IL-MUSBIEĦ No. 95

Il-Musbieœ

MALTA NURSING AND MIDWIFERY JOURNAL Malta Union of Midwives and Nurses

Numru 95 - Ġunju 2022

the heartbeat of healthcare

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

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contents

Ħarġa nru 95 - Editorial/President’s message

pages 4-5

- Horation Congress Malta

pages 22-23

- Palliative Care Nurse…

pages 36-37

Ġunju 2022 Group Committees - Chairpersons & Secretaries Mater Dei Hospital: Emily Galea, Chairperson: 77440050; Glen Camilleri, Secretary: 79205674 SVP: Therese Decelis, Chairperson: 79809080; Mario Galdes, Secretary: 79449324 RHKG: Graziella Buttigieg, Chairperson: 79275872 Health Centres: Roseanne Bajada, Chairperson: 79671910 MCH: Angelo Abela, Chairperson: 79594326; Malcolm Bezzina, Secretary: 77822561 SAMOC: Ronnie Frendo, Chairperson: 77000919 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; Daren Stilato, Secretary: 77222999 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 Ronnie Frendo: 77000919 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 Warner Complex, MUMN, Triq il-Vitorja, Qormi QRM 2508 • Tel/Fax: 2144 8542 • Website: www.mumn.org • E-mail: administrator@mumn.org Il-fehmiet li jidhru f’dan il-æurnal mhux neçessarjament jirriflettu l-fehma jew il-policy tal-MUMN. L-MUMN ma tistax tinÿamm responsabbli gœal xi œsara jew konsegwenzi oœra li jiæu kkawÿati meta tintuÿa informazzjoni minn dan il-æurnal.

Dan il-æurnal jitqassam b’xejn lill-membri kollha u lill-entitajiet oœra, li l-bord editorjali flimkien mad-direzzjoni tal-MUMN jiddeçiedi fuqhom.

Il-bord editorjali jiggarantixxi d-dritt tar-riservatezza fuq l-indirizzi ta’ kull min jirçievi dan il-æurnal.

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

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

Çirkulazzjoni: 5,000 kopja.

Ritratti tal-faççata: MUMN

Il-Musbieœ jiæi ppubblikat 4 darbiet f’sena.

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Editorial

Are we doing our bit?

Are we as nurses and midwives doing our bit to reduce the amount of waste from the hospital wards?

Is anybody on a plastics recycling mission? Are we doing our utmost to protect the environment? Are we reducing our carbon footprint?

On average each ward disposes of approximately 5kg of plastic, not to mention, paper and glass. The amount of plastic being thrown away from the wards include PPEs, lids, ampoules and packaging.

Ward treatment rooms particularly contain vast amounts of waste.

The Covid-19 pandemic alone seems to have threatened our very existence as our environment is changing at an accelerating rate, with direct and immediate health consequences for patients, the public and the health sector.

General Hospitals should have a sustainability team to launch new quality improvement projects which will create improvements in sustainability for everyone.

When creating improvements in sustainability everyone benefits. A hospital sustainability officer should find ways to reduce energy use and waste and encourages staff to participate actively in environmental projects.

Nurses and healthcare providers should be helping more to make sustainability changes. This is because so much that comes into patient contact is routinely used only once and this includes gowns, anaesthetic breathing equipment, surgical drapes for patients and face masks.

Other sustainable activities may include lighting “switch-offs”, recycling different items and reuse surgical equipment where possible.

Recycling should include cardboard and paper products, IV bags, oxygen tubes and face masks. Our hospitals should also avoid unnecessary and potentially harmful tests, such as performing a variety of common blood tests on all pre-operative

photo | recyclinginternational.com

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patients (even those who don’t need them). The top clinical materials that emit most greenhouse gases are blood sample tubes, bandages, dressings and gauzes, catheters, tubing and drains, clinical waste containers, caps, gowns, masks and overshoes, carbon dioxide monitors and spirometers, disposable incontinence products, electrode gels, examination gloves, medical packs, medical pulp products, needle-free connection systems, polythene aprons, single-use surgical instruments, syringes and needles.

One must bear in mind that Malta’s has a 30-year strategy leading towards a carbon neutral economy. We have a responsibility to reduce emissions across the sectors involving energy, buildings, transport, industry, waste, agriculture, and water, towards carbon neutrality by 2050.

The paradox of providing health care while simultaneously harming health must be confronted and eliminated.

Although many professionals practice within health care, nurses, the largest group of frontline providers have the greatest capability to make essential changes. Beginning with new attitudes, problem recognition, and effective action, nurses can reduce healthcare’s carbon footprint and improve the health of the entire community.

It’s time for more sustainable use of health care’s financial, environmental and social resources.

Our health depends on it. We cannot afford to wait to act. We must all commit to protecting our planet and its population to ensure a greener, more-resilient future for us all.

President’s message As MUMN, we have settled well into our new premises in Qormi. The new investment is proving its worth, the new offices allow better individual coordination between MUMN top officials with the office administration having a separate working area. In Mosta, we were all literally bundled in just one room, making it impossible to work with so many people around you. Now in Qormi, a huge improvement was noted as we have all had expected.

But the biggest improvement is the choice of ample space for seminars, meetings and concurrent sessions which were impossible to do in Mosta.

In Qormi, we had the opportunity to do two concurrent meetings including a well-attended seminar which shows that the much-needed new space is now being fully utilised. This was all possible by the trust of all MUMN members in the Council and the wisdom of MUMN Council that all membership money was directed in direct reinvested into the needs of its members.

Updates on various Sectorial agreements The ECG Technicians’ sectorial agreement has been finalised from our end and sent to the Health Department. We are still awaiting the counter proposals and the dates to start meetings on this agreement which will expire on the 06th July 2022.

The Phlebotomists and the Decontamination Sterile Technicians have been nearly finalised with the Government and as MUMN, we are still awaiting some minor amendments besides other small issues.

As regards the sectorial agreement of the Nurses and the Midwives, a major unexpected issue brought forward by the Permanent Secretary which could result in industrial actions. For the Nurses’ and the Midwives’ sectorial agreement and possible even for the ECG Technicians, the Permanent Secretary decided to include into the meeting political “advisors” who served in the GWU. This implies several issues.

Sectorial agreements are to be discussed solely with stakeholders who belong

to the Government various entities who can contribute to the finalization of the sectorial agreement. MUMN officials are not only outnumbered in such meetings but also the majority of these Government Officials are not fully aware of the actual duties, actual responsibilities and the stress and difficulties of the Nurses and Midwives in the Health/Elderly sector.

Now a political advisor, certainly a job for the boys, has been appointed to attend these highly confidential meetings even though having a direct conflict with MUMN. On principle this clearly shows that the Permanent Secretary and the Health Minister is there more to appease this particular political advisor than to see the needs of the nursing and midwifery work force.

Under a PN administration, when a political advisor was appointed, MUMN had also objected strongly and such a political advisor who was an ex-UHM official never attended to MUMN’s meeting with the Health Division. But the current Health Minister is not a nursing friendly Minister and is arrogant enough to go against any trade union relationships and against the interest of the Nurses and Midwives. MUMN is sure that any other Minister even within the current Government would never have showed so much defiance for his political advisor who after all will be present just to interrupt MUMN’s arguments and make the discussions more difficult for MUMN officials.

normality for the general public, but our members still need to be highly vigilante since hospitals and clinical institutions are always high-risk areas.

Covid seems to be over, but Covid is an opportunistic pathogen which cannot be trusted, and it is a bit too early to state that the Covid epidemic is over and never to return. Life for all hospital employees has slightly improved from what we all been through these last two years. The pressures and the new practices brought about by Covid will need to blend in the new norm. But Covid left in its stride a more depleted work force in nursing as ever before and nurses are still paying a hefty price as always.

