Il- Musbieh Edition No.84 by MaltaUnionofMidwivesandNurses

Il-MusbieÅ&#x201C; MALTA NURSING AND MIDWIFERY JOURNAL

Malta Union of Midwives and Nurses

Numru 84 - Settembru 2019

MUMN

defends & supports all its members the heartbeat of healthcare

www.mumn.org Tel: 7714 1260 E-mail: mumn@maltanet.net

Tablet 1 !white) Glucosamine Sulphate 1500mg

Glucosomlne is on essential building block of a substance known as glycosomlnoglycons !GAG's) which form the basis of the soft cartilage tissue that coots lhe bones in joints, as well as the synovial fluid which bathes joints such as knees and elbows making them move smoothly. Glucosomine works by stimulating the repair and renewal of cartilage llssue. Following a recent Iorge American trial, a dolly intake of 1500mg of glucosomlne Is now considered to be a benchmark for providing optimal support of joint health.

Chondroitin Is often provided alongside glucosomine as Ills also a major component of the GAG's which make up articular cartilage. II seems to be particularly valuable In oMrocllng fluid into the cartilage llssue making it more spongy and improving Irs cushioning and shock absorbing abilities. Follovving a recent large American trial, a doily intake of 1200mg of chondroitin sulphate is now considered to be a benchmark for providing optimal support of joint health.

Softgel 3 !clear) Fish Oil Omega-3 Fatty Acids

Capsule 4 !yellow) MSM, Turmeric, Roseh1p, Ginger & VItamins 0 &

Alongside glucosomlne and chondroitin, fish oils hove a long tradition of use In helping support joint mobility which Is now supported by scientific evidence. This Is In addition to the established benefits in heart and brain health. Scientific evidence has now established that the omego-3's EPA & DHA In these oils ore responsible for the benefits. Each capsule In Complete Joint Health Multipock contains 300mg of EPA & OHA.

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MSM is a source of sulphur and some studies show thaiMSM may help to support the repair of cartilage In joints. Turmeric, ginger and rosehlp may help support joint health by collectively reducing the levels and effects of wear and tear on the joints especially as we age. Vitamins 0 and E ore essential for the maintenance of connective and bone tissue health and also octs as antioxidants to help neutralize damaging free radicals.

contents

Ħarġa nru 84

Settembru 2019 - Editorial & President’s message

pages 4-5

- From our diary

pages 20-21

- Meta konna naħarqu l-awrina

pages 28-29

Group Committee Chairpersons and Secretaries MUMN - 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; Vincent Muscat, Secretary: 99455982 Health Centres: Roseanne Bajada, Chairperson: 79671910; Miriam Aquilina, Secretary: 99830893 MCH: Angelo Abela, Chairperson: 79594326; Malcolm Bezzina, Secretary: 77822561 SAMOC: Ronnie Frendo, Chairperson: 77000919; Dennis Darmanin, Secretary: 79826533 GGH: Joseph Camilleri: 79485693; Anthony Zammit: 79617531; Jennifer Vella: 79277030 ECG Technicians: Alex Genovese, Chairperson: 79860571; Charmaine Caruana, Secretary: 99462992 Physiotherapists: Pauline Fenech, Chairperson: 79491366; Luciano Pace Parascandolo, Secretary: 79455083 Midwives: Catherine Bonnici, Chairperson: 99252438; Abigail Plum, Secretary: 79592466 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 Simon Vella: 79703433 Claire Zerafa: 99217063 Joseph Aquilina: 99467687 MUMN Office: 21448542 Editorial Board Joseph Camilleri (Editor) CN M1 MDH Christa Gauci (Member) SN SJ 6 SVPR Norbert Debono (Member) EN

Pubblikat: Malta Union of Midwives and Nurses Les Lapins Court B, No.3, Independence Avenue, Mosta MST9022 • Tel/Fax: 2144 8542 • Website: www.mumn.org • E-mail: mumn@maltanet.net 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.

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: 4,000 kopja.

Ritratt tal-faççata: Joseph Aquilina.

Il-Musbieœ jiæi ppubblikat 4 darbiet f’sena.

- Ltd., SETTEMBRU 2019 Diÿinn uIl-Musbieħ stampar: Union Print Co. Marsa

Editorial

Health, Well-Being and Obesity

ater Dei Hospital announced and stopped non-nutritional items, such as pastizzi, fried food, donuts, chocolates, high sugar yoghurts and salted nuts to its staff, patients and visitors alike. This caused quite a stir as first of all staff was not treated as an adult to choose what they want, Unions were not consulted, and food was restricted to an antagonising meal, notwithstanding that most healthcare workers have to work a 12-hour shift. Staff also debated that sugary drinks are not necessarily ‘unhealthy’ when they are needed to boost them up after a long day. Why can’t people take responsibility for their own health? Why do we need this nanny state? Banning for example sugar for everyone may be far too late. Isn’t a spoonful of sugar fine? Too much of it is dangerous and yes, maybe highly addictive. The intention behind such a decision may be good but is this enough to promote a healthy living lifestyle and well-being amongst healthcare providers? MUMN has already made it clear that Mater Dei Hospital should introduce a free gym on its premises if it is worried about staff health. It would have been better if our hospitals promoted physical exercise e.g. during our breaks rather than enforcing such

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bans. On the other hand employers in some European countries are pushing the idea of on-the-job exercise compulsory. Mandatory workouts, usually in a group and during their duty hours (not break time), also have other benefits as they bring together all the departments of an organisation, allowing employees to put their work responsibilities aside, get to know each other on an equal footing and get higher wages if they do not skip compulsory workouts. The compulsory two hours a week workout classes, differ each week, and include boxing, CrossFit, high intensity interval training and yoga. If employees cannot attend the class, for example if they are off-site or pregnant, then they are encouraged to complete another form of physical activity. Such an idea is debatable whether such an initiative should be mandatory or voluntary. Another initiative is that any employees’ sporting activity is subsidised by the employer or get tax-breaks. Gyms at the place of work help increase employee retention, increase workplace morale, reduce workplace injuries and absenteeism, increase productivity, increase employee confidence and decision-making, break down workplace barriers and increase positive experiences at the

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photo | usnews.com

workplace. On-site gyms must be open 24 hours/ 7 days a week, with no booking and no rigid fitness class. Exercise is an essential part of a healthy diet starting with brains and working down. Studies have found that in most hospitals around the world a majority of workers are overweight or obese and do not take part in vigorous physical activity. This is especially worrying for the Maltese healthcare workers as Malta has one of the highest rates of obesity, standing at 29.8%, according to a report by the World Health Organisation. It is actually a known fact that people who take care of others on a regular basis are generally less likely to take care of themselves. The focus of hospitals is on patient care, so sometimes the workers’ own care can take a back seat. This is troubling because these are hospital employees active in the workforce and we need them to be healthy. Because obesity is linked to so many cardiometabolic risks, such as elevated glucose and lipids, this calls for immediate intervention to prevent chronic diseases. Mater Dei Hospital already has a worksite wellness programme but this is not utilised enough by our staff. Managers have a duty to promote, as much as possible, to all their staff, such healthy initiatives.

President’s message Summer is nearly over and so is the holiday season, as summer comes to an end, the new intake of nursing students from the UOM would have been allocated to our hospitals, residences and homes bringing to some of the nursing workforce the much-needed new blood. For most the new intake of nursing students would not make any diﬀerence since the staﬃng levels in their ward did not increase at all. Also during the summer months, there were certain wards which experienced major crisis and rightly, so these wards requested the intervention of the union.

But the big question remains … Will the shortage of nurses be really addressed? When will such a longstanding dilemma be effectively addressed? After hard discussions with the health department, MUMN has been granted the open call for foreign nurses. Having said this MUMN will still be taking an active stand (in the coming weeks) on wards/theatres and other departments in MDH and other entities when under staffing is experienced on a daily basis. As always, when wards/theatre and other places have a depleted nursing compliment, staff will always be having all the backing of MUMN. On a different note, it is a great pity that Northumbria University situated at MCAST, have included in their entry qualifications only one specific science subject being biology, which is similar, if not identical to the UOM. MUMN is stressing that if the criteria of an A level subject is to be introduced as an entry requirement, a wide variety of A level subjects should be acceptable as an entry requirement. Also the scope of having two nursing universities was to introduce two different pathways

for young people to join nursing profession. Thus, the scope of having two nursing universities both having identical entry requirements has literally neutralised this aspect and this is not right at all. MUMN will be having meetings with Northumbria University hoping that this University would be pro active and offer the much-needed alternative pathway so that more students will join nursing. The scope of MUMN and myself of taking up an active role in bringing to Malta another nursing university was not to compete with the UOM but to have alternative pathways similar to those offered in the UK. Having to different pathways is important since the intake of nursing students graduating from both universities is to say the least pathetic and the existing nursing workforce are the one’s which are feeling the burnout due to the huge nursing shortage. Also depleting other countries such as India and Pakistan from their nursing work force is not morally right since such countries also needs nurses for their patients and so the aim of MUMN is for Malta to be self-sufficient as regards recruitment. During the meeting going to be

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held with Northumbria University on this issue, MUMN will point out that the current situation between the two universities is that we are just robbing the UOM to give to Northumbria University or vice versa. In other wards there will be no increase in numbers when you combine the intake of both universities and that is not right for Maltese patients and present nurses. It is time that every profession in the health sector is independent from all other professions and not incorporate ten health professional groups into one group as to make a one fit for all agreement. I personally called it the Kawlata since no health profession deserves to be treated in such a way. Definitely UHM, being a general union and not a professional union such as MUMN does not have the sense of pride of developing one’s own profession, something which MUMN is proud of. MUMN’s position for nurses and midwives also stands for the Physiotherapists, ECG Technicians, Social Workers and all other health care professions who eventually would be joining MUMN. Paul Pace MUMN President

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Kelmtejn

mis-Segretarju Ġenerali K

if inthom œbieb? Nispera li tinsabu tajjeb u li sibtu ftit çans fis-Sajf biex tistrieœu ftit u tinqatgœu mir-rutina tas-soltu. Il-Kunsill il-ædid qabad sewwa u kulœadd qed jaœdem fir-rwol li æie mogœti lilu. L-akbar uæiegœ ta’ ras jibqa’ dejjem in-nuqqas ta’ nurses. Din is-sena laœaq grupp sabiœ u minn hawn nixtieqilhom l-akbar suççess filkarriera tagœhom. Importanti wkoll naraw kemm telqu nurses, kemm irriÿenjaw jew œadu 6 xhur biex jaddottaw f’impjieg ieœor anki barra minn pajjiÿna. Meta tgœodd il-bilanç issib li gœadna lura. F’waœda milllaqgœat li jkollna mad-Dipartiment, ilœaqna ftehim biex f’Jannar li æej tinfetaœ open call gœan-nurses biex b’hekk kull min irid jirritorna lura jew jitœajjar jimpjega ruœu madDipartiment tas-Saœœa, ikun jista’ jagœmel dan mingœajr l-ebda restrizzjoni. Mis-sena d-dieœla dan il-æurnal ser jibda jintbagœat b’mod elettroniku u jkun ukoll fuq il-website tal-union.

