l-fatt li l-applikant kien laœaq l-età ta’ rtirar (ta’ 61) u gœalhekk ‘ma stajniex nassiguraw li ser ikollna a long term relationship tiegœu marresidenti’. Il-Fondazzjoni m’gœandha ebda obbligu li timpjega lil xi œadd li jkun laœaq l-età tal-irtirar.

Il-piÿ tal-prova jaqa’ fuq min jallega li hemm œtieæa okkupazzjonali æenwina (li f’dan il-kaÿ kienet il-Fondazzjoni). U l-Fondazzjoni kkonvinçiet lill-NCPE li impieg ta’ persuna anzjana ‘ikun detrimentali gœal pazjent li jkun rabba bond u sar jafda l-carer tiegœu.’

Kien hemm ÿewæ carers li laœqu l-età tal-irtirar, u t-tnejn li huma kienu æeddewlhom. It-tnejn kienu nisa. X’QALET L-NCPE L-NCPE qalet li skont il-Liæi (Kap 456), jista’ jsir diskriminazzjoni abbaÿi ta’ sess, orjentazzjoni sesswali, età, reliæjon jew twemmin, oriæini etniçi jew razzjali, jew identità tal-æeneru, sakemm ‘ikun xieraq jew meœtieæ u jkunu jistgœu jiæu ææustifikati permezz ta’ fatturi oææettivi’. L-NCPE sostniet wkoll li l-istess Kap 546, qalet l-NCPE, tgœid li jista’ jsir diskriminazzjoni fl-impieg ‘minœabba

KONKLUŸJONI L-NCPE gœalhekk ikkonkludiet, f’Settembru 2023 li l-ilmentatur m’gœandux raæun fejn ilmenta magœha f’Diçembru 2021 li r-raæuni li ma æiex magœÿul kien gœax æie diskriminat. Dan juri kemm hu façli li min iœaddem jiddiskrimina minn kull aspett, u jikkonvinçi l-Awtoritajiet. Meta min iœaddem, li diæà jistqarr li gœandu ratio ta’ 10 nisa: 1 raæel, qed jgœid bl-aktar mod çar li jeœtieg carers u jœajjar biex issir applikazzjoni u min japplika jkollu l-kwalifiçi u esperjenza neçessarja, u mingœajr biss intervista jiæi rriæettat, issa wieœed jista’ jiæi refused sempliçiment gœax qabeÿ issittin. ❙

Il-Musbieħ - DIĊEMBRU 2023

September 2023 editor: REMIX NEWS author: THOMAS BROOKE

Some 48 Nigerian professionals practicing in Britain and 669 applicants are accused of fraudulently passing a computer-based test taken in their home country Hundreds of Nigerian midwives working for Britain’s National Health Service (NHS) have been suspected of gaining their medical qualiﬁcations by fraudulently having others take their exams for them in their home country, and dozens remain under investigation. In a press release published on Wednesday, the U.K.’s Nursing and Midwifery Council (NMC) explained it had received reports back in May this year of “unusual data” relating to computer-based tests at the Yunnik Technologies Test Centre in Ibadan, Nigeria.

proxy tester, where someone takes the test on behalf of someone else. Overall, this means we cannot have confidence in any CBT result from this test center and we’re treating all CBTs obtained at Yunnik as invalid,” the NMC said in a statement.

It added that, following an investigation, it now believes “there is evidence of widespread fraud at the Yunnik site.”

A further 669 nurses and midwives who have applied to work in Britain but are not yet employed are also understood to have fraudulently passed the exam.

Foreign nurses who wish to join the NMC register and work in healthcare in Britain are required to undergo several assessments to prove their competency, one of which includes a computerbased test (CBT).

“We’ve paused their applications,” the NMC confirmed. “We’re writing to these applicants to ask them to retake the test, and to request more information that we’ll use to make a final decision about their application.”

The healthcare regulator initially raised doubts over the legitimacy of test results pertaining to 515 Nigerian nurses and midwives currently practicing in the U.K. and deemed their results invalid.

However, despite the investigations into the fraudulent applicants, those already employed will still be allowed to work in their current roles during the process, a decision that has been slammed by critics as a potential threat to the safety of patients.

This list has since been narrowed down to 48 individuals the NMC believes are “likely” to be fraudulent applicants, although all who took the exam at the test center will be required to retake it. “We suspect some people fraudulently obtained their CBT, probably by use of a

“Nobody wants to see individuals who may be innocent automatically penalized, but the nursing regulator has a duty to protect patients, and the sensibilities of those whose qualifications are in doubt must come second to this

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duty,” Prof. Len Shackleton, an editorial and research fellow at the Institute of Economic Affairs told MailOnline. “We understand this continues to be a distressing time for people facing uncertainty about their application or place on our register. We’re committed to managing these concerns in the safest and fairest way we can. It’s been essential to look carefully at all the data and other information presented to us before deciding on the right and proportionate approach for everyone,” said Andrea Sutcliffe, NMC Chief Executive and Registrar. “Internationally educated nurses and midwives make an incredibly important contribution to our health and social care system. Our paramount concern remains to protect the public by maintaining the integrity of the register for nursing and midwifery professionals practicing in the U.K. That’s why we’ve responded to this situation with such painstaking care and consideration,” she added. Nigerian-trained healthcare professionals comprise the third-largest foreign contingent in NHS staff in Britain, with 10,639 trained nurses and midwives practicing across the country. However, their recruitment is controversial with the African nation declared a “red list” country for healthcare recruitment over fears of a brain-drain of educated individuals. ❙

Il-Musbieħ - DIĊEMBRU 2023

The Self-care and resilience workshop On Thursday February 6 2020, we, the hospital chaplains’ team at Mater Dei Hospital, had a very interesting Selfcare and Resilience Workshop. This seminar was organized at Mount St. Joseph, the Jesuit Retreat House and was successfully led by Dr Natalie Kenely, Head of Department of Social Policy & Social Work at the Faculty for Social Wellbeing at the University of Malta. The outline of this Workshop followed the subsequent iter: (1) Compassion fatigue, burn out and secondary traumatisation; (2) Compassion fatigue – why do we get it?; (3) Resilience; (4) Self-care; and (5) tools and strategies. Like other professional people involved within the helping sector, hospital chaplains do benefit from many intrinsic emotional rewards when they care for patients and other clients. In fact, compassion satisfaction (CS) is the term employed to describe this powerful phenomenon. The capacity to feel good regarding one’s contribution at work can help greatly in better overall well-being. However, as Radey and Figley suggest, “compassion, altruism, sympathy, and empathy are critical to human survival and facilitate human flourishing. Given that empathetic practitioners will face negativity, the chaplain profession requires a constant source of inspiration that increases our positivity’’ (Radey and Figley, 2007, p. 214). Extensive interviews with helping professionals have constantly revealed that they often feel emotionally depleted with reduced motivation as coming from protracted distress while helping clients.

photo | centerstone.org

But what is Compassion Fatigue? And who, in fact, gets it? Why do we get it? In a nutshell, compassion fatigue is the wearing down of compassion or the ability to care over a period of time. Compassion Fatigue (CF) is a normal consequence of doing the work you do. It is not a medical diagnosis, it is a set of signs and symptoms that you