On a positive note, MUMN had the annual meetings with all students graduating this year from both Universities.

Unfortunately, their numbers would not be sufficient to fill all the vacancies when they start working in August. These new graduates will be in a position to replace the nurses of the SLSL and the nurses who will be promoted to Charge Nurses in the recent call issued. With a positive note, MUMN is counting on this new sectorial agreement to stop the exodus from the nursing profession, attract ex-nurses into the profession and most importantly attract more young people.

Summer is coming…sun and sea…as hospital employees such season gives us a relief to enjoy our families, our lives and most important to enjoy living.

This summer should be close to

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Paul Pace - President

- ĠUNJU 2022

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Kelmtejn

mis-Segretarju Ġenerali

Is-Sajf irranka u daœal æmielu. Niftakar fiÿ-ÿmien meta kont naœdem fl-isptar San Luqa fejn ma kienx hemm arja kkundizjonata! Sakemm inlestu l-washings filgœodu nkunu diæà sirna gœasra! Imma nsomma, dak kien ÿmien ieœor.

Illum il-problemi huma oœrajn.

Nuqqas kbir ta’ nurses, social workers u ECG Technicians. Arroganza millmanagement fejn jirrigwardaw physiotherapists, ICT officers u engineering division. Biex nikkomplikaw il-œajja issa gœandna Segretarju Permanenti ædid u bœal kull œaæa oœra, il-ædid iæib miegœu taqlib u nuqqas ta’ stabbilità.

Barra minn hekk gœalkemm il-Prim Ministru xeba’ jœambaq li jridu jibqgœu umli u li jrid ikun Gvern aktar viçin ilunions, qed naraw kollox bil-maqlub.

Arroganza flok umiltà u distanza flok viçinanza. Ma nafx jien, œawwadni œa nifhmek. Iæibuk titkellem waœdek.

Il-Ftehim Settorali tal-Phlebotomists u DSTs huwa kwaÿi lest. Baqa’ l-aœœar ÿewæ kjarifikazzjonijiet u jista’ jiæi ffirmat. Dak tal-ECG Technicians qed nistennew l-ewwel laqgœat fuqu però l-abbozz intbagœat lill-Gvern. TanNurses u l-Midwives saret l-ewwel laqgœa fejn spjegajna l-punti kollha u waqafna hemm. Jumejn ilu bagœtulna appuntament gœat-tieni laqgœa. Mhux biex ninnegozjaw ta’... le... ma tarax... biex nispjegawlhom aktar gœax ma fhemux kollox!!! Barra minn hekk iridu jinkludu persuna fil-laqgœat, li ma jaœdimx fiç-çivil, kien trejdunjonista sa ftit taÿ-ÿmien ilu (u gœalhekk kompetizzjoni diretta) u lill-Gvern tah palata qabel l-elezzjoni. Dawn l-affarjiet l-MUMN qatt ma aççettathom. Taœt ilGvern Nazzjonalista kien se jsir l-istess œaæa preçiÿ – l-MUMN oææezzjonat u l-Gvern fehem u irtira lil dan il-persuna mill-laqgœat. Imma dan il-Gvern le… ma tarax... L-umiltà qed tixgœel u tiddi!!! Jista’ jÿommu kemm irid u jtih il-paga li wegœdu imma fil-laqgœat tagœna ma jiæix. Jew hu jew aœna.

Aœna m’aœniex imæienen li ser nidœlu gœal laqgœa meta nafu li minn qabel li ser jiswilna deni. Infatti anki offrewlna flixkun vaÿellina qabel nidœlu!!!

Ix-xogœol fil-premises il-æodda miexi mhux œaÿin. Is-sular ta’ fuq huwa kwaÿi

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kollu lest. It-Training Centre jonqsu ftit l-aœœar affarjiet imma jista’ jibda jintuÿa.

Infatti diæà saret l-ewwel laqgœa. Baqa’ xi affarjiet fejn æejja l-librerija u l-œanut.

Nippruvaw inlaœœqu ma’ kollox imma ma jimpurtax, sakemm nibqgœu b’saœœitna x-xogœol qatt ma dejjaqna jew qatgœalna qalbna u l-istess issa.

Bdejna naœdmu wkoll sabiex ikollna suççess fl-elezzjoni biex jiæu eletti 7 rappreÿentanti fil-Bord Regolatorju tan-Nurses u l-Midwives. L-akbar sfida hija fejn jirrigwardaw l-iStaff Nurses.

Il-kandidati tagœna se jkunu Geoffrey Axiak, William Grech u Kevin Holmes u rridu ntuhom l-appoææ kollu tagœna.

Nagœtukom aktar dettalji aktar tard però importanti li dawn it-tlett ismijiet iÿommuhom f’moœœkhom.

Nirringrazzjawkom bil-quddiem.

Ninkeddu bil-kbir meta naraw pajjiÿi oœra jieœdu miÿuri importanti sabiex isolvu n-nuqqas ta’ Nurses li gœandhom f’pajjiÿhom. Aœna m’aœna nagœmlu xejn! Il-Gvern xbajna ngœidulu x’jista’ jsir u offrejna li aœna nkunu involuti iÿda gœalxejn. Ma nistax nifhem. Pajjiÿi oœra qed jiæu f’Malta u jagœmlu l-interviews lin-Nurses tagœna biex iœajruwhom imorru jaœdmu f’pajjiÿhom u aœna nibqgœu çassi u nœarsu. Bil-Malti jgœidulek K…… Kuntent! Aœna però mhux se nçedu jew naqtgœu qalbna.

Nibqgœu ninsistu u nagœfsu sakemm isir xi œaæa kif suppost, sakemm il-Gvern iqum mir-raqda u jibda jagœmel xi œaæa fl-interess tal-pazjenti u qrabathom, tan-nurses u l-familji tagœhom u ta’ pajjiÿna.

Gœal llum se nieqaf hawn. Nixtieq nieœu l-opportunità biex nixtieqlek Sajf trankwill u eçitanti kemm jista’ jkun, il’ bogœod mill-œsibijiet tax-xogœol.

Gawdi kemm tista’.

Tislijiiet mill-qalb,

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Seœibkom, Colin.

Overseas nurses in the UK forced to pay out thousands if they want to quit jobs Observer investigation uncovers NHS trusts and private care homes charging staff who leave to recoup recruitment costs

Trapped and destitute: International nurses working for NHS trusts and private care homes are being trapped in their jobs by clauses in their contracts that require them to pay thousands of pounds if they try to leave. In extreme cases, nurses are tied to their roles for up to five years and face fees as steep as £14,000 if they want to change job or return home early.

The Royal College of Nursing and human rights lawyers are calling for an urgent government review after an Observer investigation uncovered evidence of the clauses being used in both the NHS and private sector.

Designed to retain staff and recoup recruitment costs, they often cover hiring expenses such as flights to the UK, visas and the fee for taking language and competency exams. In many cases, they also include the costs of mandatory training, which workers hired in the UK are not routinely required to pay.

Nurses affected by the repayment terms, many of whom served on the frontline at the height of the pandemic, said they had

ho

te:

Forced to pay to quit jobs

me a reference unless I paid the full amount”.

Susan Cueva, a trustee of the charity Kanlungan, which supports Filipino migrants, said: “They are taking advantage of these workers who have no clue about the rules in the UK,” she said. “They end up thinking, ‘I better sit tight, even though I’m suffering,’ because they can’t afford to pay it back.”