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Œsieb li dejjem iberren f’moœœna huwa dak li nressqu talba quddiem il-Gvern sabiex is-salarju tan-nurses li jkunu nieqsa æo sala, jinqasam bejn in-nurses preÿenti jew gœalinqas jiæi stabbilit allowance fiss li jingœata linnurses f’dawk is-swali li ma jingœaqadx il-compliment minœabba vakanzi li ma ntlewx. Min-naœa l-oœra rridu noqgœodu attenti li b’din it-talba, ma jibdewx jitnaqqsu l-isforzi biex jinstabu aktar nurses. Irridu nsibu l-bilanç neçessarju. Jekk jirnexxielna, dan ikun allowance li jingœata fejn hemm nuqqas f’dik il-æurnata partikolari minœabba li ma ntlewx ilvakanzi. Ÿgur li hemm bÿonn li din il-materja tiæi maœsuba aktar però f’xi œin jew ieœor tafu tisimgœu dwarha. Bœal sajjetta fil-bnazzi, b’daqqa ta’ pinna, il-Gvern iddeçieda li jneœœi l-gœarfien ewlieni tal-fiÿjoterapisti lill-MUMN. Naturalment l-MUMN ma çedietx pulzier gœaliex temmen bis-sœiœ li l-Gvern qed jiÿbalja u qed jimxi œaÿin. Kulœadd irid ibaxxi rasu gœal dak li jridu l-fiÿjoterapisti nkluÿ

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il-Gvern u l-Unions. Dawn b’saœœa enormi iddeçidew li jridu lill-MUMN biex tirrapreÿenthom u fl-istess waqt qed jibagœtu messaææ çar daqs ilkristal li ma jridux jibqgœu parti millAllied Health Professionals. U dak proprju li se tagœmel l-MUMN anki jekk ikun hemm il-œtieæa li nirrikorru gœall-æustizzja fil-qrati. Nista’ ngœid b’wiççi minn quddiem li qegœdin infittxu premises æodda peress li dawk li gœandna m’gœadhomx komdi gœall-œidma sœiœa u œajja, li jkollha l-Union kuljum. Diæà kien beda xi xogœol millKunsill preçedenti u issa æie deçiÿ li tingœata spinta biex id-Dar tagœna lkoll tkun tixraq lill-professjonisti li nirrapreÿentaw u barra minn hekk ikun hemm il-façilitajiet kollha meœtieæa li nagœmlu dan mingœajr l-ebda xkiel. Kif ikollna informazzjoni konkreta ngœaduwilkom mill-ewwel. Æew eletti tlett Group Committees æodda, tnejn æo MDH, tan-nurses u l-ieœor tal-Midwives u l-ieœor tannurses f’MCH. L-ewwel nett nixtieq

ngœidilhom prosit u grazzi. Prosit gœaliex æew eletti biex jirrapreÿentaw lill-kollegi tagœhom fuq il-post taxxogœol u grazzi gœaliex dan huwa xogœol volontarju li però jœallilek sodisfazzjon kbir. Il-fatt li tkun strumentali biex ittejjeb is-sitwazzjoni u l-qagœda ta’ sieœbek hija xi œaæa inkredibbli u li barra li tœallilek sodisfazzjon kbir, timmotivak biex tkompli gœaddej bil-œidma tiegœek. Tajjeb li tkunu tafu li l-Gœaqda Dinjija tas-Saœœa ddeçidiet li s-sena d-dieœla tkun iddedikata gœall-œidma li jwettqu n-nurses u l-midwives. L-MUMN qed tipprepara anki ma’ stake holders oœra sabiex tkun sena memorabbli. Hemm numru ta’ attivitajiet li ser jiæu organizzati. Aktar informazzjoni tingœata ’l quddiem. Nixtieq però nieœu din l-opportunità sabiex ninfurmakom li l-attività prinçipali tal-MUMN gœal festi Natalizji ta’ din is-sena ser tiæi organizzata fid-19 ta’ Diçembru fixXara Palace fir-Rabat. Œudu œsieb li tœallu din il-æurnata libera biex

tingœaqdu magœna gœal dak iÿ-ÿmien sabiœ. Nixtieq ninfurmakom li missena d-dieœla dan il-æurnal ser jibda jintbagœat b’mod elettroniku u jkun ukoll fuq il-website tal-union. Dan peress li ma kull œarga li qed tintbagœat bilposta, il-Union qed titlef ¢1200 li f’sena waœda jammontaw gœal ¢5000. Din hija somma sostanzjali u li bdiet iseœœ minn din is-sena. Appena æibdilna l-attenzjoni l-Awditur, mill-ewwel ilKunsill œa passi biex jirrimedja. Ser tkun afsa ta’ qalb li mhux ser nibqgœu nippubblikawh u nibgœatuh bil-posta wara 23 sena, però sfortunatament ilprogress kultant iæibek f’poÿizzjoni li ma tistax tagœmel mod ieœor. F’dawn l-aœœar snin qed ninnutaw li l-istudenti li jkunu qed isegwu kors filprofessjonijiet li aœna nirrapreÿentaw, m’gœadux ikollhom l-istess œeææa biex jorganizzaw is-settur tagœhom. Madwar 8 sa10 snin ilu dawn l-istess studenti kienu kwaÿi jaqilbu lill-union bl-entuÿjaÿmu tagœhom biex jimxu ’l quddiem u jieœdu dawk l-esperjenzi

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kollha possibli. Kienu jiæu organizzati bosta attivitajiet u saœansitra jsiefru u jattendu laqgœat ma’ studenti oœra Ewropej barra minn xtutna, jirrapreÿentaw lill-MUMN fis-settur tagœhom. Sinçerament nœares ’il quddiem biex neræa’ nara lillstudenti organizzati kif suppost. Illum gœandna ÿewæ universitajiet f’pajjiÿna u gœalhekk il-kollaborazzjoni gœandha tkun isbaÿ u aktar interessanti. Barra minn hekk l-MUMN nirçievu bosta inviti biex nibagœtu studenti f’laqgœat u konferenzi li jkunu apposta gœal dawk li jkunu qed jirrapreÿentaw lil sœabhom. Naf li hemm numru sabiœ ta’ membri li gœandhom ittfal tagœhom studenti u jkun tajjeb li nœeææuwhom sabiex jorganizzaw ruœhom biex b’hekk jieœdu esperjenzi æodda li ÿgur ikun ta’ æid. Gœal llum ser nieqaf hawn gœaliex gœedna biÿÿejjed. Aœna ser inkomplu nÿommukom aææornati b’dak kollu li jkun gœaddej. Colin Galea Segretarju Generali

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A prayerful response in times of sickness Sickness is really one of the most trying times in a person’s life. Sickness is a diﬃcult phase in one’s life because it does not only put into question the physical, emotional and spiritual well-being of the person. It also seriously challenges the sick person’s family and friends. Pope Francis teaches that the Church is our Mother. In one of his catecheses regarding the mystery of the Church, entitled The Church, Mother of Christians, the Holy Father explained how the Church is a Mother. “The Church, as a good Mother, does the same thing: she accompanies our growing up by transmitting the Word of God, which is a light that indicates the way of the Christian life, administering the Sacraments. She nourishes us with the Eucharist, she gives us God’s forgiveness through the Sacrament of Penance, she supports us in the moment of sickness with the Anointing of the Sick. The Church accompanies us in our whole life of faith, in our whole Christian life.” Since the Church believes in the power of intercessory prayer it offers prayers that greatly help her sons and daughters who are sick. The Church ardently believes that Jesus Christ heals. All the Four Gospels unravel to us this extraordinary reality of how the God of Our Lord Jesus Christ operates and deals with sickness. Let us take one episode from the Gospel according to Matthew. “And when Jesus entered Peter’s house, he saw his mother-in-law lying sick with a fever; he touched her hand, and the fever left her, and she rose and served

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him. That evening they brought to him many who were possessed with demons; and he cast out the spirits with a word, and healed all who were sick. This was to fulfil what was spoken by the prophet Isaiah, ‘He took our infirmities and bore our diseases’” (Matt 8:14-17). Furthermore the Church, animated by the Spirit of Christ the Healer, shares the solicitude of Her Divine Founder for sick people and their families. Her ministry with them includes prayers, visits by Her pastoral ministers and other Christian believers, the comforting work of doctors and other health professionals, and the prayers for the sick person and his/her family at Mass and the official prayer of the Church. In the Introduction to the Pastoral Care Rites for the Sick we find the following instruction: “The concern that Christ showed for the bodily and spiritual welfare of those who are ill is continued by the Church in its ministry to the sick. This ministry is the common responsibility of all Christians, who should visit the sick, remember them in prayer, and celebrate the sacraments with them. The family and friends of the sick, doctors and others who care for them, and priests with pastoral responsibilities have a particular share in this ministry of comfort. Through words of encouragement and faith, they can help the sick unite themselves with the sufferings of Christ for the good of God’s people. Remembrance of the sick is especially appropriate at common worship on the Lord’s Day, during the general intercessions at Mass and in the intercessions at Morning Prayer and Evening Prayer. Family members and those who are dedicated to the care of the sick should be remembered on these occasions as well” (Pastoral Care for the Sick General Introduction 43). The Church’s prayerful response in times of sickness can easily be detected from its early days. Suffice

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to look at the Letter of James to see appreciate how the nascent Church has been prompt in giving her comforting pastoral answer to those distressed by sickness. “Is any one among you suffering? Let him pray. Is any cheerful? Let him sing praise. Is any among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord; and the prayer of faith will save the sick man, and the Lord will raise him up; and if he has committed sins, he will be forgiven. Therefore confess your sins to one another, and pray for one another, that you may be healed. The prayer of a righteous man has great power in its effects” (Jas 5:13-16). In the Roman Missal there is a prayer called A Prayer for any need which encourages the Christian to hope in the Lord, to hold firm and take heart. As one delves deeper into it one can also see the reasons as to why one is to hope in the Lord, be steadfast and be encouraged in the turbulent waters of sickess. The prayer describes the Lord as light, the afflicted’s help, and stronghold. The Lord’s acts with the person in need are themselves salvific. In fact, He gives him or her confidence, courage, sweetness, and keeps the person safe from trouble. Who, more than the sick person, really needs this powerful intercession from the Church in front of God’s throne? Let us now savour this prayer together! The Lord is my light and my help; whom shall I fear? The Lord is the stronghold of my life; before whom shall I shrink? There is one thing I ask of the Lord, for this I long, to live in the house of the Lord, all the days of my life, to savour the sweetness of the Lord, to behold his temple. For there he keeps me safe in his tent in the day of evil. He hides me in the shelter of his tent, on a rock he sets me safe. O Lord, hear my voice when I call; have mercy and answer.

photo | bahaiteachings.org

Of you my heart has spoken: ‘Seek his face’. It is your face, O Lord that I seek; hide not your face. Dismiss not your servant in anger; you have been my help. Do not abandon or forsake me, O God my help! Though father and mother forsake me, the Lord will receive me. All-powerful Father, God of mercy, look kindly on us in our suffering. Ease our burden and make our faith strong that we may always have confidence and trust in your fatherly care. Grant this through our Lord Jesus Christ, your Son, who lives and reigns with you and the Holy Spirit, one God, for ever and ever. Amen. Love pays attention to details. Thus, bearing this in her mind, heart and spirit, the Church then dedicates a special Prayer for the Sick. This prayer is found in the Roman Missal. The theology behind the prayer of the sick is, indeed, rich. The prayer is addressed to God the Father in the Name of His Son Jesus, the Suffering Servant. It is Jesus who, by his example, teaches the sick person to grow in the virtue of patience during the trial of illness. Through the intercession of Jesus the prayer of our sick brothers and sisters is heard. Seen from the salvific suffering viewpoint illness, pain and disease can be powerful instruments for the person’s sanctification. The sick person can join his/her suffering with that of Christ for the salvation of the world. H/She can do this sublime offering of his/her suffering to God the Father on Christ’s example because s/he is aided by the Father who is “the lasting health of all who believe in [Him]”. The Church keeps interceding for her sons and daughters who are sick so that when they are healed by God then can “offer [their] joyful thanks” in the Church.