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can choose to do something about. Compassion fatigue impacts cognitively such as lowered concentration, apathy, rigidity, disorientation, minimization, preoccupation with trauma. Emotionally it triggers powerlessness, anxiety, guilt, anger, numbness, fear, helplessness, sadness, depression, feeling depleted, shock, blunted or enhanced affect, experiencing troubling dreams and suddenly and involuntarily recalling a frightening experience while working with a client. CF impacts behaviourally too. For instance, one feels irritable, withdrawn, moody, having poor sleep, nightmares, appetite change, hyper-vigilance, and isolating. Spiritually, one starts questioning life’s meaning, pervasive hopelessness, loss of purpose, questioning of religious beliefs, loss of faith/scepticism. Even the body reacts to CF because it experiences sweating, rapid heartbeat, having breathing difficulty, aches and pains, dizziness, impaired immune system, headaches, difficulty in falling or staying asleep and so forth. It is interesting to point out that, according to Bride and Figley, CF and CS may be experienced by the same individual concurrently. Numerous studies demonstrate a strong negative correlation between CF and CS. Hence, if CS is nurtured by the worker and the organization, it is expected that there will be less CF present (Bride & Figley, 2007). In the research findings of an article entitled: Emotional Distress and Compassionate Responses in Palliative Care Decision-Making Consultations, in the Journal of Palliative Medicine, it was found that: (a) Patients and loved ones expressed emotional distress frequently during palliative care consultations; (2) Fear/anxiety/ anger were the predominant emotions expressed; (3) Clinicians tended to respond to distressing emotions with compassionate language. Charles Figley, the university professor in the field of psychology, family therapist, psychoneuroimmunologist, family studies, social work, traumatology, and mental health, said that people who experience compassion fatigue

are often the best and the brightest. They have extra sensitivity. They are empathic people. Empathy can be seen as an emotional armour. Indeed, Kinman & Grant (2014) suggest that empathy needs to be semi-permeable since it allows emotional connection with the patient/ service user but also provides boundary and distance from the distress felt by service user. At this point it is important to see what emotional resilience is all about. To begin with, resilience is the ability to bounce back from the stuff that life throws at us, much of which is out of our control. Some people appear to be naturally more resilient than others. Having said that, there are things you can do to increase your ‘bouncebackability’. Life steadily shows us that, at times, we will be more resilient than others. Grant & Kinman give the subsequent description of Emotional Resilience: “Successful adaptation to every day events rather than unusual ones; emerges from ordinary human capabilities’ (Grant & Kinman 2015). One is said to be resilient when is s/he is able to overcome stressors or withstand negative life events, able to not only recover from such experiences, but also find personal meaning in them, and, finally, s/he is able to exhibit resourcefulness by using available internal and external resources in response to different challenges being faced. In this workshop about self-care and resilience, I became more aware that for me to build resilience I need emotional literacy/intelligence, reflective ability, empathy, effective social skills, support networks, optimism, positive re-framing, problem solving skills, and seeing solutions rather than barriers. At this point of the workshop I was gently challenged to currently rate myself on these qualities. The million-dollar question was the coming one: What is Self-care? For McGarrigle & Walsh, “Self-care can be described as an individual’s ability to balance personal, professional, emotional, mental, physical and spiritual components in order to live in a balanced, energized manner that assists one in coping with day-to-day stressors”

(McGarrigle & Walsh 2011, p. 214). By simply acknowledging the importance of self-care it will not enable you to take better care of yourself. Hence, it is of paramount importance to address the obstacles that limit attention to self-care and perpetuate stress such as excessive expectations, perfectionism, avoiding discord and having an exaggerated sense of responsibility. These obstacles lead to destructive survival strategies like people pleasing and unhealthy giving styles. Therefore it is essential to be aware of and care for each of the dimensions in your life. After all, selfcare is about being true to oneself, self-compassion, being attuned to what is in your best interest and taking a proactive stance toward your needs and goals. Self-care is not about selfishness or being self-absorbed. So, why self-care for Hospital Chaplains? By working within a hospital environment there is a greater risk for vicarious trauma and compassion fatigue (such as listening and witnessing). The chaplain works in stressful conditions and may experience multilayered levels of stress resulting in depression and anxiety. Also, high stress and/or vicarious trauma or compassion fatigue may result in ineffective care for service-users. Moreover, there is an increased stress resulting from dealing with challenging, demanding and complex situations, often with limited resources. Shapiro, Brown and Biegel remind us that self-care is engaging in positive activities that help to manage stress, include getting enough rest, eating a well-balanced diet, exercising, and utilizing a support system (Shapiro, Brown, and Biegel, 2007). There are some practical tips that can be acted upon in order to administer self-care successfully. In the bodily and physical arena regular exercise, healthy diet, adequate sleep, regular general physical checkups, relaxation techniques etc. Regarding the emotional field, self-awareness, self-expression, communication, assertiveness, creative work, music and art, intimacy, friendship, support are helpful mechanisms. Concerning the mind-cognitive aspect positive inner dialogue, challenging faulty beliefs, constant learning,

problem solving, and lateral thinking are fruitful. Finally, within the spiritual dimension meditation, prayer, spiritual retreats, upholding positive values and principles, clear mission statement, and integrity are pivotal. What action can you take? First, be aware of how you feel in different circumstances. If you can recognise the ‘early warning signs’ of compassion fatigue then you can take steps to take care of yourself. Secondly, put boundaries in place between work and home. These could be simple techniques such as leaving your work ‘thoughts’ somewhere on the way home and picking them back up again when you are next travelling to work… Thirdly, put in boundaries with the organisation you work with. Start and finish on time. Work smarter not longer. Fourth, get GOOD professional support and supervision. Supervision is the key in protecting yourself from compassion fatigue. Having the opportunity to de-brief and talk through your experience is key. Peer supervision is also healthy. Fifth, decide on how you will deal with the things you can’t control...mindfulness…Life is a short and precious gift and you are in the perfect work to make a difference in the lives of people. Challenge your current habits and ways of thinking, and be re-energised. Sixth, learn to be your best self; play to your strengths; be adaptive; appreciate the moment; remember YOU AREA HUMAN “BEING” NOT A HUMAN “DOING”. Seventh, deal with the guilt. If your work/life balance is making you feel guilty, find ways to regain your balance. Acknowledge that you can’t change the world for everybody. Eighth, make some time for you. What makes you happy? When was the last time you had some fun? Spend time with family and friends who make you smile and give you energy. The best workers spend time doing things for themselves as well as other people. Ninth, look at your diet and exercise – are there changes there that you can make? Research shows that gentle exercise can help with a feeling

continued on page 32

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EFN Brieﬁng Note on Pact for Skills:

The use of validation of non-formal and informal learning for upskilling and reskilling

The EFN is a member of the Pact for skills, DG Employment. Within the coalition building, EFN participated in a meeting on “The use of validation of nonformal and informal learning for upskilling and reskilling”, which aimed to set the scene on the different EU initiatives to boost upskilling and reskilling of the health workforce.

the 2016 Council Recommendation on Upskilling Pathways.

The Validation describes a process of confirmation tha t an individual has acquired learning outcomes through non-formal and informal learning, which are measured against a relevant standard. This is important for frontline nurses! The validation consists of the four stages: Identification; Documentation; Assessment; Certification.