She said it was unfair for employers to pass recruitment costs on to workers, when hiring internationally can save them huge sums.

how foreign nurses’ UK dreams turned sour been pushed into debt or locked into long-term payment agreements after leaving roles, even in cases of bullying or family emergencies. Others stay in jobs despite illness or poor working conditions as they fear they will be unable to repay, charities and unions said.

Parosha Chandran, a barrister and UN expert on human trafficking who helped shape the UK’s modern slavery laws, likened the clauses to “debt bondage” and called for them to be reviewed at the highest level. “This gives rise to very serious concerns about exploitation,” she said.Patricia Marquis, director for England at the Royal College of Nursing, said she was “very concerned” by a practice which flourished “in a climate of chronic understaffing”. The RCN was aware of some employers using punitive clauses which could result in workers being forced to pay thousands of pounds.

“We have also heard of cases in which employers try to frighten and intimidate staff with threats of deportation should they choose to work elsewhere,” Marquis said. The UK recruits heavily from overseas in an effort to plug a shortage of 40,000 nurses in the NHS alone, with most recruits coming from the Philippines and India.

One contract seen by the Observer, used in an NHS hospital trust in the east of England, says international nurses must repay unspecified “costs related to [their] recruitment” if they leave within three years. Those leaving within 18 months must repay “100%” of the costs. Another, used by University Hospital Southampton NHS Foundation Trust, includes a £5,000 repayment clause for candidates from the Philippines that halves after a year. The trust said the fees could include exam costs, flights, visas and accommodation, adding that retaining staff was vital to its operations.

The UK recruits heavily from overseas to plug a shortage of 40,000 nurses in the NHS alone.

In the private sector, the fees can be steeper. One nurse from Zimbabwe was told to pay £10,850 when she tried to leave her job at a care home, according to Unison. She said it was obvious the charges had been exaggerated, “but the manager said she would not give

It costs between £10,000 and £12,000 to recruit an overseas nurse, but employers can save £18,500 in agency nurse costs in the first year alone, according to one estimate. By comparison, it takes three years to train a nurse in the UK and costs about £50,000 to £70,000. The government does not pay tuition fees, but provides maintenance grants of £5,000 a year.

Stuart Tuckwood, nursing officer at Unison, said the union knew of cases where nurses were “trapped by unethical contracts” – including a case where a nurse was required to pay £14,000 despite her salary being just £16,000. He said: “The government must protect and support these nurses.

That means having safeguards that can be properly enforced. Otherwise the UK may be breaking not only obligations to the individual nurses, but also the agreements signed with the nations they come from.”

The Department of Health said it was aware of repayment clauses being used to recoup upfront costs where candidates do not meet the terms of their contract, but it would be “concerned if repayment costs were disproportionate or punitive”.

A spokesperson said: “We are clear that overseas staff should not be charged fees for recruitment services when gaining employment in the UK. We are grateful to all those who have come from abroad to train, learn and work in our NHS and social care sector.”

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Press Information Communiqué de presse Comunicado de prensa

International Council of Nurses and BBC Storyworks launch online film series celebrating work of nurses 12 May 2022, International Nurses Day, and will run for 12 months.

Howard Catton, ICN Chief Executive Officer, said: “Nurses are making an incredible impact in all sorts of settings, ensuring that the most vulnerable and marginalised people have access to quality care. These amazing films and articles, brought to life by BBC StoryWorks, tell the stories of nurses working in the heart of communities and at the frontlines of healthcare. Their stories show not only the commitment and sacrifices of nurses, but also how, if we invest in them, they are the solution under our noses to how we rebuild and recover from COVID-19 and meet increasing waiting times and other unmet demands exacerbated by the pandemic.”

photo | www.emergingrnleader.com

Geneva, Switzerland; 12 May 2022 - The International Council of Nurses (ICN) and BBC StoryWorks Commercial Productions today launched a new online film series to celebrate the incredible work of nurses around the world, and their role in leading development in the healthcare sector as well as improving patient health.

Produced for ICN by BBC StoryWorks Commercial Productions, the films and articles in Caring with Courage reveal the power of care and dedication in the inspiring work of nurses.

Nurses have been forging new paths in healthcare and leading communities towards a healthier future. With incredible developments driven by passionate people, this sector is

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working to progress patient care as well as advocating for the important role that nurses play. This series celebrates the key work being done by nurses to create safer environments for patients and discover innovative solutions to contemporary health problems.

Caring with Courage features numerous inspiring stories from around the globe - from a dynamic Ugandan nurse on a mission to stop tuberculosis in its tracks and nurses harnessing the potential of AI to care for mental health in Asia, to the training health care to communities in rural South Africa and the midwives working towards a safer birthing experience for indigenous women in Mexico by combining knowledge from both the past and the present – these stories cover the incredible impact of nurses all over the world.

Caring with Courage launches on www.caringwithcourage.com on

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Simon Shelley, vice president of BBC Programme Partnerships – part of BBC StoryWorks, said: “We set out to understand how nurses can be at the centre of positive change in the delivery of care across the globe, mindful of the challenges that face the profession. What we found through creating this series is the most extraordinary people playing a pivotal role that far surpasses the delivery of healthcare, profoundly impacting people and communities.

‘We’re excited for global audiences to engage with these stories, and continue the mission of creating equitable, accessible and effective systems of care.”

Join the conversation on social media via the #CaringWithCourage hashtag.

International Nurses Day (IND) is celebrated around the world every 12 May, the anniversary of Florence Nightingale’s birth. ICN commemorates this important day each year with the production and distribution of the IND resources and evidence. To access the report and other resources, please go tohttps://www.icnvoicetolead.com/

ICN condemns the criminalisation of medical errors after nurse found guilty of negligent homicide

Geneva, Switzerland, 30 March 2022 – The International Council of Nurses has condemned the criminalisation of medical errors after a United States nurse was found guilty of causing criminally negligent homicide by administering an incorrect drug.

Former Tennessee intensive care nurse RaDonda Vaught, who made a drug administration error in 2017 which killed 75-year-old patient Charlene Murphey, was found guilty of criminally negligent homicide and impaired adult abuse.

Instead of administering the sedative Versed (midazolam) Ms Vaught gave Vecuronium Bromide, a skeletal muscle relaxant used in anaesthetics. She will be sentenced in May and faces up to six years in prison. Speaking after the ruling, ICN President Dr Pamela Cipriano said that criminalising Ms

Vaught’s mistake raises grave concerns and could erase years of progress to improve patient safety. Dr Cipriano said: “ICN has worked closely with the World Health Organization on developing the current Global Patient Safety Action plan, which recognises that a safe organisation is one where there is a no-blame culture of openness and transparency.

of trust in healthcare while nurses have the threat of individual criminal prosecution hanging over them if they were to make an honest error.”

‘It is vital to recognise the effects of system failures whenever such tragic errors occur, because patients will not be made safer by criminalising nursing errors and scapegoating individuals.

The ANA went on to say that healthcare is complex, mistakes are inevitable, and systems will fail, and to think otherwise is “unrealistic.” It said the verdict sets a dangerous precedent and that there are more effective and just mechanisms to “examine errors, establish system improvements and take corrective action.”

‘This ruling risks being a significant backward step for the advancement of patient safety globally, and could also drive nurses to leave the profession given the fear of prosecution for an honestly declared mistake. Patient safety is about learning and continuous improvement, and this ruling potentially stands in the way of that. You cannot build a culture

The American Nurses Association (ANA) issued a statement describing its distress at the verdict and the “harmful ramifications of criminalising the honest reporting of mistakes.”