Father, your Son accepted our sufferings to teach us the virtue of patience in human illness. Hear the prayers we offer for our sick brothers and sisters. May all who suffer pain, illness or disease realise that they are chosen to be saints, and know they are joined to Christ in his suffering for the salvation of the world, who lives and reigns with you and the Holy Spirit, one God, for ever and ever. Amen. All-powerful and ever-living God, the lasting health of all who believe in you, hear us as we ask your loving help for the sick; restore their health, that they may again offer joyful thanks in your Church. Grant this through Lord Jesus Christ, your Son, who lives and reigns with you and the Holy Spirit, one God, for ever and ever. Amen. Real love includes and widens its perspective. Thus, the Church has a special Prayer for relatives and friends of the sick person. She prays that the relatives and friends of the patient be restored by the Holy Spirit in their “health of mind and body” so that they will support their loved one “with perfect love”. Obviously then can do so because the Father, “by the power of [His Holy Spirit] [has] filled the hearts of [His] faithful people with gifts of love for one another”. This is how the Roman Missal presents to us this prayer: Father, by the power of your Spirit you have filled the hearts of your faithful people with gifts of love for one another. Hear the prayers we offer for our relatives and friends. Give them health of mind and body that they may do your will with perfect love. We ask this through our Lord Jesus Christ, your Son, who lives and reigns with you and the Holy Spirit, one God, for ever and ever. Amen. The crème-de-la-crème of the

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Church’s prayers for the sick is found in the prayer which the Community of believers makes For health care workers. The Church describes the health care workers as those “whose special care is the health of mind and body”. The Church prays that “their hearts” be filled “with awe for the life” that is “[God’s] gift”. Fully conscious of their proper mission the Church intercedes for them to be helped by God’s grace, day after day, at “[the Lord’s] service”. She asks the Father to use “their hands [that] they may bring to others the comfort of [His] healing touch”. Wondrous God, author of life, you fashioned us in your likeness and breathed into us the life which is your own. Be with those whose special care is the health of mind and body. Fill their hearts with awe for the life which is your gift and sustain them daily in your service, that their hands may bring to others the comfort of your healing touch. We make our prayer through our Lord Jesus Christ, your Son, who lives and reigns with you in the unity of the Holy Spirit, God for ever and ever. Amen. You don’t need to be a liturgical expert to grow spiritually from the liturgical prayers of the Church. All you need to do is to listen carefully to the words of the prayer concerned and let them penetrate your heart and soul. They inflame you with the Holy Spirit’s love, as manifested by the Church, the Community of the believers, for those who are sick, their families and friends as well as for those who take care of them with the utmost patience! How encouraging it is to realize that the Church appreciates your work as a healthcare professional by praying constantly for you! Remember, She always remains your dear Beloved Mother! Fr Mario Attard OFM Cap

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Nurses in Wales leaving job due to stress, report says The Guardian - Steven Morris, Wed 21st August 2019

Inquiry ﬁnds community nurses feel unsupported and view themselves as ‘invisible service’

orale among community nurses is low and many are leaving the service due to stress and an increased workload, a report has claimed. The report from a Welsh assembly committee said the changing nature of healthcare, in particular the move to provide more help in the home and the ageing population, made the role of community nurses increasingly important. But it said many community nurses feel they do not get the support they need and some see themselves as the “invisible service”. While the assembly’s health, social care and sport committee focused on Wales, its findings will resonate across many areas of the UK. Members expressed concern that despite the importance of the service they could find no accurate national picture of the number and skill mix of community nursing teams, or the number of patients receiving care in their own homes. They concluded this was likely to have an impact on the effectiveness of the service. One of the biggest issues raised by nurses in Wales during a committee inquiry was their inability to access to technology to enable them to do their job effectively.

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Community nursing is a collective term for all nurses, midwives and health visitors working within a community setting. A district nurse is a nurse who has successfully completed training that has led to a specialist practitioner qualification (SPQ) being formally recorded against their Nursing & Midwifery Council registration. Half of the community nurses who took part in the inquiry said they had no access to a mobile. They also reported that many mobiles provided by the employer had no software access to office calendar or emails. Instead, the committee found they were reliant on paper-based systems and outdated technology. Dai Lloyd, the committee chair, said: “We are proud of the work that community nurses do. They are unsung heroes in the health service. We are concerned to hear from nurses about low staff morale and in some cases nurses are leaving the service as a result of stress and increased workload. “For the service to improve and thrive we need to make sure that staffing levels are right, that nurses are provided with the mobile technology they need to do their jobs effectively and that community nursing is seen

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as an attractive career.” The committee made 10 recommendations to the Welsh government including doing more to understand staffing levels and making sure nurses had access to the technology they need. Members also said they were extremely concerned to hear that children were less likely to be cared for at home at the end of life than adults because of shortages in skilled community nurses. It called on the government to make sure there were enough skilled community nurses to deal with the specific needs of children with complex medical conditions. Lisa Turnbull, of the Royal College of Nursing in Wales, who gave evidence to the inquiry, said: “Morale is quite low, particularly at the senior levels, in community nursing because of the tremendous pressure they’ve been under and feel that they’ve been under for a long time, and also this feeling of being invisible to the wider service.” A report from the Queen’s Nursing Institute flagged up by the committee said enrolment levels across the UK for the district nurse qualification had been steadily falling.

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Results from two studies among Maltese Nurses in Malta & Gozo

Maltese Hospitals’ Nurses’ Study ABSTRACT This study looked at the impact of burnout on the psycho-social and spiritual variables of Maltese nurses. Participants (N=241), who work in three different hospitals in Malta, were assessed on burnout levels and related variables. Nurses completed the Maslach Burnout InventoryHuman Services (Maslach, Jackson, &Leiter, 1996), the Satisfaction With Life Scale (Diener, Emmons, Larsen, & Griffin, 1985), the Faith Maturity Scale (Benson, Donahue, and Erickson, 1993), the Positive and Negative Affect Scale (Watson, Clark and Tellegen, 1988), the Big Five Personality Inventory (Donahue and Kentle, 1991), and demographic variables. Results from this cross-sectional correlational study indicated that: a) professional nurses in Malta suffer from high levels of burnout, particularly from high exhaustion and depersonalization and low professional accomplishment; b) as expected, burnout negatively correlated with subjective well-being; and c) a path analysis indicated the progressive impact of burnout, first on one’s personality and affective mood, and eventually on one’s wellbeing and spirituality. The implications and

photo | http://cdn.gospelherald.com/

recommendations from these results were discussed. DESCRIPTIVE STATISTICS: a) Participants: Maltese professional nurses from3 hospitals (64% Female): • Mater Dei Hospital (MDH), (4 units: A&E, Cardiac & Crises, Gynae, FW1) • Rehab Hospital KarenGrech (RHKG) (3 departments); • Mt Carmel Hospital (MCH) (5 units: Secure unit; Mixed Ad; MW1, FW1, YPU) b) Respondents: 88% nurses, 12% nursing (& deputy) officers c) Response Rates: 87%, 69%, 70% for MDH, RHKG, & MCH respectively, • Total Average Response Rate of 75%. d) Employed for: 52% worked for <10 yrs 22% worked for 11 – 20 yrs 26% worked for 21+ yrs e) Data collected: 1st trimester of 2013. f) Measures: Burnout, Personality, Wellbeing, Spirituality, Positive & Negative Affect, Demographics KEY RESULTS a) No significant differences of

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burnout levels were found among these 3 different hospitals; b) Maltese nurses are prone to high levels of burnout (see Table A) c) Limitations: • This study is correlational in nature. No inferences of causality can be made • Study’s reliance upon selfreported & recalled data may have introduced error d) Strengths: • Study’s inclusion of Burnout is a strength, especially as it is a novel aspect in research done locally, despite the extensive focus it receives elsewhere. • Study’s multidimensional focus (bundling together measures of personality & psycho-social & spiritual wellbeing) is noteworthy. e) Burnout among Maltese nurses is a worrying reality that requires immediate attention. Reaching one’s breaking point through job-related issues is definitely a serious component that requires attending to. Considering that such a reality has a direct bearing on patients’ holistic wellbeing, it is clearly important to attend to it. • continued on page 32

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Ethics & Health Care…

Moral Courage The next series of contributions will be focusing on Virtue Ethics and related topics. This will be done ﬁrst by looking at the six nursing values – care, compassion, competence, communication, courage and commitment – that each nurse is ideally compelled to put into practice. This writeup will take a closer look at courage and the importance of moral courage in nursing practice. The term ‘courage’ comes from the Latin word cor, which means heart and the Old French word corage, which means heart & spirit. The meanings of the term courage have changed over time and today, it is widely considered to be related to something of a heroic nature. In fact, a gap in understanding the relationship between nursing and the act of being courageous exists. The requirements of being a nurse typically focus on being caring or compassionate. Courage and being courageous does not generally feature as a requirement to be a nurse and is typically acknowledged as an afterthought. Yet when you stop and consider your daily practice does the need to be courageous or pluck up courage feature anywhere, anytime? The need for nurses to have courage in their daily practice is invariable. Virginia Henderson, in one of her most famous quotes came up with the salient examples that require care and compassion as well as courage. “The nurse is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the

infant, the knowledge and confidence of the young mother, and a voice for those too weak to speak.” — Virginia Henderson ThetheoryofVirtueEthicsoriginated in ancient Greek philosophy. Aristotle contemplated that the soul consists of three things; passions, faculties and states of character, where virtue relies on the state of character. In addition, Aristotle firmly believed that of all the virtues, courage is the essential human virtue as with courage all other virtues can be attained. Going back to the original meaning of the term courage, heart & spirit, and linking this to the background of Virtue Ethics and Aristotle’s philosophy one can appreciate the overlooked dimension of what it means to be courageous, its importance in Virtue Ethics and as well as nursing. It is no coincidence that Virtue Ethics is increasingly recognised as an appropriate guide for nurses to follow in their practice. The RCNi (2015) explain that courage enables nurses to do the right thing for their patients, to speak up when they have concerns and to “have the personal strength and vision to innovate and to embrace new ways of working”. Numminem,

Repo & Leino-Kilpi (2017) analysed the concept of moral courage in nursing and identified seven core attributes of moral courage. These are true presence, moral integrity, responsibility, honesty, advocacy, commitment and perseverance. These attributes were found to be based on ethical sensitivity, conscience and experience. Numminem, Repo & Leino-Kilpi (2017) also found in their analysis that the consequences of these included both personal and professional development as well as empowerment. The authors acknowledge that their analysis requires further exploration. However, they highlight that nurses in all areas need moral courage considering that “nursing as an ethical practice requires courage to be moral, taking tough stands for what is right, and living by one’s moral values” (Numminem, Repo & Leino-Kilpi 2017). This view supports the explanation given earlier by the RCNi, where it can be noted that although the relationship between moral courage and nursing requires further analysis the obligation to be courageous is clear. Marisa Vella

You may contact Marisa on marisalvella@gmail.com for references and information related to this article.