The evaluation report and Staff Working Document give a picture of the overall moderate impact of the Recommendation:

In an increasingly digitalised and constantly changing world, the necessary skills are changing especially in the healthcare sector.

Relevant indicators show moderate positive trends; Implementation has been uneven across the Member States with measures often lacking scale and coordination; Some stakeholders view the Recommendation as a catalyst for renewed focus on support for adults to acquire basic skills as well as upskilling in general; The three step-approach is considered as a useful reference point; The objectives of the Recommendations are still relevant.

It is necessary to keep pace and to engage nurses in this development to build capacity in the supporting nurses activities and as such build the resilience of the entire healthcare ecosystem. EFN workforce Matrix 3+1 is essential to build the healthcare system workforce capacity.

The EU has a long history of promoting validation of non-formal and informal learning, also for upskilling and reskilling. Key initiatives include the Council Recommendation on the validation of non-formal and informal learning, the European Skills Agenda,

The objective of the Council Recommendation adopted in 2016 is to provide adults with lower level of skills, knowledge or competence, for instance adults with a qualification below the upper secondary level, with opportunities to develop basic skills and/ or acquire a wider set of skills, relevant for active participation in society and the labour market.

Moreover, in the last 3 years, guidelines have been developed in order to define the procedures and the principles to develop the validation process. The guidelines are divided into different chapters: A strategic vision: the individual at the centre; Validation as a facilitator of individual, lifelong and lifewide learning; Validation provision elements; Validation methodologies and tools.

So, it is key for the NNA to focus on the available funding opportunities, don’t miss them!

Il-Musbieħ - DIĊEMBRU 2023

Tmexxija ġdida għall-Awtorità għall-Kura Soċjali u l-Istandards L-infermier George Fenech inħatar bħala Aġent Kap Eżekuttiv tal-Awtorità għall-Kura Soċjali u l-Istandards, wara li sa riċenti serva bħala Senior Nursing Manager ﬂ-Isptar Mater Dei.

Il-qabla, c. 1950s, qed tnaddaf it-tarbija wara l-ħlas

Fenech huwa infermier b’esperjenza vasta ta’ 39 sena u gœandu Higher Diploma fix-Xjenza Politika u Masters (MSc) fil-Æestjoni u Governanza.

Isptar San Luqa gœall-Isptar Mater Dei kif ukoll fit-twaqqif u l-æestjoni tal-COVID-19 Swabbing Hubs fl-Isptar Mater Dei u n-Naxxar.

Minbarra r-rwol tiegœu bœala senior operating theatre scrub nurse, okkupa wkoll rwoli ewlenin fl-akkwist ta’ konsumi fl-isptarijiet u fi rwol ta’ loæistika u management.

Fenech jieœu post Lisa Cassar Shaw, li rriÿenjat fl-aœœar ta’ Lulju gœal raæunitajiet li qatt ma œaræu filpubbliku. Fi stqarrija dwar il-œatra ta’ Fenech, il-Ministeru ma gœamilx riferenza gœar-riÿenja ta’ Cassar Shaw u ma tax raæunijiet gœaliha. ❙

Kien involut ukoll fit-tranÿizzjoni tal-

BioGaia Protectis Drops Small drops Big difference Ȋȱ ȱ ȱ ȱśȱ ȱ ¢ǲ Ȋȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ȱ ȱ ȱ Ȭ ȱ ǲ Ȋȱ ȱ ȱ ě ȱ ȱ ȱ ȱ ȱ ¢ȱ Șǲ Ȋȱ ȱ ȱ ě ȱ ȱ ȱ ȱ ǰȱ ȱ ȱ ǯ

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www.pemix.com.mt | +356 21 437 926 | info@pemix.com.mt ȘǱȱ ȱ ȱ ȱ ǯȱ ȱ ȱŗřȱ ¢ȱŘŖŗŚȱ ȱ ȱ ǯ

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ICN CEO:

photo | premier-research.com

“Not enough to listen to patients, we must act on what they say to really improve safety and quality care” Geneva, Switzerland, 15 September – Ahead of World Patient Day, International Council of Nurses (ICN) Chief Executive Ofﬁcer Howard Catton is calling for urgent action on patient safety to back-up the World Health Organization’s new charter on patient safety rights. Mr Catton was speaking after the WHO-hosted global conference on patient safety and patient engagement concluded with agreement on the ﬁrst-ever Patient Safety Rights Charter. The ICN CEO, who moderated one of the group sessions reviewing the Charter, underlined the importance of creating a culture in healthcare settings that advocates for continuous learning and quality improvement and a culture that supports transparency, and listens and acts on the feedback of patients and health workers. He called on governments to heed the tragic stories of patients and relatives of patients who were harmed or died unnecessarily and take urgent action to make patient safety a renewed priority. Mr Catton said the new Patient Safety Rights Charter, coupled with the Health Worker Safety Charter launched in 2020, was an important step on the way to making health services safer for patients. But he said only committed action would make a difference to families and prevent further tragic accidents: “The theme of this year’s World Patient Safety Day is about engaging patients in their own care. One of the ways we must do that is to ensure that people are really listened to, and their concerns addressed. Unfortunately, and sometimes tragically, patient feedback

often goes into a blackhole instead of becoming the oxygen to stimulate safety and quality improvement. ‘The conference heard many stories directly from patients and the families of patients who have suffered harm and died unnecessarily because of a patient safety issue. It was incredibly moving to hear those heartbreaking stories about incidents that were all, tragically, avoidable. Hearing such stories is so powerful because they force us see the lives of the people involved, rather than just the statistics on a page. ‘It is crucial that decision makers in healthcare organizations hear such stories, not just to motivate them to act, but also so that the views and suggestions of patients and their relatives, who have unique insights into what is happening within healthcare situations, can be heard and acted upon.” After the conference Mr Catton held a bilateral meeting at ICN head office with the Executive Director of the World Patients Alliance (WPA), Hussein Jafri and founding Director, Jolanta Bilinska where they agreed to hold a joint webinar around person centred care, particularly improving the engagement of patients. Mr Catton said: “Patient engagement is more than just asking people what they think: it is about listening and then involving them in solutions that make their experiences safer and more positive, and their health outcomes better.” ICN has previously emphasised the fact that patient safety and healthcare worker safety are intimately linked, and that patients are safer when there are

appropriate nurse staffing levels, and when healthcare organizations have open and transparent cultures where lessons are learned from mistakes.

World Patient Safety Day The World Health Organization’s (WHO) World Patient Safety Day is intended to raise global awareness about patient safety and call for action to reduce patient harm. This year’s theme, Engaging Patients for Patient Safety, aims to highlight the vital role that patients, families and caregivers play in the safety of health care. It emphasises that treating patients as partners in their own care generates significant gains in their safety, satisfaction and health outcomes. Using the slogan, Elevate the Voice of Patients, WHO hopes to achieve the following objectives among its member states: Raising global awareness of the need for active engagement of patients and their families and caregivers in all settings and at all levels of health care to improve patient safety. Engaging policymakers, healthcare leaders, health and care workers, patients’ organizations, civil society and other stakeholders in efforts to engage patients and families in the policies and practices for safe health care. Empowering patients and families to be actively involved in their own health care and in the improvement of safety of health care. ❙ Advocating for urgent action on patient and family engagement, aligned with the Global Patient Safety Action Plan 2021– 2030, to be taken by all partners.