The ANA said the ruling would have a long-lasting negative impact on the profession, which is already shortstaffed, under intense strain and facing huge pressures.

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Ethics & Health Care by Marisa Vella photo | masteringconflict.com

Clinical Mentoring The lasting impact clinical mentors (CMs) have on students is highlighted in the literature. The influence CMs have on students’ future practice, attitude, and behaviour is appreciated by many. CMs are clinical leaders as they strive to promote good practice and professional values daily.

Students learn about compassion in practice by working with CMs and nurses who demonstrate this. Providing care in a dignified way, through empathy, time and attention are ways in which students can understand what the delivery of compassionate care entails as this may be challenging to grasp through theoretical components and definitions alone.

The importance of good role modelling cannot be underestimated. In 2012, the Willis Commission identified a lack of ‘high’ quality role models in nursing education noting that bad role models can be as powerful, if not more influential than good role models (Firth-Cozens & Cornwell, 2009). In view of this, Duffy (2015) reiterated the importance good role modelling and identified strategies that CMs can implement to show students how the 6 C’s can be integrated into practice.

The thought of implementing the 6 C’s consistently throughout practice may seem challenging, however it is believed that if you succeed in demonstrating one C in your practice it is likely that you are demonstrating all 6 C’s to some extent.

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Williamson et al. (2013) point out that nursing students’ confidence, motivation and future career decisions are shaped by the extent that they experience belongingness during their practice component of their training, which although can be exciting can also be frightening, unpredictable and perhaps even disorganised. Morely (2014) supported this claim and highlighted that this is important for first year nursing students, and perhaps even more so as students progress with their studies. The importance tied to belongingness is found by several sources in the literature with similar findings. Simple caring actions can support students to settle in more easily and include, allocating a space for their personal items, introducing

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them to equipment, routine of the area as well as documentation. In relation to practice encouraging students to engage in care delivery is also significant. The article titled Integrating the 6Cs of nursing into mentorship practice by Duffy (2015) provides practical and useful guidance for CMs to adopt into their daily practice with students.

Duffy (2015) highlights that CMs that are committed to their mentoring role are often compassionate towards their students and demonstrate competence. To achieve this effective communication skills, appropriate role modelling and the courage to give constructive feedback to students and take the necessary steps for those students who are not achieving the required level is crucial. Duffy (2015) reiterates that the 6 C’s can be the basis for professional CMs together with other supportive elements required from them, the organisation they work in as well as academic staff.

In addition, although released a decade ago, the Willis Commission report presents six themes as the way forward to promote quality with compassion in nursing education. These themes are the future nursing workforce; degreelevel registration; learning to nurse; continuing professional development; patient and public involvement in nursing education; and infrastructure.

This report, which presents the UK context, provides insight not only for nurse educators in academia but also for all nurses with a role in nursing education in clinical areas, management, and wider organisational levels.

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News from EFN - Climate change and health Taking further one of its key policy agenda topics, the EFN has been following closely the EU developments on climate/ planetary health. As such, the EFN participated in the European Commission meetings on Climate & Health in Europe, as on 16 March (organised by DG Santé together with DG for Climate Action, and European Environment Agency) that focused on climate change impacts on health through national policies, with some concrete examples of integration of health and climate into national governance structures, policy and action from Finland, France and Germany.

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The meeting made clear that addressing climate change impacts on health in an effective manner requires actionable national policies, and in particular, emphasis on protecting health in national climate change adaptation policies, and the consideration of climate change impacts in the national public health strategies are needed.

Climate change is part of our daily routine and can no longer be underestimated.

As such, through the “Proposal for a Council Recommendation on learning for environmental sustainability” the European Commission invites the EU Member States and the educational partners to invest in skills and training on sustainability, climate change and environment. The aim is to promote environmental sustainability policies, education and training programs and processes to educate citizens about the green transition, and to 09:16 develop a coherent approach to the

competences, skills and attitudes that people need to act, live and work in a sustainable manner, strengthening the importance of lifelong learning to ensure that everyone can acquire those competences and skills; next to facilitating the sharing of policy maker, researcher and educator expertise and best practices at system and institution level. Climate change has a negative impact on the environment and health.

We must be prepared to handle this change!

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by Megan Ford

Number of children needing eating disorder support ‘through the roof’ School nurses are witnessing an “exponential rise” in the number of children and young people (CYP) with eating disorders, while mental health trusts say they are treating more than double the number of urgent cases compared to before the Covid-19 pandemic.

The chief executive of the School and Public Health Nurses Association (SAPHNA), Sharon White, has told Nursing Times of her concerns around the rising levels of eating disorders among CYP and of long waiting lists for services which she said meant their conditions were “worsening”.

To help address the situation, the association has recently launched a series of eating disorder training webinars for school nurses. “School nurses are indeed witnessing an exponential rise in CYP developing eating disorders, as well as a range of mental health problems,” said Ms White.

Referrals from parents or carers, teachers, social care, the public or peers, as well as self-referrals for eating disorder and mental health support were “coming to the attention of school nurses”.

Many CYP were “utilising text services to initially contact, build up trust and then ask for help”, she noted.

However, she warned that children and adolescent mental health services

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(CAMHS) and eating disorder services had “very long waiting lists”.

Therefore, “although school nurses can offer invaluable support at a universal level, many CYP are worsening as they have lengthy waits for the specialist help, they need”. Separately, the NHS Confederation has also raised concerns about increased demands and growing waiting lists for CYP seeking eating disorder support.

According to the confederation, which represents NHS trust leaders in England, Wales and Northern Ireland, there has been a 72% increase in CYP being referred for urgent support for eating disorders over the last two years since Covid-19.

One mental health trust in London had reported that demand for eating disorder services in its area had increased by 150% from pre-pandemic levels. Meanwhile, the confederation pointed to latest data from NHS Digital which showed almost 250 CYP in England who urgently need support were on waiting lists, with 94 of those waiting more than 12 weeks.

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The number of those on waiting lists with less severe needs was higher at 1,697, including 662 CYP who were waiting more than 12 weeks. The confederation’s mental health network has this month called for around £12m in government funding over the next two years to ensure that CYP with eating disorders can access the care they need.

Matthew Taylor, chief executive of the NHS Confederation, said: “The explosion in the numbers of children and young people seeking and needing treatment for eating disorders is really

Children needing eating disorder support the treatment and care they need as quickly and effectively as possible”, added Mr Taylor.

Ifti Majid, chair of the NHS Confederation’s mental health network and chief executive of Derbyshire Healthcare NHS Foundation Trust, added: “Specialist eating disorder services for children and young people are undoubtedly under strain. “The numbers seeking treatment have gone through the roof following the intense and often very difficult situations that many of our country’s children and teenagers have experienced over the last two years.”

Referrals from parents or carers, teachers, social care, the public or peers, as well as self-referrals for eating disorder and mental health support were “coming to the attention of school nurses”.

concerning and it is very worrying that this could just be the tip of the iceberg as we start to uncover what the pandemic has meant for their mental health over the past two years.” He said there was an estimated 1.5million children and teenagers who would “need new or additional support for their mental health over the next three to five years”, including seeking treatment for eating disorders.

An “urgent plan” must be developed, alongside investment, to “allow the NHS to get back on track and give these most vulnerable of young people

Responding to concerns about rising demands in eating disorder services, the Royal College of Nursing’s professional lead for CYP, Michelle Eleftheriades, told Nursing Times: “The increase in demand across both community and acute settings must be understood within the wider context of the challenges facing children, young people and their families.” She recognised there were several factors impacting the demand for these services, including the pandemic, health inequalities, rising cost of living and increased rates of domestic violence and child abuse.