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UNBLOCKS THE NOSE

IN 2 MINUTES Fast decongestion action Long lasting relief elief up to 10 hours 1

OTRIVIN (xylometazoline hydrochloride) (Refer to full Summary of Product Characteristics (SmPC) ) Presentation: Each 1 ml OTRIVIN preservative free nasal spray, solution (metered dose) 0.1% contains 1 mg of xylometazoline hydrochloride. Each dose contains 0.14 ml of solution (0.14 mg/dose). Indication(s): For the relief of symptoms affecting the nasal mucosa due to common cold, allergic rhinitis or sinusitis. To aid drainage of secretions in diseases of the paranasal sinuses. As an adjuvant in otitis media, to decongest the nasopharyngeal mucosa and facilitate rhinoscopy. Posology & method of administration: For adults and children over 12 years of age: 2 to 3 times a day: 1 spray from the metered dose atomizer in each nostril over a period of time not exceeding 5 consecutive days. Do not exceed the recommended dose. Contra-indications: Hypersensitivity to xylometazoline or to any of the excipients listed in section 6.1. Like other vasoconstrictive agents, OTRIVIN should not be administered to patients after transsphenoidal hypophysectomy or nasal and buccal cavity surgery in which the dura mater has been exposed. OTRIVIN is contraindicated in the case of atrophic and vasomotor rhinitis, rhinitis due to mucosal dryness, hypertension, diabetes mellitus and closed-angle glaucoma. OTRIVIN 0.1% spray should not be used by children below 12 years of age. For children between 2 and 12 years of age, 0.05% drops are recommended. Special warnings and special precautions for use: OTRIVIN, like all other sympathomimetic agents, should be used with caution in patients showing a strong reaction to adrenergic substances, as is evidenced with symptoms of insomnia, vertigo, tremor, cardiac arrhythmias or elevated blood pressure. Like all other topical vasoconstrictors, OTRIVIN should not be used for more than 5 days consecutively. If symptoms do not improve, medical advice is required. Prolonged or excessive use may cause rebound congestion. Do not exceed the recommended dose. Caution is recommended in patients with hypertension, with cardiovascular disease, with hyperthyroidism, with angle closure glaucoma, with diabetes mellitus, with phaeochromocytoma, with prostatic hypertrophy, who are undergoing treatment with beta-blockers (see section 4.5), who have undergone treatment with monoamine oxidase inhibitors (MAO inhibitors) or who have taken MAO inhibitors in the last 2 weeks (see section 4.5). Each container should be used by one patient only, to avoid cross-contamination. Interactions with other medicinal products and other forms of interaction: Monoamine oxidase inhibitors (MAO inhibitors): Xylometazoline may enhance the effect of monoamine oxidase inhibitors and can induce hypertensive crisis. Use of xylometazoline is not recommended in patients who are taking or have taken MAO inhibitors within the past two weeks (see section 4.4). Tricyclic and tetracyclic antidepressants: Concomitant use of tricyclic or tetra cyclic antidepressants and sympathomimetic products may result in an increased sympathomimetic effect of xylometazoline and is therefore not recommended. Fertility, pregnancy and lactation: Pregnancy: In view of its potential systemic vasoconstrictor effect, it is advisable not to take OTRIVIN during pregnancy. Breast-feeding: OTRIVIN should be used during breast feeding only on the advice of a doctor, because it is not known whether xylometazoline is excreted in the breast milk. Fertility: There are no adequate data for the effects of OTRIVIN on fertility. No experimental animal studies are available. Undesirable effects: Undesirable effects are listed below, by system organ class and frequency. Undesirable effect frequencies are defined as: very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000) or very rare (<1/10,000). Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness. Common: Nervous system disorders: Headache, insomnia, weakness. Respiratory, thoracic and mediastinal disorders: Dryness of the nasal mucosa, a burning sensation in the nose or throat. Gastrointestinal disorders: Nausea. General disorders and administration site conditions: Burning sensation in the application site, local irritation. Very rare: Immune system disorders: Hypersensitivity reaction (angioedema, rash, pruritus). Eye disorders: Transient visual impairment. Cardiac disorders: Cardiac dysrythmias or thachycardia, hypertension. Prolonged and excessive use can cause rebound congestion. With prolonged or heavy use, chronic oedema of the nasal mucosa and destruction of the olfactory epithelium may be observed. Overdose: Excessive administration of topical xylometazoline hydrochloride or accidental ingestion may cause severe dizziness, perspiration, severely lowered body temperature, bradycardia, hypertension, respiratory depression, coma and convulsions. Hypertension may be followed by hypotension. Small children are more sensitive to toxicity than adults. Appropriate supportive measures should be initiated in all individuals suspected of an overdose, and urgent symptomatic treatment under medical supervision is indicated when warranted. This would include observation of the individual for several hours. In the event of a severe overdose with cardiac arrest, resuscitation should be continued for at least 1 hour. Special Precautions for Storage: Store below 30°C for 36 months. Use within 17 months after first opening the container. Supply classification of the product: OTC. Nature and contents of container: 10ml (71 doses) high-density polyethylene bottle with a metered dose pump and a polypropylene nozzle (nosepiece) with protective cap. Marketing Authorisation Holder: GSK CH GREECE S.A., 274 Kifissias Ave, 15232 Halandri, Athens, Greece. MA Number(s): MA1177/00302. Date of revision of the text: July 2017. Further information available from: Alfred Gera & Sons Ltd, 10, Triq il-Masgar Qormi QRM 3217 Malta. Telephone: 00356 2092 4000. Trade marks are owned by or licensed to the GSK group of companies ©2017 GSK group of companies or its licensor.

Adverse events should be reported. Report forms can be downloaded from www.medicinesauthority.gov.mt/adrportal and sent by post or email to; P: ADR reporting/Sir Temi Żammit Buildings, Malta Life Sciences Park, San Ġwann SĠN 3000, Malta E: postlicensing.medicinesauthority@gov.mt or E: pv@alfredgera.com

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Zinc job code: CHMLT/CHOTRI/0010/17. Date of preparation: November 2017

1. Eccles R, et al. Am J Rhinol 2008;22:491–496.

How Nutrition can support your child’s health

alnutrition is very often underrated and like an iceberg, its threat remains hidden under its surface. It is widely perceived as a condition related with death, which happens for instance during catastrophic events like wars or natural disasters, but for the majority, malnutrition affects slowly and silently, by delaying child’s physical and brain development, causing permanent delays and decreasing the immune system activity. Indeed very often behind a frequent episode of infections, low growth rates, skin problems and poor cognitive development, there is a history of neglected malnutrition. Malnutrition should not be confused with starvation and scarcity of food, but a complex combination of many factors such as: protein deficiency, fat or carbohydrates or even micronutrients deficiency like vitamin D, Calcium, Zinc and DHA and it can come in all sizes, people with malnutrition could be both underweight and overweight! Obviously the majority of cases affect the first group, and eventually may cause a condition called failure to thrive or even just a decrease in term of growth, that your Pediatrician or Pediatric Dietitian identify as a negative “deviation” on the growth chart. The second group does not show signs of stopping growing, but still may cause brain development and cognitive system delays.

Malnutrition should also be related to other acute or chronic diseases that may interfere with the nutritional intake, absorption or metabolism of food, like celiac disease, cystic fibrosis, inflammatory bowel diseases, cardiovascular problems, hyperthyroidism or cancer.

Take it in time! As mentioned above, malnutrition causes permanent growth delays, it is therefore crucial to intervene immediately by correcting the issue. Your Pediatrician and Pediatric Dietitian will guide you through, so once again, be suspected if your children has got one of the symptoms related with it! Resource Junior is a high energy 1.5 kcal/ml, ready to drink sip feed for children aged 1-10 years. It is a nutritionally complete and provide the right amount of protein, carbohydrates and fat. It also includes a blend of fat soluble and water soluble vitamins enough to satisfy your child’s requirements, can be used as a supplement or as solely source of nutrition when is needed. Moreover it has fibre inside, which are essential to prevent diarrhea, to maintain a normal intestinal function and microbiome. Available in two popular children’s flavours (strawberry and vanilla) to improve the palatability and compliance even for a long term. This article has been brought to you by:

Mirko Cirolli

BSc (Hons.) Dietetics (Italy) MSc Human Nutrition (Rome, Italy) Business Developer Nestlé Infant Nutrition & Nestlé Health Science

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BOV Investment Funds Some people think investments are complex. We can help you better understand and choose the right investment strategy that fits your personal risk tolerance. BOV Asset Management, at the forefront of your investment needs

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Past performance is not necessarily a guide to future performance. The value of the investment can go down as well as up. Investments should be based on the full details of the Prospectus, Offering Supplement and the Key Investor Information Document which may be obtained from BOV Asset Management Limited, Bank of Valletta p.l.c. Branches/Investment Centres and other Licensed Financial Intermediaries. BOV Asset Management Limited is licensed to provide Investment Services in Malta by the MFSA. The BOV Investment Funds is a common contractual fund licensed by the MFSA as a collective investment scheme pursuant to the Investment Services Act and the UCITS Directive.

Issued by BOV Asset Management Limited, registered address 58, Triq San Ĺťakkarija, Il-Belt Valletta VLT 1130. Tel: 2122 7311, Fax: 2275 5661, Email: infoassetmanagement@bov.com, Website: www. bovassetmanagement.com. Source: BOV Asset Management Limited.