Il-Musbieħ Il-Musbieħ -- DIĊEMBRU 2023

Meaning in care SENIOR CARE AND SERVICES

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Il-Musbieħ - DIĊEMBRU 2023

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October 2023

EFN Statement on the conﬂict Israel-Gaza Once again, the healthcare professionals, and the nurses in particular, are put at stake in the conﬂict in Israel and Gaza. Nurses and many other healthcare professionals have to continue their work under life-threatening circumstances, with many being injured or killed. The EFN is very concerned about the working conditions and environment of these nurses and condemns the attacks on healthcare facilities. The EFN is therefore calling for all parties to the conflict to respect the international principle of medical and healthcare neutrality, that the principle of human rights is upheld and protected, to protect and respect access to healthcare and ensure the safety of the population and the healthcare professionals (cf. Geneva Convention1).

regardless gender, race, ethnicity, or profession.

religion,

The EFN condemns the terrorist attacks and is calling for safe spaces and safe passage for civilians trapped in Gaza to be urgently established, and that human life should be respected

The European Federation of Nurses Associations (EFN) - Registration Number 476.356.013; Clos du Parnasse 11A, 1050 Brussels, Belgium Tel: +32 2 512 74 19 Email: efn@efn.eu Website: www.efn.eu

Patients must have full access to healthcare. Healthcare professionals must not be prevented from performing their professional duties, and any action to prevent or sanction them for carrying out their duty of care to protect lives, contravenes international law. Access to health is a human right. Any attack on health professionals, and the patients they care, is totally unacceptable.

photo | www.aljazeera.com

Why supplement children with probiotics?

Why Optibac Probiotics? At Optibac we use only the most highly researched strains of friendly bacteria and the strains in our children’s range have featured in gold standard clinical trials.

The science

A child’s microbiome starts developing from birth and there are many factors that can impact the levels äñç ÷üóèö òé éõìèñçïü åäæ÷èõìä ÷ëä÷ ĥòøõìöë ìñ ÷ëèöè early years.

At Optibac we always prioritise the most natural ingredients and use ecoconscious packaging where possible. Optibac is the UK and Ireland’s most recommended brand of friendly bacteria supplements and rated ‘Excellent’ on Trustpilot.

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A healthy and balanced microbiome supports digestion, optimal energy levels, immune health and overall wellbeing, so it’s important to nurture its developments throughout childhood.

Digestion

Friendly bacteria help digest food, some can even break down milk sugars. Healthy digestion also supports regularity and vitamin production.

Energy levels

Friendly bacteria keep gut cells and the overall environment in good condition, supporting optimal absorption of nutrients for energy, growth and proper functioning.

Immunity

Children are born with immature immune systems and may experience up to 10 infections per year! Friendly bacteria help immune development and modulate immune activity, protecting against infections. Imbalanced immune responses are associated with asthma, allergies and eczema.

Parents want the very best for their children, which is why Optibac’s range of high-quality öøóóïèðèñ÷ö ëäùè åèèñ öóèæìĤæäïïü formulated especially for little tummies and researched in children. Available in three formats, there’s something for everyone:

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Easy liquid drops, containing the renowned B. breve M-16V®. Researched in thousands of infants worldwide and used in hospital baby care units. Suitable from birth for breast and formula fed infants.

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Easy-to-use sachets suitable from birth to 12 years. Contains three highly researched strains, including the world-renowned L. rhamnosus GG. Collectively these strains have been researched in over 5,000 infants. Also contains, prebiotic FOS and Vitamin D for extra gut and immune support.

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In the most desired format for kids, this tasty strawberry gummy for 3 years+ is a great all-in-one gut and immune supplement, with highly researched B. coagulans Unique IS-2, prebiotic FOS, Vitamin D and Calcium. Unlike other gummies they contain only naturally occurring sugars (55.5% real fruit juice/puree) and no additives.

Antibiotics

In the UK, nearly 15% of all antibiotics prescribed are for children, half of these are for children aged 0-4. Antibiotics lower the number of friendly bacteria, úëìæë ìñæõèäöèö ÷ëè õìöî òé öìçè èģèæ÷ö äñç æäñ ìðóäæ÷ ëèäï÷ë ïä÷èõ ìñ ïìéè

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Optibac is the brand of friendly bacteria most trusted by parents*

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àõèñ Õäåòõä÷òõìèö Õ÷ç "! "" ÖäüĤèïç Êùèñøè Òñçøö÷õìäï Ùäõî Êñçòùèõ Ñäðóöëìõè ÜÙ!! (ÑÞ +44 (0) 1264 369 936 | www.optibacprobiotics.com/uk References available upon request

Il-Musbieħ - DIĊEMBRU 2023

from our

diary

Our Pensioners Group Committee organised a brilliant outing in Gozo.

for Well done to Debbie ul erf nd wo s thi ing achiev ion. reward and recognit

nal – Il-Musbieœ The Editorial Board of our Jour together with ting mee ual ann r thei – attended ss Europe. acro ors Edit other European Nursing

A group of healthcare professionals organised a fantastic day to commemorate this special occasion in our calendar.

a zo.

The Institute for Healt h Professionals organise Care d a very interesting conference in Gozo.

A dynamic seminar was organised at our premises. The photos speak for themselves. Keep it up.

Ethics & Health Care by Marisa Galea Vella

Dementia Care and Ethical Practice - PART 1 The National Strategy for Dementia in the Maltese Islands 2015 - 2023 “Empowering Change” was launched with the purpose of improving the quality of life of individuals living with dementia, their care givers and family members. Emphasis on timely diagnosis, a competent workforce, improving care provision in all settings, promoting an ethical approach to dementia care as well as strengthening the evidence base were all identiﬁed as priorities to achieve this purpose.

The strategy is now reaching the end of its duration with another document currently available for public consultation. The ‘National Strategy for Dementia in the Maltese Islands 2024 – 2031 “Reaching New Heights” Public Consultation Document’ puts forward several priorities established in the previous document, indicating further improvement, and strengthening of current frameworks, resources, and services as well as the addition of new approaches.

The strategic document for consultation “Reaching New Heights” sustains the main aim of the previous document, that is to improve the quality of life of people with dementia, their caregivers, and family members. A number of challenges are also identified, namely increase awareness and understanding of the condition, across all settings and across the life course; control the risk of developing dementia by controlling modifiable risk factors; strive towards timely diagnosis; encourage individuals living with dementia through empowerment and person-centred care;

photo | http://theneurologicalinstitute.com

Dementia is a condition that can be caused by several diseases which over time destroy nerve cells and damage the brain, typically leading to deterioration in cognitive function beyond what might be expected from the usual consequences of biological ageing (WHO, 2023). There are various types of dementia, with Alzheimer’s disease being the most common form of dementia. The WHO (2023) note that dementia is currently the seventh leading cause of death and a major cause of disability and dependency globally.

Alzheimer’s Europe (2019) report that locally, as of 2018, 6,552 individuals are diagnosed with dementia, with a notable higher prevalence amongst women where 4,309 females are living with dementia compared to 2,242 males. It is interesting to note that this makes up for 1.38% of the population as of 2018, noting that an estimated prevalence of 3.31% of the population are expected to be diagnosed with dementia by 2050 (Alzheimer’s Europe, 2019). Dementia is a local (and global) public health challenge, and hence continuity, extension and the implementation of the strategic documents is timely and necessary.