Ms Eleftheriades agreed that increased funding was needed but stressed this was “only part of the solution” and that action on workforce shortages was also required. Separately, the Royal

College of Psychiatrists has this month launched new ‘medical emergencies in eating disorders’ guidance for health professionals, to help ensure all people with eating disorders needing urgent care, including children, can be identified and treated earlier and appropriately.

The college referenced separate data from NHS Digital which showed hospital admissions for eating disorders of all ages in England have increased by 84% in the last five years. It added that CYP “are the worst affected”, with a 90% rise in hospital admissions between 2015/16 and 2020/21 – up from 3,541 to 6,713. There had been a 35% increase in admissions among these groups in the last year alone, it added. The new guidance covers recommendations on carrying out risk assessments, the location of care, safe refeeding of malnourished patients and behavioral manifestations of eating disorders in medical and pediatric wards. It aims to support health professionals to identify and manage eating disorders when they become life-threatening.

Dr Dasha Nicholls, who chaired the development of the guidance, said it “encourages healthcare professionals to spot when someone is dangerously ill, and dispel the myths surrounding them”. To “stop the eating disorders epidemic in its tracks”, she said it was “vital” the guidance reached health professionals “urgently” and that it was supported with necessary resources to aid its implementation.

A Department of Health and Social Care spokesperson said: “Eating disorders can be devastating for people living with them, and we are focused on improving services so that everyone has access to the right support.” They said it was investing “an extra £2.3bn per year by 2023/24 to transform mental health services”, which included £53m for CYP’s eating disorder services.

The spokesperson also pointed towards a recently launched call for evidence to support the development of a new cross-government 10-year mental health plan.

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by Emma Baines

Family nurse scheme in Scotland reaches 10,000 young mothers The Family Nurse Partnership is producing real benefits for young mothers and their babies, according to an analysis of data from the first 10 years of the programme in Scotland.

The programme is a home-visiting scheme offered to all first-time mothers aged under 19, and up to the age of 24 in some places. It aims to improve health and development outcomes for mother and child and involves regular hour-long nurse visits throughout pregnancy and the first two years of infancy.

Data from nearly 10,000 young mothers who took part in the programme over its first 10 years show it increased rates of breastfeeding, and reduced smoking in mothers at 36 weeks of pregnancy, and 12 months after giving birth.

This is in contrast to a 2015 evaluation of the scheme in England which did not find the expected short-term benefits

to breastfeeding or stopping smoking that had been anticipated from the programme.

Very few of the babies in the Scottish programme had any child development problems, and 95% received all immunisations given before the age of two years. In addition, 40% of mothers had returned to work or education by 24 months after giving birth, however this was still lower than the proportion in work of education when they enrolled onto the programme during pregnancy.

The review also identified improvements that needed to be made, including addressing the current variation in the point of gestation of women joining the programme and in the number of women receiving the optimal number of visits.

Developed in the US by Professor David Olds, the programme was set up in England in 2007-08, and started in Scotland in 2010, with a pilot project in NHS Lothian. The scheme in Scotland is now countrywide and employs more than 200 whole-time equivalent nurses.

Val Alexander is service manager of the Family Nurse Partnership and has been with the programme since it began as a pilot in NHS Lothian. She said: “We are so proud of the Family Nurse Partnership and everything our clients have achieved.

photo | www.muhealth.org

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“The Family Nurse Partnership programme works to support young, first-time mothers to prepare for motherhood and continues that support for them and their child through the first two years. “FNP was first delivered in NHS Lothian and to see it extended across Scotland to reach thousands more families is something very special for all of us.

“This 10-year analysis of the delivery of the service across Scotland will help us to see how far we have come and map out our goals and ambitions for the future of the programme and young families.” Scotland’s women’s health minister Maree Todd met mothers and staff who have taken part.

She said: “Over 10,000 young women have now received support through this programme since it started, which is a fantastic milestone. “Family nurses help mothers to think about the future, what kind of parent they want to be and their goals and aspirations for other areas of their lives like education and employment.”

She said the government had committed to supporting an additional 500 families through the scheme by 2025 by extending it to all first-time mothers aged 21 and under, and those aged 21-24 who have experiences of the care system or are from deprived communities.

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Leprosy, little did I know that…

Leprosy also known as Hansen’s disease, is a chronic granulomatous disease caused by the bacterium Mycobacterium leprae. This affects the peripheral nerves and mucosa of the upper respiratory tract and if left untreated, leprosy can cause permanent damage to the skin, nerves, limbs and eyes (Dias et al., 2018). It is not known exactly how leprosy is transmitted; however it is believed that transmission of the disease may happen when an infected person coughs or sneezes, and a healthy person breathes in the droplets containing the bacteria. It is understood that prolonged, close contact with someone with untreated leprosy over many months is needed to catch the disease (CDC, 2017).

Despite this, Leprosy is considered as a curable disease if it is diagnosed early (Legua, 2018).

Archaeological evidence confirms the presence of leprosy in Egypt during the 2nd century BC with the first accurate description written by the Greek physician Galen of Pergamun in 150 AD. Locally the first recorded case of leprosy goes back to the 1630 during the Hospitaller Period which involved a Dominican friar who died in the Rabat convent (Buttigieg & Micallef Stafrace, 2008). The local medical authorities Malta have always been on the forefront in the treatment of leprosy.

In fact, in 1972 a leprosy eradication project with an estimated 300 patients was initiated in Malta. This project was jointly funded by the Sovereign Military Order of Malta in collaboration with the German Leprosy Association and the Maltese Government was was eventually approved by the World Health Organization. The treatment regime for this project consisted of combined treatment with rifampicin,

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isoniazid (INH), prothionamide, and diaminodiphenylsulfone (DDS). The Malta Project was concluded formally in December 1999, and there has been no case of endemic leprosy reported since (Freerksen et al., 2001). To this date, this multiple drug therapy regimen as pioneered in Malta, now using a combination of dapsone, rifampicin, and clofazimine, remains the best treatment for preventing nerve damage, deformity, disability, and further transmission.

Leprosy is known to be ‘eradicated’ from the Maltese islands as of the 21st century with no cases being reported in the Maltese native population (Buttigieg, Savona-Ventura, & Micallef Stafrace, 2008). Despite this ‘eradication’, patients who previously contracted leprosy, are still found in Malta. During my first clinical placement within a primary care setting, I encountered a leprosy case. This patient was suffering from severe open leg ulcers on both legs and was so in denial of his condition that he repeatedly refused recommended amputations. In fact, he continuously stated that the deformities were due to a previous mechanical injury. This specific case left an impression on me and following a discussion with my mentor I decided to do further research and reflect about leprosy which is a condition associated with great stigma due to the deformities it produces (Legua, 2018; WHO, 2021).

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My reflection was backed by the ‘Dimensions of Wellness Model’ which helped me to identify the clinical needs for this patient who suffers from leprosy. Physically, this disease caused wounds which covered both legs, some of which were MRSA positive and led to frequent hospitalisations for wound assessment and treatment. From the mental health perspective, it is evident that patients who suffer or suffered from leprosy are affected by stigma and discrimination because of the physical deformities and fear of cross infection.

This often leads to depression, anxiety, and low self-esteem (Somar, Waltz and Van Brakel, 2020). I could easily relate this literature to my experience as the patient repeatedly expressed his fear, sadness, and anxiety. This was even evident with his high emotional status as he continuously burst into crying when asked how he feels and how he was coping with the wounds. He explained how his spirituality helped him a lot throughout this journey because praying makes him feel better and lucky to be alive at his age.