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- SETTEMBRU 2019

from our

diary

stand MUMN has once more set up a sesâ&#x20AC;&#x2122; nur the t rke ma at a Career Fair to s ent stud st ong am profession

New elected MUMN Council wit h the Deputy Prime Minister and Minister for Health

New elected MUMN Council with the President of Malta

The photo shows the Valletta railway station tunnel (ex Yellow Garage) being used as a shelter in the second world war â&#x20AC;&#x201C; 10 years after the Malta Railway stopped operating

nce to protest MUMN organised a press confere to include n isio dec against the Governmentâ&#x20AC;&#x2122;s lthcare hea d allie the in the Physiotherapists gnition reco sole the s ard reg professionals as

A group of 5 nursing and health care students from the Univer sity of Guanxi, China attended MCAST for a 40-hour induction course on Maltaâ&#x20AC;&#x2122;s health care services and practices. They paid a visit to MUMN. The students were given a tour of the premises and met with MUMN Administration. Together they explored the role of MUMN and nursing in Malta. The discussion also included an overview of the local health care services. The students had the opportunity to share their own experiences.

t New elected MUMN Council me ion osit Opp the with the Leader of

Cashless payments for an easier life In an age when speed and convenience have become the new mantra, we are witnessing a global shift towards full digital payment experiences. Yet in Malta, the usage of cash and cheques is so ingrained within our habitual behaviour that we tend to ignore the multitude of beneﬁts that come with electronic payments. Switching to digital we stand to gain from increased cost savings, zero chasing efforts associated with dishonoured cheques, improved cash flow management; faster reconciliation; spending pattern insights; better budgeting and insurance protection through credit card payments. BANKING ON YOUR INTERNET AND MOBILE PHONE The BOV Internet Banking and BOV Mobile Banking give you control over your finances and the flexibility to conduct your banking requirements anytime, from wherever you are. Through these digital systems, you can check account balances and transactions; pay bills; transfer money between your accounts; send instructions to the bank; effect payments in Ð and foreign currency; top up anyone’s mobile phone; carry out future-dated transactions; investment services; report lost / stolen cards and much

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more. Both systems are very easy to use and have recently been upgraded with the use of fingerprint, digital signatures and digital secure key, making it much easier and faster to effect transactions. The BOV Mobile App can be downloaded for free from Google Play and the App Store. PAYING BY CARDS Bank of Valletta also offers payment cards that can be used locally, abroad and online. For those who prefer debit cards, BOV meets this need with its Cashlink suite of cards, all of which are free of charge. Cashlink Malta can be used locally in ATMs and retail outlets, while Cashlink Visa is a debit international card that can be used locally, abroad and online. The BOV premium credit cards come with additional benefits such as travel insurance, purchase protection, and a loyalty scheme through which customers are rewarded with loyalty points for every euro they spend. Loyalty points can be redeemed

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against the annual card fee, airline tickets as well as cash vouchers at a number of retail outlets across the Maltese islands. The BOV contactless cards make small purchases by card viable. Contactless is a fast, easy and secure way to pay for purchases costing, up to Ð25 for Mastercard and up to Ð20 for Visa Card. You simply tap, and you are ready to go. For higher amounts, tap your card and enter your PIN. CASHING ON CONVENIENCE The wide range of BOV ATMs found across the islands provide services such as real-time deposit of cash and cheques, bill payment facilities and mobile top ups, affording convenience and efficiency. Standing orders and direct debits enable you to take the load off your mind and get your bills, insurance premia, regular fees and subscriptions to be paid automatically. At each point in time, you may stop or amend these instructions as necessary and through internet and mobile banking can monitor and control transactions. These are simply a few of the wide array of electronic banking offered by BOV. For more information on payment options and how you can be part of today’s cashless society, visit any BOV Branch or drop us an e-mail at customerservicecentre@bov.com.

Some advantages of using an insulin pump instead of insulin injections are: · Using an insulin pump means eliminating individual insulin injections · Insulin pumps deliver insulin more accurately than injections · Insulin pumps often improve A1C · Using an insulin pump usually results in fewer large swings in your blood glucose levels · Using an insulin pump makes delivery of bolus insulin easier and in a more controlled manner · Using an insulin pump eliminates unpredictable effects of intermediate- or long-acting insulin · Using an insulin pump means you only need to wear the pump and do not carry anything. Innotech is a simple to use and accurate Insulin Pump -

OLED colour screen and extremely user friendly. Touch Screen. Auto-lock to prevent unintended operation. Ability to achieve a precise delivery of 0.008U per pulse.

Auto Basal Features - Auto basal Allocation. - Daily basal can be adjusted according to individual needs. - Easy operation. Easy Bolus Features - One key to set bolus. - Choices for Normal, Square and Dual bolus. Delivering insulin via an insulin pump is the most natural form of insulin treatment available today.

ADVANCED USES OF AN INSULIN PUMP Another great thing about an insulin pump is that you have the chance to program in insulin doses to be delivered at certain times or up to several hours into the future. CUSTOM BASAL RATES Insulin pumps can be programmed to deliver different basal rates at different times of day. For example, you may need less insulin over night than you do upon waking in the morning, so your insulin pump can be set up to give a higher rate of insulin when you wake and a lower rate when you go to bed.

You can even suspend delivery of insulin if you need to, such as when playing sports, to stop your sugar levels dropping too low. CUSTOM BOLUS RATES Not every meal affects our blood glucose levels the same way and insulin pumps can be set to deliver bolus doses in specific ways to cope with the different absorption and digestion rates of different foods. As well as delivering one up front dose of insulin, pumps can also be set to deliver special doses such as delivering half of the dose up front and then delivering the second half of the dose an hour or so later, which can be helpful for managing certain foods such as pizza.

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- SETTEMBRU 2019

An unfortunate team: Arrhythmia and high blood pressure Scientists found the medical link between arrhythmia and high blood pressure The list of experts couldn’t be more prestigious: The European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE) report in the European Heart Journal (Vol. 38, Issue 4, 21 January 2017) that hypertension has been recognized as the principal and most common risk factor responsible for death and disability of non-communicable diseases worldwide. They state that high blood pressure leads to heart failure, coronary artery disease, stroke, peripheral artery disease, and chronic renal failure. In short: High blood pressure is considered one of the main risk factors for arrhythmia. Heart rhythm problems are the result of irregular electrical impulses that coordinate the heartbeat. If the heart beats too fast, too slowly or irregularly, it might feel unpleasant – at best. At worst it can be life-threatening. Tachycardia refers to a fast heartbeat; Bradycardia refers to a slow heartbeat. The first step to find out if you suffer from arrhythmias is to measure them. Many domestic blood pressure monitors can detect arrhythmias. However, in case arrhythmias occur, blood pressure monitors with oscillometric measurement methods may display incorrect values. By adding the Korotkoff measurement

method the blood pressure can be measured correctly. In case medical treatment is advised to treat heart arrhythmia, a pacemaker or cardioverter-deﬁbrillator has to be implemented. However, this only affects a certain percentage of arrhythmia-patients.

If your heart experiences chaotic electrical signals, it’s high time to check your blood pressure Another heart rhythm problem which causes hundreds of thousands of deaths each year is atrial fibrillation. It’s an irregular and most often rapid heart rate, also perceived as palpitations or anginal chest pain. It happens when the two upper heart chambers experience chaotic signals. However, atrial fibrillation doesn’t necessarily have symptoms at all, which makes it hard to detect. The underlying problems of atrial fibrillation are high blood pressure, an overactive thyroid gland or a lung disease. Since atrial fibrillations occur at irregular intervals and can therefore only be detected as they happen, monitoring the heart rhythm with electrocardiogramequipped blood pressure devices, portable ECG devices (holter monitors), event or specific mobile heart rhythm monitors can literally save lives. Cardiac arrhythmias, such as dangerous atrial fibrillations and high blood pressure, are the main risk factors for developing strokes.

For further information about monitoring Arrhythmia and high blood pressure visit https://veroval.info/en TheIl-Musbieħ Veroval® range of- products in Malta by Alfred Gera & Sons Ltd. Tel: 21446205 4 NUMRUis8distributed

Times of Israel - 23rd July 2019

Nurses go on strike to protest working conditions, heavy caseloads Walkout impacts hospitals and health clinics across Israel; emergency care and other essential services to continue

Nurses protest against their work conditions outside the Ministry of Health in Jerusalem July 22, 2019

Nurses went on strike across Israel on Tuesday after negotiations between the National Nurses Union and the Health Ministry broke down the day before. The nurses are protesting what they say are poor working conditions, heavy caseloads and low standards of care. The strike began at 7 a.m. and impacts nursing services at hospitals and health clinics across the country where nurses will only offer reduced services. Emergency treatment, including surgeries, will still be available. Other essential services, such as care for hospitalized patients, intensive care, neonatal care, oncological treatment and dialysis, would be available, but limited. In nursing schools, staff would not work. Geriatric and psychiatric facilities will continue to function, but service will be limited. “The health and finance ministries are directly responsible for the intolerable queues in providing health care to the public and community. They create heavy burdens for the

nurses and undermine their ability to provide safe and appropriate treatment to patients,” the nurses said in a statement. The Health Ministry said that it had tried to prevent the strike in talks with the union. “Representatives of the state met today with the National Nurses Union in order to prevent the anticipated harm to patients as a result of the planned strike tomorrow,” the Health Ministry said. “There were many constructive proposals in the meeting, but unfortunately the talks did not reach an agreement, and the state will turn to the Labour Court tomorrow.” A recent report by the Taub Center for Social Policy Studies in Israel said that Israel’s health system has been subject to systemic failures in planning,

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budgeting and regulation by the government, resulting in an acute shortage of beds, inefficiencies and gaps in accessibility of treatment. The report found that the country lags behind others in the 36-member Organisation for Economic Cooperation and Development (OECD) in number of hospital beds, and has shorter hospital stays and particularly high occupancy rates. In Israel, the number of hospital beds per 1,000 people is 2.2 versus 3.6 in the OECD. While the number of beds is trending down in most countries, the decline is especially sharp in Israel — a 22 percent decline versus an OECD average of 15% between 2002 and 2017. The shorter average hospitalization time in Israel — about five days per patient in contrast to an average of 6.7 days among all OECD countries — and the high occupancy rate, about 94% versus an average of 75% in the OECD, diminishes hospitals’ ability to handle emergencies and points to a potentially lower level of treatment quality, the report said.

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Suicides among nurses are on the rise

Here’s why one of America’s fastest-growing jobs is facing a major crisis Business Insider Allana Akhtar - 20th August 2019

Nurses are more susceptible to suicide than non-nurses in the US, a new study found. A report on nurse suicides recently found that the profession had higher rates of death by suicide than non-nurses in the US. Nursing is one of the fastest-growing occupations in the US, yet nurses work long hours and often face physical abuse on the job. Nursing is one of many occupations with increasing rates of suicide. Nurses - who typically work long hours and may face abuse on the job - are more likely to take their own lives, a new study found. Researchers from the University of California at San Diego recently conducted what they said is the first nationwide investigation into nurse suicides in more than 20 years. They found that both male and female nurses had higher rates of suicide than men and women in the US. The findings are consistent with the increasing rates of suicide across the country. The US suicide rate has risen in recent years, increasing by 28% in the past two decades, to the highest it’s been since World War II. For nurses, hardships on the job include working long hours because of nationwide worker shortages, plus dealing with physical and verbal abuse

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on the job. Here’s what the high rate of suicide among nurses tells us about the crisis facing one of the nation’s most in-demand jobs. NURSING IS ONE OF THE FASTESTGROWING OCCUPATIONS IN THE COUNTRY — YET NATIONWIDE NURSE SHORTAGES MEAN NURSES CAN WORK LONG HOURS WITH LITTLE TIME FOR REST. Nurse practitioner is the sixthfastest-growing career in the US, according to the Bureau of Labour Statistics. Jobs for registered nurses and licensed practical nurses are also expected to grow at a pace higher than the national average by 2026. As baby boomers get older, more nurses will be needed to provide medical care to them.