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educate the workforce in dementia care to promote the best care delivery; ensure the provision of person centred, coordinated and flexible support for individuals living with dementia across a range of settings, with more care being delivered in the community; ensure that that palliative and end-of-life care services are responsive to the individual needs of people living with dementia; and invest in local research to improve the evidence base and highlight local needs. These challenges are presented as seven action areas for implementation, with each action presented with objectives and measures as well as stakeholders and respective time frames. Action area six is focused on ‘Dementia Management & Care’ which refers to the need for ‘holistic services to offer advanced care planning, assistance as well as physical, emotional, and spiritual support for persons with dementia and their care givers’. The document defines advanced care planning as ‘a process of reflecting on personal values and having discussions with a substitute decision maker about the care that the person with dementia would want to receive should he/she become unable to make decisions.’ Locally, the concept, introduction and implementation of advanced care planning is new and requires a wide consultation on its own, not to mention its application within the context of dementia and the particular needs of individuals living this reality. Further exploration of this point will be discussed further in the next issue of IlMusbieœ. This write up refers mainly to this document, and can be accessed on https://activeageing.gov.mt/wpcontent/uploads/2023/10/NationalDementia-Strategy-2024-2031-2.pdf.

Il-Musbieħ - DIĊEMBRU 2023

BioGaia Protectis, a powerful strain of L. reuteri in colic, constipation and regurgitation Probiotics, defined as live strains of bacteria with documented health effects, have become a well-recognized option to support the composition of a beneficial microbiota in infants and children. Different strains of a specific species have different probiotic properties and effects. Hence the benefits of one specific strain cannot be extrapolated to the effects of other probiotics.

promote the growth of other good bacteria, and inhibit pathogens. L. reuteri Protectis may also strengthen mucosal integrity by tightening the epithelial barrier and improve immune response.

Limosilactobacillus reuteri Protectis is special Limosilactobacillus reuteri Protectis (L. reuteri DSM 17938) is indigenous to the human digestive tract and one of few probiotics that have co-evolved with humans since beginning of time. L. reuteri Protectis temporary colonize both the stomach and the small intestine. The probiotic exerts its effects, or mode of actions, in many different ways. It has been proven that L. reuteri Protectis influences gut motility and may also reduce visceral pain by the release of neuromodulating molecules. Moreover it influences the intestinal microbiota by releasing reuterin, lactic acid and acetic acid, which help

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Scientific evidence Numerous trials have shown the safety and significant effects of L. reuteri Protectis on functional gastrointestinal disorders and protection of infections in infants and children. Clinical guidelines support the use of L. reuteri Protectis The use of L. reuteri Protectis in paediatrics is supported by a number of international guidelines. Indications with a recommendation are infantile colic, functional abdominal pain, treatment of acute gastroenteritis, as adjunct to oral rehydration solution and prevention of common infections. Clinical effects of L. reuteri Protectis in infants with colic, constipation and regurgitation include reduction in crying time, increase in bowel movements and reduced number of regurgitations in both breast-fed and formula-fed infants. BioGaia Protectis baby drops can be given from birth and do not affect breast-feeding or the taste of food.

References • Reuter G. The Lactobacillus and Bifidobacterium microflora of the human intestine: composition and succession. Curr Issues Intest Microbiol 2001;2:43-53. • Valeur et al. Colonization and Immunomodulation by Lactobacillus reuteri Protectis in the Human Gastrointestinal Tract Applied and environmental microbiology. 2004;1176-1181. • Chung TC et al. In vitro studies on reuterin synthesis by Lactobacillus reuteri. Microb Ecol Health Dis, 1989;2:137-144. • Hojsak I et al. Guidance on the use of probiotics in clinical practice in children with selected clinical conditions and in specific vulnerable groups. (EPA/UNEPSA) Acta Paediatr. 2018;107:927-937. • WGO: World Gastroenterology Organisation Global Guidelines Probiotics and Prebiotics. Review team: Guarner F et al. Feb. 2017.

EFN Policy Statement on Lifelong Learning and Continuous Professional Development In support of the EFN Position Papers on Lifelong Learning (LLL) (2019) and Continuous Professional Development (CPD) (2015), aligned with the European Commission Pillar of Social Rights, the EFN supports the need to invest in education and skills as essential to sustain a high level of quality in nursing and care, which will have a positive impact on patient safety. EU citizens have the right to comprehensive nursing, care and treatment, particularly with the increasing number of chronic diseases in our society and the importance of prevention and early intervention. It is precisely in such circumstances that welleducated and knowledgeable nurses with the most up-to-date evidencebased practice make a significant difference to assessing, diagnosing and administering appropriate and safe treatment for optional health outcomes. The EU-Directive 2013/55/EU provides the education requirements to become a general care nurse, in addition the Directive emphasises the high priority of LLL/CPD. Therefore, opportunities are required to be created for nursing professionals to continue their professional development and maintain high quality and safe standards for patient care. Research says that LLL/CPD enhance the professional knowledge and skills for better patient care through improved care standards, how they communicate and collaborate with other professionals. Learning also increases nurses’ career progression.

structures, including regulation and formal acknowledgement, and pay rise alongside the growing responsibility. Nurses should have the opportunity to access LLL/CPD activities within working hours (with employers making sure to have enough nurses to cover those CPD). Employers should support nurses to stay in the profession and ensure they have adequate career opportunities, with the content of the learning being flexible and tailored to the needs of nurses and the population health needs. Developments for example in IT or simulation must be incorporated in education and ongoing learning, as digital solutions can make a real positive difference to supporting LLL/CPD. Therefore, digital learning environments and digital media didactics can be designed as low-threshold access and must be an integral part of the nursing education and training curricula for all care settings. It is important, that educators and trainers also have digital skills and are able to generate digital learning units.

In order to guarantee LLL/CPD as an integral part of a nurses’ career pathway, the framework and operating conditions must be created, including for example, the availability of sufficiently university courses with the appropriate levels of staff to enable the enhancement of university learning environments within the healthcare environment. It is recommended that the national governments consult the National Nurses Associations regarding the development of national education and training programs. This is essential in order to be able to implement a national strategy regarding LLL/CPD. In addition, specifications are needed on how further education and training should be documented, for example documentation in a national register. EU-wide free movement of professionals is enshrined in the EU Directive 2013/55/ EU and the free movement of nurses can only be guaranteed with nursing education being mutually recognised within and between EU countries. Investing in the education of the nursing workforce, through LLL and CPD, is essential to ensure the nursing workforce is skilled and prepared to provide high quality and safe patient care that contributes to improving patient outcomes and the public confidence in the healthcare ecosystem. ❙

Promoting the LLL/CPD of nurses in the clinical context is fundamental, given its positive impact on patients, professionals and organisations. The EFN welcomes the following recommendations that strengthen nurses’ accessibility to LLL/CPD: Nurses access to LLL/CPD in all EU Member States should be mandatory (employers’ responsibility), supported by appropriate structures, in accordance with the Member States obligation under the revised Directive on the Mutual Recognition of Professional Qualifications. There needs to be in place, on national level, systematic career path

Prize day of S.R.N.s

A cutting from L-Orizzont of Friday 18th November 1966.