Patients suffering from leprosy are known to suffer from social isolation as they are unable to socialise due to pain and insecurities secondary to physical deformities and foul smells from wounds. Within this case, the patient even shared how at times when he was not able to attend work because of the severe pain cause by his leg ulcers,

Jgħidulek biex ma tibkix Jgœidulek li huwa sempliçiment kelb, mhux persuna.

Jgœidulek li issa jgœaddilek.

Jgœidulek li l-annimali ma jafux li gœandhom jmutu.

Jgœidulek li l-importanti huwa li ma jœalluhomx isofru.

Jgœidulek li tista’ ææib ieœor.

Jgœidulek li normali jiæri hekk.

Jgœidulek li hemm uæigœ aktar insapportabbli minn dan.

which in turn affected his financial situation and mental health status. As this was not enough, he explained how several places were not accessible due to pain which in turn left him within his environmental limits. I noticed that this patient did not mind waiting in the waiting room as he would have some time to socialise with other patients.

Logically, this patient spent most time by himself, and unfortunately this is often the sad reality that patients suffering from leprosy patients find themselves in (Dias et al., 2018).

Unfortunately, history shows that Leprosy was always viewed with abhorrence requiring segregation of the unfortunate sufferers. Being a first-year student on my first clinical placement, I could not fail to notice how none of the nurses were taken aback from caring for this patient. What impressed me most was the compassionate way care was provided by the nursing staff who were very sensitive in their communication methods, both verbally and nonverbally. This served for the creation of an excellent therapeutic nurse-patient relationship. As I said previously, in the beginning I was impressed, however looking back, this experience served me as an excellent way to start my nursing career as I was provided with an immediate understanding of the diverse role of the nurse based upon an example which showed the importance of holistic person-centred care and compassionate care. Looking back, I feel that I was lucky to meet this patient and privileged that he allowed me to care for him.

Amy Camilleri, 2nd year student Northumbria University Bachelor of Science (Honours) in Nursing Studies, MCAST Jonathan Vella Senior Lecturer, Nursing and Health, MCAST jonathan.vella@mcast.edu.mt Who needs more information or access to references please send an email to Mr. Vella.

Iÿda dawn ma jkunux jafu kemm -il darba œarist lejn gœajnejn il-kelb tiegœek.

Ma jafux kif œafna drabi kontu l-kelb tiegœek u inti li œaristu flimkien lejn il-dlam tal-œajja.

Ma jafux kif œafna drabi kien il-kelb tiegœek biss li baqa’ biswitek.

Ma jkunux jafu li jista’ jkun li l-kelb biss qatt ma ææudikak.

Ma jafux kemm-il darba raqad miegœek il-kelb meta l-œajja kienet mingœajr forçina.

Ma jafux kemm inbidlet gœall-aœjar œajtek minn meta l-kelb sar parti minnha.

Ma jafux kemm -il darba offrilek wens meta kont marid.

Ma jafux li kien il-kelb tiegœek kien minnufih jinduna meta kont tkun qiegœed issofri jew gœaddej minn xi uæigœ.

Ma jafux liema sentimenti tœoss meta tara l-kelb tiegœek.

Ma jafux li l-fiduçja li gœandu l-kelb tiegœek, f’kull mument talœajja tiegœu, hija bla limitu.

Ma jafux li gœall-kelb tiegœek li jarak dieœel lura mix-xogœol kienet tkun biÿÿejjed biex litteralment itir bil-ferœ.

Wara kollox, ma jafux x’œassejt meta mellistlu wiççu fl-aœœar mumenti ta’ œajtu, inti u ssellimlu bid-dmugœ f’gœajnejk u r-Requiesant in Pace fuq fommok....

Tiææudika qatt l-uæigœ psikoloæiku ta’ xi œadd li qiegœed iæarrab it-telfa ta’ xi annimal li akkumpanjah f’œajtu.

Oqgœod attent xi kliem tuÿa.

Dr. Nicholas Briffa Clinical Psychologist and Sexologist

photo | breedyourdog.com

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from our

diary MUMN met with the newly appointed Minister for the Acti ve Ageing & Community Care.

ss conference MUMN organised a pre onal Day ati ern to celebrate the Int s where certain of Midwives & Nurse . ted issues were highligh

MUMN met with a de legation from the Na tionalist Party with whom cer tain issues were discu ssed.

At the new premises a section is dedicated to the visit that MUMN Officials paid to the E.T. Pope Francis last year marking the 25th MUMN Anniversary and the Year dedicated to Nurses & Mid wives.

discuss certain MUMN met with SVP Nurses to tial Facility. den Resi this to ng aini pert issues

The Institute for Health Care Professionals is organising mon thly seminars at the new premises.

s to meet MUMN organised two meeting amination ont Dec the and sts the Phlebotomi r Sectoral thei Sterile Technicians to approve ed. sign be will it re Agreement befo

MUMN meets the new graduate d Nurses & Midwives every year to explain important deta ils and situations. This year 4 meetings were organised for diff erent students. This meeting was the first one organised at the new Training Centre.

Reuniting Mental Health Nurses

Sharing experiences and cultivating knowledge in Malta

by Alexei Sammut President - MAPN Horatio is a distinctive name in the English literature, as a character in William Shakespeare’s tragedy ‘Hamlet’. He was the king’s counselor, his confidant and someone who stood by his side through both his happy and dark moments. Hamlet, the king, was a troubled man and he choose only Horatio to be his friend and help him with the struggles of his inner life. In this context, the European Association of Psychiatric Nurses deemed this to be the right name to represent the works of psychiatric and mental health nurses across Europe.

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In co-operation with other organisations, projects and individuals, Horatio is an active partner in discussions that influence European mental health issues with particular reference to the viewpoint of nurses. The Maltese Association of Psychiatric Nurses is a central partner of this organization, and was involved in co-hosting The Horatio Festival in Malta in 2008, 2014 and 2017. Once more, the MAPN will be co-hosting for the 4th time, another major Horatio event in 2023.

The Horatio Congress of Psychiatric Nursing: ‘Reuniting Mental Health Nurses’ Sharing Experiences, Cultivating Knowledge’ will be taking place in Malta, at the Marriott Hotel, Balluta Bay between Monday 13th and Tuesday 14th of March 2023. This year the event

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is very unique, following a two year period of restricted pandemic measures.

The focus in on celebrating the nursing profession, reuniting after a time of uncertainty, sacrifices and challenges which saw the world stand still, except for health care professionals. These two years proved to be a testament to the hard work, dedication, love, resilience and commitment that nurses and other health care professionals expressed in these unprecedented times. These two years have brought new challenges, which will guide the knowledge of the next generation of health care professionals.

Under the theme of “Reuniting Mental Health Nurses”, Horatio, the European Association of Psychiatric Nurses and the Maltese Association of

Reuniting Mental Health Nurses

Psychiatric Nurses, welcome all health care professionals from Malta and the rest of the world, to participate in this congress, either as a speaker or as a delegate. The Congress will have a blend of scientific and practice development presentations, workshops and symposiums from around the world, including speakers from the field of mental health, plus a full array of cultural and fun activities including a gala party and music night.

A number of major, high profile keynote speakers will be participating in this event, with very distinctive names in the field of mental health nursing, including Professor Agnes Higgins, Professor Bengt Karlsson and Professor Thomas Kearns.

Professor Agnes Higgins, is an icon in clinical nursing and academia. Professor Higgins is a registered mental health nurse, general nurse and nurse tutor with over thirty-five years of clinical and education experience in the areas of mental health, palliative/hospice care and general nursing. She was elected Fellow within College in 2014 and Elected Fellow (Ad Eundem) Royal College of Surgeons in Ireland in 2016.