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Despite the job opportunity, many hospitals are struggling to fill roles and the problem is expected to get much worse. By 2030, the US will have hundreds of thousands of vacant RN jobs, particularly in the South and on the West Coast, a 2012 paper from the University of Nebraska found. Since nursing is a relatively highpaying profession - registered nurses make an average of $71,730 a year - the job’s high demands could be turning workers away. Many nurses are also reaching retirement age, while enrolment at nursing schools is not rising fast enough to keep up with demand, the American Association of Colleges of Nursing said. The shortage has led to nurses working 12-hour shifts and overtime, researchers at New York University found. Nurses have told Business Insider they sometimes don’t even have time to use the bathroom during their workdays. NURSES, FACING DIFFICULTIES ON THE JOB, ARE TAKING THEIR OWN LIVES AT RATES HIGHER THAN THE GENERAL US POPULATION Researchers from the University of California at San Diego’s School of

Suicides among nurses on the rise Medicine conducted what it said was the first national investigation on nurse suicide in over 20 years, publishing their results this summer. The researchers found a suicide incidence of 11.97 per 100,000 people among women who are nurses, versus 7.58 per 100,000 for American women in general. Women overwhelmingly make up the profession, but men who are nurses are also more likely to kill themselves than men in general, the study found: 39.8 per 100,000 people, versus 28.2 per 100,000. While researchers have often documented burnout and suicide among physicians, very few have spent time assessing the mental health and suicide rates among nurses, the study’s lead researcher, Judy Davidson, told MedPage Today. “Nurses are known not to care for themselves as much as they care for others,” Davidson, a nurse scientist, told the publication. “It’s just a part of who we are.”

the #SilentNoMore campaign are attempting to shed light on the hardships facing people in the profession.

ALONG WITH WORKING LONG HOURS, NURSES OFTEN FACE PHYSICAL, VERBAL, AND EMOTIONAL ABUSE ON THE JOB.

NURSES ARE ONE OF MANY GROUPS OF PEOPLE TAKING THEIR LIVES AT HIGHER NUMBERS, PART OF A NATIONWIDE INCREASE IN SUICIDE RATES

One of the most pressing problems facing nurses is abuse on the job, a representative for the American Nurses Association told Business Insider in an interview. ANA says that one in every four nurses is physically assaulted on the job - consistent with other research pointing toward high rates of nurse abuse. The research has found that patients - especially people with dementia or Alzheimer’s - are more likely to abuse nurses. Assaults range from getting cursed at to grabbing and kicking, a 2014 survey of more than 5,000 nurses found. Visitors to medical centres have also been accused of abusing nurses. The survey found that emergency nurses had the highest likelihood of experiencing abusive behaviour. While many nurses face abuse on the job, few report their experiences, ANA found - in part because there are no federal rules mandating that hospitals protect nurses from violence. Movements such as

More Americans of every age group are taking their lives today than 20 years ago, a 2016 study by the Centers for Disease Control and Prevention found. Other than nursing, industries like construction work and food service have seen a rise in suicide rates among workers. Native Americans are the ethnicity most affected by suicide, yet suicides are rising among white Americans without a college degree, a 2017 paper released by the think tank Brookings found. Researchers have attributed the rise in suicides in part to the deterioration of good bluecollar jobs. “If you go back to the early ‘70s when you had the so-called bluecollar aristocrats, those jobs have slowly crumbled away and many more men are finding themselves in a much more hostile labour market with lower wages, lower quality and less permanent jobs,” the Brookings researcher Angus Deaton told NPR

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in 2017. “That’s made it harder for them to get married. They don’t get to know their own kids. There’s a lot of social dysfunction building up over time.” MANY NURSE-ADVOCACY GROUPS ARE CALLING FOR GREATER WORKPLACE PROTECTIONS. Davidson pointed to work volume and violence as two of the largest contributing factors to nurse suicides. In February, ANA helped introduce a bill in the House that would require the Department of Labour to address workplace violence toward healthcare providers, as well as require workplaces to train and educate employees at risk of being harmed and implement a comprehensive plan to protect nurses from violence. A New York City nurse union earlier this year persuaded hospitals to ease understaffing after threatening to strike. “From the bedside to the boardroom, all nurse leaders have a role in creating a healthy work environment supportive of mental well-being,” the trade group American Organization for Nursing Leadership said in a statement. “We continue to advocate for funding of mental health resources and are working with fellow nursing organizations to address nurse suicide.”

- SETTEMBRU 2019

Meta konna naħarqu l-awrina Jien ma lħaqtiex wisq din li ‘taħraq l-awrina’ imma sassebgħinijiet ċerta swali kien għad kellhom għal-lest ilBenedict’s Solution, f’każ li jispiċċaw l-istrippi tal-awrina. Li tiċċekkja għaz-zokkor ﬁs-swali minn dejjem kienet xi ħaġa mportanti biex wieħed jikkontrolla d-dijabete, u speċjalment minn kien jieħu l-insulina. L-iççekkjar gœad-dijabete imur anke lura lejn l-1776, meta Matthew Dobson ikkonferma li l-awrina taddijabetiçi seta’ jkollha togœma œelwa meta dduqha. It-test proprju gœazzokkor imur lura gœall-1925, meta ftit qatriet tal-awrina kienu jitœalltu mal-Bendict’s solution f’test tube u jissaœœnu fil-misœun gœal-madwar 5 minuti jew fuq lampa (tal-alkoœol).

Il-Benedict’s Solution u l-ittestjar gœaz-zokkor fl-awrina

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Skont kif jinbidel il-kulur tal-likwidu kien jindika kemm kien ikun gœoli z-zokkor tal-pazjent. Gœalhekk l-epressjoni ‘taœraq l-awrina’ u li anke baqgœet tintuÿa saœansitra meta l-ittestjar ma baqax isir b’dan il-mod. Lejn l-aœœar tal-erbgœinijiet id-dinja medika rat titjib sostanzjali fl-ittestjar gœaz-zokkor meta æie ntrodott id“dip-and-read”, test tal-awrina

Skala bil-kulur skont kif issib iz-zokkor

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Meta konna naħarqu l-awrina

Eÿempji ta’ l-ewwel HGT machines li œaræu fis-suq mediku

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imsejjaœ Clinistix, li kien itik riÿultat malajr u effiçjenti. Fil-kotba tal-iskola tan-Nursing kien ikun hemm imniÿÿel x’tirrikjedi biex taœraq l-awrina, kif suppost: L-awrina gœall-ittestjar bil-Benedict’s kellha tkun l-ewwel waœda ta’ filgœodu u mid-stream. L-ewwel jinœaslu l-idejn (bis-sapun, l-ilma u xxuttati f’xugaman) u jitnaddfu l-uçuœ fejn ser isir it-test. Wara li jintlibes il-fardal, jiæu ppreparati l-pipetti, test tube u holders æo kidney dish u tinxtgœal l-alcohol lamp jew l-isteriliser. Il-Benedict solution (3-5 ml) kien jitpoææa fittest tube u jitœallat ma 6 sa 8 qatriet awrina u jissaœœan fuq il-lampa gœalminuta jew æo steriliser. Hemmhekk kien il-waqt li jiæi interpretat il-kulur tal-likwidu fit-test tube u jitnaddaf u jiæi disinfettat l-apparat kollu. Jekk il-likwidu kien ikun blu kien ifisser li ma kienx ikun hemm zokkor, jekk ilblu ikanæi fl-aœdar kien ikollu +, jekk jinbidel isfar fl-aœdar kien ikollu ++,

jekk fl-isfar kien ikollu +++ u jekk floranæo ++++. L-ittestjar gœaz-zokkor mill-awrina mhux perfett minœabba diversi raæunijiet u gœalhekk lejn is-sittinijiet l-industrija ipproduçiet l-ewwel strippi gœall-ittestjar gœaz-zokkor fid-demm. Qatra demm kienet titpoææa fuq l-istrippa gœal-minuta u mbagœad tinœasel. Skont il-kulur li jibqa’ kien ikun indikattiv kemm wieœed gœandu zokkor. Dawn ukoll ma kienux preçiÿi. Lejn l-aœœar tas-sittinijiet gie vvintat l-ewwel portable glucose meter (Haemoglucotest machines), l-Ames Reflectance Meter® (ARM) minn Anton Clemens. Apparat goff, jaœdem bil-batterija, analog u jiswa’ madwar$495. Lejn l-aœœar tas-sebgœinijiet u l-bidu tat-tmeninijiet komplew jevolvu l-portable blood glucose monitors permezz ta’ l-Ames Eyetone li kien jiÿen madwar 4 libbri u twil 7 pulzieri imma irœas minn ta’ qablu.Kien irid jiæi pplagjat mal-mains tal-elettriku u gœal-dak iÿ-ÿmien kien jidher qisu æej minn xi film tal-fantaxjenza. Madan

kollu kien jagœti riÿultat f’minuta! Minn hemm il-quddiem l-affarijiet bdew mexjin b’mod mgœaææel u minn apparat goff u kultant mhux preçiÿ, imxejna gœall-apparat li jgœaææel, preçiÿ, tista’ tafdah u sempliçi biex jintuÿa. Kien inqas invaÿiv, juÿa ammont iÿgœar ta’ demm, m’hemmx gœalfejn tikkalibrah u fuq kollox ma baqax id-daqs ta’ bagalja! Kienet anke bdiet l-era tas-self-testing u mhux apparat li jissakkar fl-ufficju talKonsulent. Fl-1975, bdew jiæu manifatturati fuq livell kummerçjali, l-ewwel glucose biosensors u lejn l-aœœar taddisgœinijiet u l-bidu tal-2000 beda’ l-continuous glucose monitoring (CGM).Illum qed jiæu manifatturati glucose monitoring devices permezz ta’ flash glucose monitoring (mingœajr ma jittaqqab is-subgœa). It-teknoloæija dejjem tavvanza u saœansitra jeÿistu wkoll l-Ambulatory Glucose Profile (AGP) li jtuk rappreÿentazzjoni viÿwali tal-livelli taz-zokkor. Tassew imxejna miÿ-ÿmien li konna ‘naœarqu l-awrina’. Joe Camilleri

BGM machines aktar riçenti u tal-llum

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- SETTEMBRU 2019

The Person’s Journey to Coping with Liver Cirrhosis Throughout my experience in nursing, liver cirrhosis always fascinated me, both in its physiology and how it affects the person that is inflicted by it. Liver cirrhosis is characterized by the formation of scar tissue in the liver. This condition leads to the malfunction of the liver leading to multiple complications. It is a chronic illness that requires adaptation of one’s life to cope with the challenges which the condition may present. The aim of this study was to explore the strategies for coping employed by individuals affected with liver cirrhosis in Malta.

To achieve this, the study used a qualitative methodology whilst collecting data through indepth, semi-structured, one-to-one interviews. These interviews drew upon principles of constructivist grounded theory. Grounded theory is a methodology which investigates the relationships between various concepts in a social process. In this case the social process is that of living with liver cirrhosis. As an active nurse it was essential that bias was counteracted through various strategies. These include but were not limited to involving the literature after the data collection and the upkeep of a reflective diary. The study was conducted in Malta through the liver clinic at the medical outpatients department. Prior to conducting these interviews

ethical approval was achieved from the appropriate department heads from both the University of Malta and from Mater Dei hospital. The Interviews took place according to the wishes of the participants. Inclusion and exclusion criteria were set to choose the participants. These had to have been diagnosed with liver cirrhosis of child-pugh score A or B. Child-pugh score is a scale which gives a classification to the level of morbidity of the liver cirrhosis. Five male and one female person who were recruited from a follow-up clinic, were interviewed. Data analysis involved coding the interviews using constant comparison of the data presented.This lead to the emergence of a theory about the challenges imposed by the condition and strategies used for coping.