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World Heart Day 2023 Cardiovascular disease (CVD) is the leading cause of mortality globally, killing more than 20 million people annually, which is more than any other cause. Coronary artery disease and stroke account for about 80% of these deaths, mostly in middle to low-income countries. The circulatory system can be affected in a harmful manner by certain unhealthy lifestyle habits, such as a lack of exercise, smoking, high cholesterol levels, living with a high blood pressure and eating an unhealthy diet. When the heart and the circulatory system become compromised due to the effects of these risk factors, this is referred to as cardiovascular disease. Most often CVD is symptomless, that is a person will not show any signs of disease. The first sign may be a heart attack or a stroke. Symptoms, when they manifest, vary depending on the condition present and can include: • Chest pain, discomfort or tightness • Shortness of breath, • Easily tiring during exertion or exercising • Light-headedness or fainting • Weakness or fatigue Men are more likely to experience severe chest pain which often radiates to the left arm or jaw and shortness of

breath. Women may also experience the same symptoms, but the severity may be less, and the pain may present as indigestion and not consistent. Nausea and cold sweat may also be present during a heart attack. There are several tests which can be done to diagnose CVD. These include blood tests, a stress test, echocardiogram (Echo), electrocardiogram (ECG) cardiac catheterisation and coronary angiography. Of course, one of the most important aspects of CVD is that 80% of the disease is mostly preventable. While some of the risk factors are non-modifiable, such as age, there are other behaviours which can be changed. Unhealthy eating habits, such as high-salt and high sugar intake, smoking and physical inactivity, which in turn can lead to an increase in diabetes, hypertension and obesity can all be modified. All these factors can lead to the development of CVD. Changing unhealthy behavioural habits should be

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performed both on an individual level and on a larger national scale, whereas government health policies need to be in place to ensure that the larger community has access to a healthy environment and to provide the tools necessary for individuals to live a hearthealthy lifestyle, such as affordable healthy foods, clean air, and urban areas suitable for active recreation. World Heart Day is a yearly event which takes place on the 29th of September, and whose aim is to remind society about the importance of taking care of our heart. In a world where there is so much heart-health illiteracy and inadequate health policies in place, this event aims to create awareness among the general population about the importance of taking care of our heart before it is too late. It is organised by the World Heart Federation (WHF), a leader in global cardiovascular health, a major campaigner on heart health which acts to reduce the global burden of heart disease and stroke. Through their policies, guidance, and resources, they aim to provide the necessary tools and knowledge so that people can live healthier, longer lives.

World Heart Day 2023

The cardiac rehabilitation unit in Mater Dei hospital, Malta, organises a yearly event to commemorate World Heart Day. Cardiac rehabilitation is a multifactorial, nurse-led, medically supervised secondary prevention program whose aim is to guide people with CVD in the prevention of further cardiac events, especially after a heart attack, through education and exercise programs. This year, the unit organised a walk at Ta’ Qali to mark this day. This event was a collaboration between the cardiac rehab unit, Maltese Cardiac Society, the Health Promotion and Disease Prevention unit, the physiotherapy department (MDH), Resus practice nurses and the Malta Resus Council. For more information on Word Heart Day and Malta’s participation by visiting https://world-heart-federation. org/world-heart-day/whd-stories/ whd23-celebrations-in-malta/ Clifford Xuereb MSc Preventive Cardiology (Imperial College, Lond.); Cardiology Senior Practice Nurse, Mater Dei Hospital On behalf of the organising team [Cardiacrehab.mdh@gov.mt]

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International Council of Nurses Board New Statement on Israel-Gaza Conﬂict Geneva, Switzerland; 08 November 2023: The International Council of Nurses (ICN) Board of Directors, meeting in Geneva, expressed its deepest concern for those suffering in the on-going conﬂict in Israel and Gaza. The ICN Board condemned all acts of violence and terrorism and renewed its demand for safe access to health services for all and the protection of health care workers. Statement by the International Council of Nurses Board of Directors: We call on all parties in the conflict to establish a peace process, stop the violence and secure peace. We condemn in the strongest possible terms the continuing violence and terrorism in the Israel-Gaza conflict and express our deepest concern for all people in the region and the continued loss of innocent life. We call for all parties to respect their legal obligations under international humanitarian law to protect and respect safe access to health care services and facilities and ensure the safety and protection of civilians and health care workers. We appeal to all parties to urgently, and of paramount

importance, find a way to provide safe access to medical and humanitarian aid and support for all people caught up in the conflict. We are deeply concerned for the innocent civilians, particularly women and children, the elderly and the most vulnerable, who are caught up in the conflict and whose physical and mental health are being damaged. We are conscious not only of the health care needs of those who are directly affected by the conflict, but also the pre-existing and on-going needs of people with long-term conditions. We acknowledge the service and enormous sacrifice of all health care workers in the conflict providing care and support to all people whilst their personal safety is at risk at a time when they are dealing with their own loss,

photo | static01.nyt.com

including caring for injured family members and mourning those lost. We recognize that nurses and all health workers in the region are personally affected by the violence, destruction and the loss and separation of loved ones, and the huge mental health burden they are living under which must be urgently addressed. We particularly express our heartfelt concern for the members of our national nursing associations in the region and all nurses working on the frontlines of care. We, as the global voice of nursing, stand in solidarity with all nurses and other health care workers affected by the conflict. ICN encourages anyone wishing to support nurses and health care in the region to join its #NURSESFORPEACE campaign which supports nurses working on the frontlines of conflict areas around the world and to donate via the ICN Humanitarian Fund. ❙

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EFN Policy Statement on Safe Stafﬁng Levels This Policy Statement draws from EFN previous policy statements and from data gathered by EFN members in relation to registered nursing ratios and registered nursing accountability. The impact of the COVID-19 pandemic worsened the critical shortage of nurses and other healthcare professionals and is now severely impeding the functioning of healthcare systems in the EU, Europe and around the world. Health budget cuts and cost saving measures introduced during the 2009 financial crisis continue to significantly impact the nursing profession with reduced staffing levels, cuts to wages and challenging working environments. Meanwhile, since this time the demand for healthcare has risen. The EFN has long highlighted the need for EU Institutions and Member States to adequately address the growing registered nursing shortages. The World Health Organization (2022) characterises current gaps in the health and care workforce in Europe as a ‘ticking time bomb’ that could lead to worsening health outcomes and, in extreme cases, system collapse. The EFN has continually campaigned on the issue of nursing workforce shortages. Specifically, the EFN’s two position statements, ‘Building and Sustaining a Resilient EU Nursing Workforce in the EU and Europe’ (April 2022) and ‘Consequences of Nurses Shortages in Public Health’ (November 2020) address the negative impacts of nursing shortages on the profession and broader healthcare system. However, the political response and rhetoric by EU Institutions and Member States to tackle the challenges have not translated into any tangible action to develop and implement solutions to protect the status of the nursing profession, improve retention and reimbursement of registered nurses within the healthcare systems. Registered nurses have long been recognised as the backbone of the