She is a member of many national and international organisations and groups related to mental health, including expert panel member of Horatio, member of the Grounded Theory Institute, and Member of European Network of Training, Education and Research in Mental Health. The central theme underpinning her research is on increasing understanding of service users’ and family members’ experience of mental health service provision and the development of psychosocial strategies that promote recovery and social inclusion. To-date, she has published 75 papers in peer-reviewed, high-impact journals, 2 books, 13 book chapters, 34 reports for national bodies and 3 best practice guides for practitioners.

Professor Bengt Karlsson works at the University of South-eastern

Norway, at the Faculty of health and social sciences. Professor Karlsson holds a professorship in mental health care and is also the leader of the Mental Health and Substance Abuse Centre in Norway. He trained as psychiatric nurse and as family therapist. His main areas of research are within Recovery, Collaborative research, Open Dialogue and Human Rights, and is a leading expert in human rights within a healthcare context. To-date, he has published 126 scientific articles and book chapters and 19 books.

was appointed Trustee of the Florence Nightingale International Museum and was recently appointed to the WHO Europe Steering Committee to establish a roadmap for Nursing in Europe.

More keynote speakers for this amazing congress will be announced in the coming months. The call for abstracts is currently open and will close on the 30th of September 2022.

The Horatio European Psychiatric Nurses and the Maltese Association of Psychiatric Nurses will be working The third announced keynote speaker at the event to ensure that psychiatric for the Congress is Professor Thomas and mental health nursing, no matter where it is being practiced, which country it is being delivered in, the professional background of its practitioners and the different skills they bring to the mental health care table; are fully recognised by everyone from colleagues, professional allies and politicians alike. This event is about celebrating the work of those nurses, whether they work in the community, a specialist centre, in hospitals, clinics or as individual practitioners. It is their work that fundamentally underpins the care offered to individuals with mental health difficulties and as such they photo | getty need the recognition and support necessary to do so.

Because they are important, Kearns. Professor Kearns is the Executive because they are very often there for Director of the Faculty of Nursing and vulnerable people when no one else Midwifery, at the RCSI, University of is and because what they do can be Medicine and Health Sciences, Dublin described as extraordinary. Psychiatric Ireland and is responsible for leading and mental health nursing needs to and delivering the strategic intent acknowledge its achievements and and operational activity of the Faculty. seek new goals, now more than ever.

He has worked as interim CEO of the International Council of Nurses in Geneva. Thomas’ doctorate is in the area For further information about of continuing professional development the Congress visit www.horatio and the maintenance of professional congress2023.com. Local delegates competence. Thomas is a non-executive can benefit from special reduced rates. director of Axia Digital Ireland, a learning For more information, contact us on and development software company horatiocongress2023@gmail.com which is based at the Faculty of Nursing and Midwifery in Ireland. Thomas has On behalf of the Boards of Horatio and developed a Centre for Nursing and the Maltese Association of Psychiatric Midwifery Advancement across the RCSI Nurses, we look forward to welcoming Hospital Group. In April 2021, Thomas you to the Congress.

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by Kevin Holmes

Male Menopause: Are you serious?

For a number of decades, this topic has been controversial. This article follows a presentation at the conference organized by The Learning Institute for Healthcare Professionals titled Challenges As We Grow Older.

‘Male menopause’ is a lay term coined in the 1980s to describe a syndrome similar to the female menopause, with which it only shares a few similarities. Menopause is universally known to refer to the cessation of menstruation so this term created confusion to a point where people even questioned its veracity.

The confusion was compounded further after the publication of the results of the WHI study in the early 90s when data collected from a sample of 161k post-menopausal women was extrapolated to the male population, an error discussed later in this article.

Today, the blur is still present. An online search will yield well over ten terms which roughly refer to the same syndrome, correctly referred to as Late Onset Hypogonadism (LOH).

Testosterone (T) T is the male sex hormone in part responsible for libido and the development of the male’s secondary sex characteristics. Libido, a person’s sexual drive, is influenced by social, psychological and biological factors (T and dopamine). Its production is regulated by the hypothalamicpituitary-gonadal axis (HPG-A) as one can see in the diagram. The Leydig cells in the testicles produce 95% of the total T in the body and its production and secretion peaks in puberty where we see the development of the secondary sex characteristics and also a growth spurt. 60% of the total T is bound to Albumin, Androgen Binding Protein, or Sex Hormone Binding Globulin (SHBG). This 60% is a circulating reservoir whereas the biologically active T is the remaining, unbound, 40%. The latter is involved in health and well-being by regulating moods, behaviour, libido, erythropoiesis,

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sebum production, prostate volume, and prevention of osteoporosis.

The problematic comparison of female menopause and LOH Although some parallels can be drawn, it is impossible to compare menopause and LOH for a number of reasons, namely: gender differences; molecular dissimilarity between oestrogen and T; different diagnosis and consequences of treatment; and the timeline both syndromes follow.

This final point is very important.

Menopause is both universal and obvious mostly because it follows a sharp decline in oestrogen over an 8-to-10-year span. This results in a barrage of symptoms. In comparison, not all males go through LOH (<40% is the highest cited in the literature) and, not all those who go through it experience symptoms (S-LOH), highlighting the inappropriateness of the term Male Menopause. LOH is a subtle, slow, linear decline over a span of 4-6 decades. This subtlety makes diagnosis difficult as often times, the males experiencing it might not even notice themselves.

The decline in T production starts

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after age 30y primarily due to two factors: a decrease in the function and the number of Leydig cells and possibly dysfunction of the HPG-A due to comorbidities. Besides, mirroring the decline in T production, by age 60y, there is also an increase in the blood concentration of SHBG, further decreasing the concentration of unbound, biologically-active T. This is reflected in the clinical picture of androgen decline mainly as decreased libido, erectile dysfunction, decreased intellectual ability, decreased concentration, lethargy, decreased lean body mass - muscle volume and strength, decreased bone mineral density, increased visceral fat, decreased body hair, skin alterations, and an increase in abnormal sleep patterns.

Treatment Low levels of T are, by themselves, insufficient to warrant treatment.

Symptomatic males with lowered quality of life should be treated with T replacement therapy (TRT). TRT has faced obstacles along the years especially due to the blind embracing of the extrapolated results of the WHI study which have predicted dire consequences for those who were

prescribed TRT. Having said this, treatment is not for everyone and prior assessment is crucial to exclude existing conditions which can be worsened by TRT. These include liver, breast or prostate malignancies; untreated sleep apnoea; pre-existing polycythaemia; severe liver, renal, or heart failure; hypercalcaemia; and significantly obstructive benign prostatic hyperplasia.

The role of nurses Nurses are placed in uniquely strategic positions to raise awareness of this condition, to disseminate knowledge both to the public and to fellow healthcare workers, to advise patients, to follow up both those who have been started on treatment and others who cannot be on TRT due to pre-existing conditions, to refer to other professionals as necessary, and to advocate for appropriate care and prescribing as outlined by international guidelines.

Conclusion It is the author’s opinion that in 2022 we’re still battling to improve acceptance of an irrefutable, albeit not universal condition, and still suffering the effects of the ridiculous confusion created by the use of less appropriate terms. Considering the increase in the world population and increased longevity, this topic will benefit from a more scientific approach rather than speculation.

Nurses, a voice to lead, can play a crucial role in making this happen.

(Endnotes) 1 Kevin Holmes MSc HS (Nurs.); MA Ad.Ed; PGC VEAR; BSc Nurs. (Hons) Sn Lecturer | IAS | Main Campus kevin.holmes@mcast.edu.mt Who needs to know more, clarify some point or need information about the references can send an email to Mr. Holmes.