Trade Enq. Vella Trading, 20, Triq Salvinu Spiteri, Santa Venera SVR1111 Tel: 21244899 email: info@vellatrading.com

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Coping with Liver Cirrhosis

From data analysis, three theoretical codes were extracted which were: the “Challenges Imposed by the Condition”, the “Support or Hindrance from the Social Environment” and “Strategies for Coping”. These theoretical codes have amalgamated into the emergent theory. This showed how individuals reacted to the various challenges imposed by their condition by utilizing social resources when present, and by drawing upon personal and other resources outside the social environment in order to cope with their condition. The Challenges imposed by the condition were divided into three factions, the physical, psychological and social challenges that affected the participant because of the condition. The following are the various codes that were extracted from the interviews relating to challenges: Feeling tired (Fatigue), losing appetite, fear of bleeding, changing body image, psychosocial challenges from needing to change lifestyle, feeling down (sadness), fearing the future, missing on meaningful social event, stigmatisation.

“Data analysis involved coding the interviews using constant comparison of the data presented.This lead to the emergence of a theory about the challenges imposed by the condition and strategies used for coping.” Family, friends and the follow up system in place according to the findings could provide both a source of support and that of hindrance to the successful coping of the condition. This means that in some cases instead of support the participant there were social elements that created a bigger

challenge. For example in those participants with substance abuse problems such as drugs or alcohol, friends were a source of temptation to fall back on old habits which had led them to their condition. Whilst on the other hand some participants’ friends were a foundation to successful coping through a supportive relationship. Coping strategies arose from the data as strategies that were independent to support or hindrance from the social environment. These always reduced the challenges that were presented to the participants and although not all strategies were positive they all helped them to cope with the condition. The strategies divided in three divisions; psychological coping strategies, physical coping strategies and coping through spirituality. Thecodes that were identified were; experiencing a turning point, keeping mentally active, attempting independence, thinking positively, keeping organised, shifting from one addiction to another, keeping physically active, finding purposeful activity, coping through prayer and coping through religion. An interesting finding was that in those whose social environments hindered their coping process pets played a strong successful role in giving the participants purpose. In others in which the family played an active role in the person’s life the role of grandfather or grandmother helped give them purpose and in turn aided their journey towards coping with the condition. The study showed how the social environment may react towards individuals with liver cirrhosis and how this may help or hinder coping. It also highlighted the multiple strategies used by individuals to maintain the best possible quality of life despite all the challenges faced. Findings may guide health care professionals assess the context in which the condition is being managed and support the individual to adopt effective coping strategies, utilizing personal and social resources. Joseph Louis Grech Staff Nurse

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- SETTEMBRU 2019

photo | onecall24.co.uk

• continued from page 15 TABLE A - BURNOUT LEVELS: a) 42% high, 34% moderate, 24% low: Personal Accomplishment* b) 59% high, 32% moderate, 9% low: Emotional Exhaustion* c) 90% high, 9% moderate, 1% low: Depersonalization* Galea, M. (2014).The Progressive Impact of Burnout on Maltese Nurses. SOP Transactions on Psychology, 3(21), 1-8. GOZOGENERAL HOSPITAL (GGH) STUDY Abstract This population study examined the incremental validity of spirituality in predicting burnout among Maltese professional nurses. Cross-sectional and mixed-method design was conducted. Measures in this selfreport questionnaire included the Maslach Burnout Inventory, Faith Maturity Scale, Satisfaction with Life Scale, Big Five Inventory and a demographic section, together with a brief qualitative section. Response rate was 78%. All hypotheses were supported. Maltese nurses (N=121) suffer from high levels of burnout, in particular from low professional accomplishment, high levels of depersonalization, and moderate to high emotional exhaustion. Qualitative data supported these findings and suggested that the physical and

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moral environment of nurses was conducive to an increase of burnout. Furthermore, multiple regression analysis indicated that spirituality predicted burnout after controlling for personality and wellbeing. This study suggests that spirituality may be an important potential source of resilience for nurses who risk burnout in their employment. DESCRIPTIVE STATISTICS: Participants: 121 (65% Female), Maltese nurses working at GGH Response rate: 78% (Population study) 87% nurses, 13% nursing (& deputy) officers Agegroups: <36yo: 17%; 37 – 46yo: 33%; 47 – 56yo: 40%; 57+yo: 10% Employed for: <10yrs: 08%; 11-20 yrs: 22%; 21-30 yrs: 56%; 31+ yrs: 14% Data collected: First trimester of 2012 Measures: Burnout, Personality, Wellbeing, Spirituality, Demographics, Qualitative KEY RESULTS: a) High burnout levels found among Maltese nurses (Table A) b) Burnout negatively correlated with wellbeing c) Spirituality indicated as a resource to buffer burnout. d) Nurses who score high on spirituality, feel more professionally

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efficient, and are less likely to be exhausted and feel depersonalized towards other staff and patients at work. e) Nurses are encouraged by ongoing formation. However, they seek remedial measures in 2 key areas: physical and moral environment of GGH (see Table B). f) Limitations: • Correlational nature • Some variables left out g) Strengths: • Population study on a reality never studied before as such locally, • Good response rate CONCLUDING REMARK: Happier and healthier nursing leads to a happier &healthier health system! TABLE A: BURNOUT LEVELS: a) 88% high, 11% moderate, 1% low: Depersonalization* b) 30% high, 50 % moderate, 20% low: Emotional Exhaustion* c) 6% moderate, 94% low: Personal Accomplishment* TABLE B: QUALITATIVE SECTION RESULTS: Two open-ended questions focused on present strengths & future recommendations. Results: a) Potential Strengths: 85% agreed with such ongoing formation programs as helpful; b) Recommendations: grouped

Results from two studies among Maltese Nurses

into two classes, and relate to the amelioration of: 1) Physical environment. Nurses suggested: i) Better management of nurse-patient ratios (86%), ii) Refurbishment required in certain areas (79%), iii) Wise management of crowded wards (68%), 2) Moral environment. Nurses recommended: i) Enhanced communication between staff and management (73%), ii) More consultation on decisions affecting staff (74%), iii) Positive reinforcement (of staff) for greater motivation (64%), iv) Less bureaucracy (60%), and v) Less undue interferences by third parties on staff (43%). vi) Local health system perceived to be more consultantfocused than patient-focused. Galea, M. (2014). Assessing the Incremental Validity of Spirituality in predicting Nurses’ Burnout.Archive of Psychology of Religion.36(1), 118-136. CONCLUDING RESULTS Considering the three scales that make up the Maslach Burnout Inventory, nurses in both studies scored extremely high on the Depersonalization scale. In other words, Maltese nurses highlighted a very high sense of unfeeling and impersonal response towards patients, care treatment, and/or instructions from their respective superiors. Nurses in Malta scored more

emotionally exhausted than their counterparts in Gozo, with 59% scoring highly exhausted in the Malta study vis-à-vis 30% in the Gozo study. Half of Gozo’s participants scored moderately exhausted. A different scenario resulted on scores of the Personal Accomplishment scale. In the Malta study, the bulk of scores varied between moderate to high, thus suggesting that nurses working on the mainland feel more satisfied at work. On the other hand, 94% of Gozo participants scored in the low range. It is interesting to seek the reason/s for such a disparity with reference to Personal Accomplishment scores (one’s satisfaction with employment). One possible reason may be the average age and period of employment of nurses, in both studies. The majority of nurses in Gozo have been working for over 21 years, with half of respondents being 47 years old or older. The opposite is true with the Malta study. Younger nurses may have more updated formation possibilities, than those who have been working for a longer time as nurses. Although experience brings with it skills, it may also require ongoing formation programs. In fact, this may resonate well with the qualitative result from the Gozo study, in which they highly favored more programs of formation, as the annual one presently taking place. Another reason may yet be the mobility possibility and flexibility of

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nurses in Malta, which is obviously different from that in Gozo. OVERALL SUGGESTIONS: a) Maslach and Leiter (1997) 6-step method to counter nurses’ burnout. These are: workload (good nurse-patient ratios), perception of self-control at work, job-related reward/s, social support at work (by administration and colleagues), fairness of/at work, and values. b) Fearon and Nicol (2011) suggested a combination of both positive emotion-focused and problem-focused strategies, which may offer protection against the development of burnout. Nursing managers should explore ways of reducing job stress and also techniques for building social support networks at the hospital. Three reasons for this: 1) to protect nurses against stress; 2) to protect and ascertain better service to patients, and 3) to lessen the concerns and worries of patients’ relatives. Dr. Michael Galea, M.Th. (UK), M.Sc. (USA), Ph.D. (USA), NBCC (USA), MBPP (Malta) Clinical Psychologist& Family Therapist, Lecturer – Faculty of Health Sciences University of Malta 23401909 79551651 mgalea00@yahoo.com

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Viruses, bacteria and fungi: not so yucky after all Human microbiome is a treasure trove waiting to be unlocked

Vasu Appanna, Laurentian University - 18th July 2019

acteria are at the centre of all life forms on planet earth and are the essential building blocks that make living organisms the way they are. Both the mitochondrion — found in most organisms, which generate energy in the cell — and the chloroplast — the solar energyharvester located in plants — can be traced to their bacterial ancestors. These specialised microbes laid the foundation for the biodiversity we live amongst. “The human microbiome is one of the largest organs, weighing approximately two to three kilograms in an adult.” Microbes are a part of all multicellular organisms, where they perform a myriad of functions essential to life, including the digestion of nutrients and signalling processes. The microbes that are an integral component of living organisms are referred to as the microbiome. The microbiome is found in creatures as

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simple as the hydra and as complex as humans, elephants and trees. HUMAN MICROBIOME Microbes are part of humans from the initial stage of development and play an important role in the functioning of the human body. The human microbiome is composed of viruses, bacteria and fungi residing in communities within and on the body. Even though these microbes have always been part of the human anatomy, they were visualised only recently with technological advances like molecular imaging tools and next-generation genetic sequencing. We can now visualise these microbial entities as they operate and execute vital tasks. The microbiome is the largest organ you may have never heard of, weighing up to three kilograms. Human Microbes: The Power within (2018), Author provided The human microbiome is one

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of the largest organs, weighing approximately two to three kilograms in an adult. Although it is invisible, the microbiome makes its physical presence evident with occasional noises and smells. The microbiome bestows on us the unique traits we possess. The make-up of the microbiome changes during our life span, and a decrease in the number and diversity of its constituents is associated with diseases and ageing. In fact, healthy individuals and centenarians are known to house a wider diversity of microbial partners than unhealthy individuals. LOCATION-SPECIFIC FUNCTIONS The microbiome works in harmony with various organs in the body and aids in the proper functioning of a human being. For example, microbes living on the surface of the skin guard against invasion from opportunistic bacteria and pathogens. These microbes also help in healing wounds, fortifying the immune system and

Viruses, bacteria and fungi producing volatile signalling molecules essential for communication within the body and the nervous system. The gut, which harbours the highest amount of microbes, would not be able to carry out its digestive duty without microbial assistance. Microbes in the gut possess a variety of enzymes dedicated to the digestion of complex carbohydrates and the extraction of nutrients from the foods we consume. An average person consumes up to 60 tonnes of food during his or her lifespan. A digestive tract devoid of microbes would require even more food, a situation the world would prefer to do without. Intestinal microbes also produce vitamins like B12 (pivotal for metabolic activity), hormones, neurotransmitters and a plethora of metabolites integral to normal bodily processes. They also play an active role in the fate of medications we ingest. In fact, drugs taken orally interact with the gut microbiome first before reaching their intended targets. The molecular entities, like shortchain fatty acids, derived from the microbiome are part of our normal development process. Microbes are unique to both the individual and the site on the body where they are lodged. For instance, the oily forehead tends to be the preferred residence of Propionibacteria while the moist nose is populated by Corynebacteria. The stomach possesses acid-tolerant bacteria while the colon harbours anaerobic dwellers.