healthcare ecosystems and were the heroes in the COVID-19 pandemic. However, European countries have not responded by providing the appropriate protections to the profession. In reality, the challenges to the profession: workforce shortages, resilience, migration, and unethical recruitment and retention, have never been tackled in a meaningful and sustained way. The outcome of this situation has been increasing the levels of stress, burnout and physical exhaustion in nursing. Even before the COVID-19 pandemic, evidence confirmed that high workloads, inadequate staffing levels, long shifts and low control over their job were associated with burnout in nurses and impacted their mental health. The lack of educational support in promoting nursing and attracting/retaining new students has been equally challenging. The end result has been a critically low workforce which severely impacts patient safety, quality of care and the welfare of nurses. While interventions targeting fair pay, safety at work, gender/ race discrimination or better career progression are important, multidimensional systemic changes are required to bring about sustained and lasting change. Studies show that some units are operating with registered nurse staffing

numbers which are considered unsafe, therefore, jeopardising the quality of care and safety of the people under their care, as well as their own safety (Aiken L., 2014, 2021). We are witnessing a concerning increase in the use of unregulated labour in the healthcare sector, leading to unsafe skill mix even when it comes to nursing roles close to the patients, with negative implications for the quality of care and patient safety. Moreover, under these conditions and increased workload, nurses are held accountable for missed nursing care incidents or the inability to maintain optimal quality standards required by patients and healthcare systems (Phelan A and McCarthy S, 2016). Nursing students have reported excessive practice hours, a lack of educators and mentors, and requirements to undertake tasks beyond their scope of clinical practice during placements leading to students leaving their studies or deciding not to seek employment within the nursing profession after completing their studies. Amid these growing concerns of dire working conditions and a shortage of registered nurses, it is crucial to have safe staffing levels in the nursing profession across the EU and Europe and find concrete solutions for recruiting and retaining European nurses, vital for providing quality and safe patient care.

continued on page 33

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The Self-care and resilience workshop continued from page 11 of well-being (and we should be eating a balanced diet, not over indulging on the alcohol front etc). Tenth, talk amongst yourselves – others may be experiencing compassion fatigue but feel too guilty to talk about it. Eleventh, the more you talk about compassion fatigue, the more you normalise it and people can get the support they need. Workers who are supported are much more able to support others. Twelfth, take a break; sometimes you may feel like you need a break to regain your balance. Much better to take a short break than to get overwhelmed and feel you have to leave for good. Thirteenth, share the changes you are going to make and ask your colleagues to help keep you on track. When you share your goals with other people it makes them much more real, and helps you be more accountable for your actions.

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Fourteenth, learn to say ‘No’. Are you the person who is the ‘go-to’ person every time something needs doing? How does that make you feel (it may

CMY

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tap into one of your ‘shadow needs’ – the need to be needed, so be honest here). How can you learn to say no better? Fifteenth, learn to say ‘Yes’! Compassion fatigue can leave you exhausted, demoralised and lacking in energy, so you stop doing the things that make you happy and rejuvenated. Start saying ‘yes’ to walks by the sea, training sessions that become available, times of sharing with your community etc. As a conclusion, choosing to start with one or 2 simple changes will give you the impetus to keep going. You may be looking at the list above and be thinking ‘Yeah, right – that’s NEVER going to happen’. Well, it’s your choice. But remember: “If you always do what you always did, you’ll always get what you always got.” So, the choice is in your hands! It is in this sense that Mater Dei Hospital chaplaincy team Self-care and Resilience Workshop was a great success and, most of all, a catalyst for change in the way pastoral care will be carried out within the same hospital in the near future. Fr Mario Attard OFM Cap

Joe Camilleri, Editor, Il-Musbieħ

The European Editor’s Network Meeting 2023

A Maltese delegation of three members representing ‘Il-Musbieħ’ publication have attended the London European Editor’s Network meeting on the 19th and 20th October 2023. The EEN is a yearly editor’s meeting representing nurses’ and midwives’ magazines and journals throughout Europe. Networking and exchange of ideas and experiences are held on 2 days, whilst the host country organises speakers to deliver lectures related to the subject.

Joe Camilleri, in the capacity of editor, together with members of ‘IlMusbieœ’ Group Committee William Grech and Alexander Lautier shared the Maltese experience with the other editors, communications officers and journalists representing the magazines. Other entities representing their journals were: the International Council of Europe; the Royal College of Nurses (RCNi-UK) (Nursing Standard); Sweden (Vårdfokus); Switzerland (Krankenflege SBK ASI); Finland (Sairaanhoitaja); Germany (Die Schwester Der Pfleger); and Ireland (WIN-INMO).

Speakers during the 2-day programme at the RCN HQ in Cavendish Square, London were ICN Senior Press Officer Gyorgy Madarasz, Sarah Lydall of the RCNi who dealt with Audience Engagement, Google analytics and social media, Susan Sinclair, chair RCNi non-executive board of directors who dealt with the Challenges and opportunities for UK Nursing, and Richard Hatchett, Senior Nurse Editor who dealt with Commissioning articles for Peer Review. A visit to the famous Florence Nightingale London Museum was also the highlight of the visit. Next year’s EEN meeting will be hosted in Berlin, Germany. ❙

EFN Policy Statement on Safe Stafﬁng Levels continued from page 31 The evidence shows that increased registered nurse staffing with an appropriate skill mix positively affects patient outcomes and mortality rates, and improves job satisfaction and nurse retention (Griffiths et al., 2018; Aiken et al., 2014, Ball and Catton, 2011; Aiken et al., 2002). Evidence-based methods to determine the most appropriate staffing levels and skill mix are also important tools for ensuring safe staffing—for example, the Framework for Safe Nurse Staffing and Skill Mix (Department of Health Ireland, 2018). Therefore, ensuring optimal nurse staffing is essential to providing safe, high-quality care. Therefore, the EFN calls on the EU and non EU decisionmakers within Europe to immediately:

Establish and legislate safe registered nurse staffing levels, with an appropriate skill mix to ensure the safety of patients and nurses, with enforcement mechanisms and penalties. Always maintain safe nurse staffing levels in all clinical areas to ensure they can respond safely to all patient needs and the ability to deal with different situations that healthcare systems might encounter to protect nursing personnel. Establish proper and legitimate agreements that will protect nurses when faced with missed nursing care due to registered nurse shortages. Invest in nursing leadership and career pathways to reduce nurses leaving the profession. Invest in nurses and nursing education, and increase all efforts to make nursing

education attractive to students and increase enrolment in undergraduate studies. Increase funding for undergraduate student nurses, increase placements and support students through clinical facilitation. The challenges in nursing education must be addressed to increase the number of nursing students completing their studies and attracting more people into the profession, thus minimising nursing shortages. Finally, having a sufficient supply of well-educated registered nurses will support the EU’s efforts to act on all health determinants (social, economic and ecological) through health promotion and disease prevention, and meet their obligations to provide expert, timely healthcare to its citizens and populations. ❙

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New Year Honours 2023

Covid vaccine centre nurse, 70, honoured A 70-year-old nurse who screened thousands of patients at Covid vaccination centres has been recognised in the King’s New Year Honours list. Mary Buck, from Swanage in Dorset, said older centre workers had been fearful of catching and spreading the disease. She previously ran services for St John Ambulance as well as helping to install community defibrillators in Swanage. Mrs Buck is awarded a British Empire Medal for services to the NHS and the Dorset community. Mrs Buck said her work with St John Ambulance was probably the biggest joy of her life She said her Covid vaccination centres at the Bournemouth International Centre and in Wareham depended on the work of retired doctors and nurses who were fearful of bringing the virus home to their families. “My husband’s that bit older so it was a thing coming through the front door and straight into the shower,” she said. “We sat opposite ends of the lounge and I was sleeping in the spare room for a few months.” More than 90,000 doses of the Covid vaccine were administered at the Bournemouth International Centre.

Mrs Buck, who had considered retiring from nursing, said she kept up her medical registration mainly because of Covid. She was previously appointed Commander of the Order of St John for her work with the St John Ambulance service. She said: “Training St John Ambulance cadets who went on to become A&E consultants and senior police officers is probably the biggest joy of my life.” ❙

“

Mary Buck said she was fearful of giving Covid to her husband.

New acting CEO at St Vincent de Paul home for the elderly

”

Jorgen Souness has been appointed acting CEO at St Vincent de Paul home for the elderly, the Active Aging Ministry said Thursday. Souness is a nurse by profession and served as director of quality assurance at the Health Ministry. Souness was responsible for the vaccination programme during the Covid-19 pandemic. He also worked as administrator at Mater Dei Hospital and more recently at the Paola Hub. He replaces Josianne Cutajar. ❙

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The role of the Psychiatric and Mental Health Nursing profession in Malta

A new recognition

In the dynamic landscape of healthcare, the importance of mental health has been gaining increased recognition over the past years and as societies grapple with the challenges of the 21st century, psychiatric and mental health nurses have emerged as integral contributors to the overall well-being of populations. This article explores the evolving roles and responsibilities of psychiatric and mental health nurses in the contemporary healthcare setting and highlights their relevance in addressing the complex mental health needs of the population. Evolution of Mental Health Nursing Historically, mental health nursing has undergone significant transformations. From the era of institutionalization to the current emphasis on communitybased care, psychiatric and mental health nurses have adapted their roles to meet the changing needs of individuals with mental health disorders. Today, their responsibilities extend beyond traditional hospital settings, encompassing a broad spectrum of care environments including, assertive outreach and crisis home treatment amongst others. Collaborative Care and Multidisciplinary Approach In the 21st century, psychiatric and mental health nurses actively engage in collaborative care models, working alongside psychologists, social workers, psychiatrists, and other healthcare professionals. The multidisciplinary approach ensures a holistic, person centred and comprehensive treatment plan for individuals experiencing mental health challenges.

Psychiatric nurses play a pivotal role in coordinating care, advocating for patients, and fostering effective communication among team members. Patient-Centered Care and Advocacy One of the core responsibilities of psychiatric and mental health nurses is to provide patient-centred care. This involves recognizing the unique needs and preferences of each individual and tailoring interventions accordingly. This is a crucial skill if the highest quality of care is to be given. Moreover, mental health nurses serve as advocates for their patients, empowering them to actively participate in their treatment decisions and promoting autonomy.

Crisis Intervention and Prevention In an era marked by increased stressors and societal pressures, psychiatric and mental health nurses are at the forefront of crisis intervention and prevention. They are trained to identify early signs of distress, assess risk factors, and implement timely interventions to prevent the escalation of mental health crises. Their expertise is crucial in mitigating the impact of acute episodes and fostering resilience in individuals facing mental health challenges. Education and Community Outreach Psychiatric and mental health nurses contribute significantly to mental health education and community outreach programs. They play a vital role in destigmatizing mental health issues, raising awareness, and promoting mental health literacy. By engaging with communities, these nurses contribute to the creation of supportive environments that foster mental wellbeing and reduce the barriers to seeking help.

continued on page 38

photo | www.careerfaqs.com.au

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ICN President says Universal Health Coverage will only be achieved by 2030 if there is a dramatic increase in investment in nursing Geneva, Switzerland - The International Council of Nurses (ICN) President Dr Pamela Cipriano has stated that nursing holds the key to changes that must be made to health systems if the goal of Universal Health Coverage (UHC) is to become a reality by the World Health Organization’s (WHO) deadline of 2030. Speaking ahead of the United Nations High Level Meeting on UHC, Dr Cipriano said nurses have the skills and expertise to make progress towards UHC, but shortages and a lack of investment around the world are reducing their impact. Dr Cipriano added: “There is no simple solution when it comes to Universal Health Coverage, but there is no doubt that nurses hold the master key to unlocking better care for people everywhere.

‘Highly skilled nurses make a real difference, but unfortunately their efforts are being thwarted by the lack of investment from governments and healthcare organizations in educating new nurses, employing more nurses, improving the training and retention of those we already have, and enabling highly skilled advanced practice nurses to expand their roles and responsibilities.” ICN is a member of the International Health Partnership’s (UHC2030) Task Force, which has launched its Action Agenda setting out what needs to be done to move the journey towards UHC forward. Dr Cipriano said having a robust nursing workforce is a vital first step on this journey, and that ICN’s own Charter for Change shows how nursing’s contribution to UHC can be maximised. “ICN’s Charter for Change calls on governments to value, protect, respect,

and invest in our nurses to ensure there is a sustainable future for nursing and health care. Without that investment, UHC will not be achieved ever, let alone by the fast-approaching deadline of 2030. ‘Access to healthcare is a universal right that should be respected by and for everyone on the planet. Nurses can make it a reality, but they can’t do it on their own, and they certainly can’t do it without a step-change in the amount of money governments are prepared to put into healthcare. It’s time we address health security by acknowledging that human capital is wealth embedded in people. ‘The world will be a better place if governments open up their coffers and put health and nursing at the top of their financial plans. Every Dollar invested in nursing will return dividends for years to come. It’s time for governments to wise up, step up and pay up - for the good of us all.” ❙

The role of the Psychiatric and Mental Health Nursing profession continued from page 37 Embracing Technological Advancements In the digital age, psychiatric and mental health nurses leverage technology to enhance patient care. Telehealth services, mobile applications, and online resources have become integral tools in providing accessible and efficient mental health support. Nurses adapt to technological advancements to ensure that mental health services remain relevant and accessible in the ever-evolving healthcare landscape. In the near future it is hoped that these technological advancements are also implemented locally to support the work of the psychiatric and mental health nurses and multi-disciplinary team alike.

As the understanding of mental health continues to evolve, the roles and responsibilities of psychiatric and mental health nurses become increasingly vital. In these current times, these professionals are essential contributors to the promotion, prevention, and treatment of mental health issues.

been on the forefront of promoting this profession both locally and at an international level. It is hoped that the roles and responsibilities of psychiatric and mental health nurses keep evolving alongside societal changes to be in a position to actively provide quality person centred holistic care.

Through collaborative care, patient advocacy, crisis intervention, education, and the integration of technology, psychiatric and mental health nurses are indispensable in addressing the diverse and complex mental health needs of individuals and communities. Their commitment to compassionate, evidence-based care makes them crucial players in shaping the future of mental health services. The Maltese Association of Psychiatric Nurses (MAPN) has always

In collaboration with MUMN, MAPN have managed to introduce the grades of “psychiatric and mental health nurse” and “senior psychiatric and mental health nurse” in the nursing specialities. This is a huge step and an significant achievement for the psychiatric and mental health nursing profession in Malta. ❙ Alexei Sammut MAPN President

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