A bioartistic microbiome mapping project. François-Joseph Lapointe, Université de Montréal

UNDERSTANDING THE MICROBIOME This invisible organ is modulated by disparate factors including parental genetics, geography, food and lifestyle. Although microbiome finger-printing is in its infancy, it is clear that an individual living in an urban area will house a different microbial community relative to a rural inhabitant. As the microbiome is like any other organ, the disruption of its cellular components — known as dysbiosis — can trigger a range of ailments like obesity, irritable bowel syndrome, dermatitis and neurological imbalance. Some of these diseases can be cured by the use of probiotics and prebiotics designed to adjust microbial imbalance. Although this expansive invisible organ was visualised only recently, the unravelling of its functions, coupled with the understanding of its origins, could lead to major changes in health care, health education, nutrition and personal traits. Understanding the human microbiome and the role it plays in health and well-being will revolutionise our approach to our bodies and their care. The identification of each microbial

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constituent and its role will enable the classification of each individual according to his or her microbe type; this has the potential to be as revolutionary as the discovery of blood groups in the twentieth century. Microbial fingerprinting would result in a seismic shift in health quality and delivery. Manipulation and enrichment of select microbial communities — referred to as microbiome engineering - would improve health, rejuvenate organs, enhance character traits and lead to more effective medications. Microbe-supplemented creams for skin diseases and microbefortified nutritional supplements are already being routinely touted as personalised cures. The tracking of microbes and their metabolites may become a common molecular strategy to identify individuals and even their behaviours. We are just at the dawn of a health revolution that has the potential to be a societal-game changer. Vasu Appanna, Professor, Biochemistry, Laurentian University This article is republished from The Conversation under a Creative Commons license.

- SETTEMBRU 2019

De-institutionalization in the 21st century The terms institutionalization and de-institutionalization are more synonymous with the 1960’s and the 1970’s, when Dr Russel Burton identiﬁed the eﬀect of long term hospitalization on patients with mental illness. This was one of the triggers which pushed the development of community care in mental health, where a number of large psychiatric hospitals (in the U.K. and U.S.A.) were literally closed down, with hundreds of patients being discharged and followed up in the community. This was not a straight forward affair. The U.S. and the U.K. made the mistake of suddenly closing down large psychiatric hospitals, without offering an alternative and much required community services, which resulted in an excessive number of people becoming homeless, and worse, succumbing to the elements, illness, crime and suicide. “Any fool can close a psychiatric hospital” a renowned psychiatrist commented at the time. He was quick to add that community care is not about closing a hospital, but about providing more robust services in the community. In Malta, the de-institutionalization process could be said to have started 30 years ago. There was the initial attempt of following patients in outpatients clinics, which at the time were amalgamated with the polyclinics. Doctors, nurses and social workers would see the patients in the local clinic, review and administer medication and offer home visits for social support and assessment when needed. This had eventually developed into the so called “pilot project”, which had the first feel of a community mental health team, with psychiatrists, nurses, social workers and occupational therapists working together as a multi-disciplinary team, and patients would be provided with a sort of one-stop shop of different professionals. Eventually, there

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were further similar teams which developed in other parts of Malta, and also the formation of the Outreach Team, who would follow more long term patients with more chronic conditions, and offer a more hands on support at the patients’ home in the form of a care-coordinator and case management approach. In tandem, a multi-disciplinary crisis service started operating from Mater Dei Hospital. This team provided assessment and follow up of patients who would require immediate care due to mental health difficulties. Unfortunately, this service had eventually dissolved. There was a momentum in Malta were the community was being developed, following the path of other EU countries, with less reliance on hospitalization, encouraging early discharge, home treatment and recovery in the patients’ communities. There are now 5 mental health clinics across Malta, from where community mental health professionals operate and provide an array of interventions to individuals experiencing mental health difficulties. These teams vary in terms of number of professionals, different qualifications, psychiatrists attending, number of sessions, waiting lists and interventions provided. Unfortunately, and alarmingly, there is a huge shortage of social workers who work within these teams. The social worker is a much necessary role in the management of mental illness. Most psychiatric difficulties stem and cause major disruptions to the social situation of the patients and their families. There is a strong link between one’s mental health and the social conditions of the individual. An improvement in one function, will most probably contribute to an improvement in the other, and vice versa. A person with schizophrenia might find it difficult to manage his or her social situation (work, finances, leisure) and assistance in dealing with these will definitely have a significant effect on his or her recovery. The shortage of social workers in the

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mental health sector is a lacuna which needs to be addressed urgently. In most teams, nurses and occupational therapists will most often end up attending to these needs themselves in the absence of a team based social worker, but there are obviously limitations to the social interventions provided. There are also limits as to what the current community mental health services can attain. Most community mental health teams are under resourced, staff shortage remains an issue, and office space and clinic structures are limited. The demand is over exceeding the supply. Serious investment is required both at community level and at in-patient level. Malta’s main psychiatric hospital, was built in 1861. Patients were transferred from what was known as Villa Frankoni and the Ospizio in Floriana during the night of the 16th July, 1861. When it opened, the hospital was considered as one of the best at the time, in terms of structure and management towards the patients. A commission organized by the USA congress gave the hospital a medal and certificate of merit for “structural and sanitary improvements and evidence of general comfort and welfare of inmates”. This was in 1893. Almost 70 years before the publication of the book ‘Institutionalized Neurosis’, by Russel Burton. The needs and knowledge of the time were obviously different from today. At the time, mental health care was about containment and segregation, nowadays is about treatment, engagement and integration. Psychiatric hospitals remain a necessity. When patients are posing a certain level of risk, when the symptoms become a burden and too severe that the person cannot continue to function and the family cannot cope, the hospital serves as a merciful haven. However, we cannot now award a hospital for its “structure, sanitary improvements and general comfort”. Even if ironically, these are the main focus of criticism nowadays.

De-institutionalization in the 21st century

The MAPN will be organizing a conference about Deinstitutionalisation in the 21st Century on the 31st October 2019 at Dolmen Hotel, Qawra. For further info and for registrations please log on to: www.mapnmalta.net

But awards should be about the care being provided, the qualifications and training necessary to work in such a place, but not just that. Its about being dedicated, sensible and compassionate. About the latest evidence based interventions being provided, professional pride and development, and about making sure that as Florence Nightingale wisely said, that the hospital should do the patient no harm. The government published a Mental Health Strategy on the 17th July 2019 (interestingly, that’s almost the same date the patients were transferred from Villa Frankoni to the Asylum in Attard in 1861). The mental health strategy is very promising, there is a focus on investment in both in-patient and community level. It talks about seamless integration, community and crisis service, and early intervention and takes into account not just the patient, but the carers, the professionals and society. This is a significant step for mental health care in Malta and it’s an ongoing process, representing Deinstitutionalisation in the 21st Century. Pierre Galea – President Maltese Association of Psychiatric Nurses

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Music therapy improves the health of premature babies

Bonding with a newborn who is in an incubator can be diﬃcult June 18, 2019 - Elizabeth Coombes, Senior Lecturer in Music Therapy, University of South Wales

inging and playing music to your baby or young child may seem to be a no-brainer. We all have strong associations with nursery rhymes or childhood ditties sung to us by our parents and grandparents. We associate these with feelings of comfort and security, and it seems like the most natural thing in the world that we would sing to our own children as we cuddle and soothe them, or put them to bed. Imagine, though, that your baby was born earlier than anticipated, and had to spend time in a neonatal unit in a hospital. Perhaps your baby also has serious medical issues and needs to be constantly monitored, being linked up to a frightening array of medical equipment. Hospital staff is constantly moving around the wards checking everything is OK, and there are alarms on ventilators going off, the hiss of oxygen and all sorts of electric lights flashing and beeping. It can’t be easy to bond with a baby when they are being kept in an incubator and need special medical treatment. Although hospital staff is trained to support families in these situations, it’s often a very traumatic time for parents. Research into parental experiences in neonatal units shows that feelings of anxiety, guilt and even depression are all common features for many mums and dads. This can prevent or disrupt the natural bonding process that is so important to the healthy development of the baby and the happiness of the family unit too. Recent research has shown, however, that music therapy can offer a way for parents to connect with and develop their relationship with their premature baby while they are in hospital. This consists of a music

therapist playing a guitar or other instruments, and singing with parents to their baby on the ward. Using melodies and lullabies that the parents choose – including favourite songs, gentle sounds and simple rhythmic structures – the baby can be soothed while parents hold, rock and, if they wish to, sing or hum to their baby. Music therapy does more than just improve bonding. A large study undertaken in 2013 in the US demonstrated other positive effects for babies who receive music therapy in neonatal units. The study showed improved oxygen saturation, better heartbeat regulation, longer periods of sleep, increased weight gain, and, perhaps most importantly, reduced time spent in hospital. These results have been replicated in other studies too. SOOTHING TONES So why is music therapy such a powerful tool for premature babies? Hearing develops from the age of 24 weeks, meaning that babies are accustomed to hearing their mother’s voice, and that of other family members while still inside the womb. They respond more readily to these voices than those of unknown adults, although even then they show a preference for live voices In addition, researchers think that every baby is born hardwired, as it were, with what has been termed “communicative musicality”. Put simply, babies respond positively to, and have an appreciation of, simple musical structures, melodies and simple vocal sounds. We are all familiar with “baby talk” – the way we instinctively alter the tone of our voices when we talk to babies and young children. This is very calming

and soothing for both baby and parent. It not only helps bonding, but lays down the foundations for later cognitive development such as speech and motor skills. At present music therapy practice is commonly used in neonatal units across the world, including in Australia, the US, Scandinavia, Columbia, and Europe too. UK provision, however, is limited to just a few sites. But, my own preliminary research has found that more and more UK parents are keen to use these techniques, often commenting that “it will give me something to do with my baby”, and “it’s something normal and natural that I can do during this very unnatural beginning to our life together”. I’ve also found that nurses are also supportive of music therapy. They believe helping parents to explore music with their babies will empower parents and give them the confidence they need to provide the extra attention premature babies require, such as special feeding techniques and potentially administering medication. Consultants are also aware that at the moment, psychological support for parents in neonatal facilities is limited. They believe that the introduction of music therapy will have an important impact on the quality of parental experiences in hospital and the health of the baby. I am currently part of a team developing a pilot study in South Wales which will offer parents the chance to explore singing to their premature babies. It is hoped that this will be the beginning of an exciting new provision of psychological and medical support for parents and babies in neonatal units in Wales and beyond, but also help ensure these little ones have the best start at life possible.

This article is republished from The Conversation under a Creative Commons license

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- SETTEMBRU 2019