A nurse who lost both legs in Ukraine has first dance with her husband in hospital TVM News In Ukraine, a nurse who lost her legs in an explosion has posted emotional video footage in which she is seen in her first dance with her husband after they got married in hospital.

Victor held his wife Oksana in his arms as they danced around a hospital ward in the city of Lviv.

This heartbreaking scene was shot on a mobile phone by a volunteer at the hospital.

an explosion occurred that took off both her legs. The Association added that whilst the man did not sustain any injuries, Oksana lost both her legs and four fingers from her left hand.

Before being evacuated to Dnipro, Oksana underwent four operations, including to the upper parts of her legs in preparation for the attachment of prostheses.

The 23-year-old nurse from Lysychansk, in the east of the country, lost her legs on 27 March when she and Victor were returning home.

“Life should not be postponed,” Oksana said. Victor and Oksana had not found the time to get married in the six years they have been together. They bought the wedding rings in Lviv, and a white dress was found for Oksana. The cake was baked by hospital volunteers, and the celebrations were held in one of the hospital wards.

The Lviv Medical Association said that as the young woman turned to warn her husband of the danger,

Oksana is now waiting to travel to Germany with her husband for more treatment.

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New Nestlé NANCARE range of products for infants and young children

During the first years of life, every child, experiences many moments of joy as well as the occasional instance with minor ailments that can cause distress.

It is particularly common for babies to suffer minor digestive problems such as diarrhoea or constipation because their digestive and immune systems are still maturing. New Nestlé NANCARE dietary supplements contain active compounds known to help resolve specific issues related to these problems in babies that are breastfed or formula fed. The New Nestlé NANCARE range of dietary supplements were recently introduced to the local market and comprise of 5 different products.

NANCARE Flora Protect+. Taking antibiotics early in life may severely disturb the developing gut flora, causing microbiota disbalance by killing both pathogenic and beneficial bacteria.

The young child’s immune system needs extra protection during early life, given that it’s still immature. NANCARE Flora Protect+ with L. Rhamnosus and two predominant human milk oligosaccharides known as HMO’s, help build a strong immune system. These active compounds present in New Nestlé NANCARE FLORA -PROTECT+ support a healthy gut microbiota and a strong immune system, even during antibiotic treatment.

NANCARE Flora Equilibrium is a supplement for children, that improves mild constipation by improving stool frequency and softening stool consistency. Nestlé NANCARE Flora Equilibrium contains FOS (fructooligosaccharides) and GOS (galactooligosaccharides). These compounds provide a prebiotic action that improve intestinal well-being and promote digestive health in children. Prebiotics are defined as ‘non-digestible food ingredients that beneficially affect the host by selectively stimulating the growth and/or activity of one or a limited number of bacterial species already resident in the colon and thus attempt to improve host health through this action.

NANCARE Vitamin D and NANCARE DHA, Vit. D & E. Several studies have demonstrated that serum levels of Vitamin D experience marked seasonal changes with a significant decline during the winter months. Both an impaired cutaneous synthesis of vitamin D and an inadequate dietary supply seem to be responsible for vitamin D insufficiency. Thus, particularly in winter, vitamin D supplementation may be an alternative solution to increase vitamin D levels. The new Nestlé NANCARE range offers two formulations that provide this indispensable vitamin, namely NANCARE Vitamin D and NANCARE DHA, Vitamin D & E. In addition to

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NANCARE Hydrate. Diarrhoea is a very common health problem in infants and children. This condition may occur due to viral pathogens (e.g. rotavirus) as well as bacterial causes (e.g. Salmonella, Shigella and E. Coli.). Recent guidelines suggest use of reduced osmolarity oral rehydration solutions (ORS) as first line treatment in young children.

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References: Langhendries, JP, et al. J pediatr Gastroenterol Nutr 1995;21:177-81.

Holscher HD et al. J Parenter Enteral Nutr2012;36:106S-117S. BraeggerC, et al. J Pediatr Gastroenterol Nutr 2013;56:692-701.

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The sacrament of the anointing of the sick in patristic sources We have all heard the famous biblical verse thanks to which the Sacrament of the Anointing of the Sick was instituted by Christ through his Mystical Spouse and our mother, the Church. *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 *(Jas 5:14-15).

Such verse surely shows the biblicalapostolic tradition of the praxis of the anointing of the sick in the Church. The latter sacrament bears the name of the Lord Jesus and it is also the prayer of the faith. Thus, these two components essentially show that this sacrament, and in that case every sacrament, is the result of the joined work of Christ, as the Head of the Mystical Body, the Church, and the cooperation of the entire Mystical Body, the Church. Head and Body, through the power of the Holy Spirit, bring about the saving effect of the Sacrament of the Anointing of the Sick.

The patristic tradition, immersed as it is in the Word of God, took at heart the theological and pastoral relevance of this powerful biblical verse coming from the catholic epistle of St. James the Apostle.

In this short reflection we shall be appreciating five patristic contributions coming from St. John Chrysostom, Caesar of Arles, the Council of Nicea, Bishop Serapion and Origen.

St John Chrysostom (14 September 407), was a Patriarch of Constantinople and an important Early Church Father <https://en.wikipedia.org/wiki/Early_ Church_Father>. In both Church history and patrology he is known for his preaching <https://en.wikipedia. org/wiki/Homilies> and public speaking <https://en.wikipedia.org/wiki/Public_ speaking>, his denunciation of abuse of authority <https://en.wikipedia. org/wiki/Abuse_of_authority> by both ecclesiastical and political leaders, the *Divine Liturgy of Saint John Chrysostom <https://en.wikipedia.org/wiki/Divine_ Liturgy_of_Saint_John_Chrysostom>*, and his ascetic <https://en.wikipedia. org/wiki/Ascetic> insights.

The

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epithe‚ (*Chrysostomos*, anglicized as Chrysostom) means “goldenmouthed” in Greek and denotes his celebrated eloquence. Chrysostom was among the most prolific authors in the early Christian Church, exceeded only

by St. Augustine of Hippo <https:// en.wikipedia.org/wiki/Augustine_of_ Hippo> in the quantity of his surviving writings.

“The priests of Judaism had power to cleanse the body from leprosy”or rather, not to cleanse it at all, but to declare a person as having been cleansed. . . . *Our priests have received the power* not *of treating* with the leprosy of the body, *but with spiritual uncleanness*; not of declaring cleansed, but *of actually cleansing*. . . . *Priests accomplish this* not only by teaching and admonishing, but also *by the help of prayer*. Not only at the time of our regeneration [in baptism], but even afterward, *they have the authority to forgive sins*: “Is there anyone among you sick? Let him call in the priests of the church, and let them pray over him, anointing him with oil in the name of the Lord. And the prayer of faith shall save the sick man, and the Lord shall raise him up, and if he has committed sins, he shall be forgiven” (*On the Priesthood* 3:6:190ff [A.D. 387]).

The second Father of the Church who reflects on the Sacrament of the Anointing of the Sick is Caesar of Arles.

His Latin <https://en.wikipedia.org/wiki/ Latin_language> name is *Caesarius Arelatensis* (468/470“ 27 August 542 AD), sometimes called “of Chalon” (*Cabillonensis* or *Cabellinensis*) from his birthplace Chalon-surSaône <https://en.wikipedia.org/

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photo | catholicparishesofborehamwood.org

wiki/Chalon-sur>. Caesar was the foremost ecclesiastic of his generation in Merovingian Gaul <https:// en.wikipedia.org/wiki/Christianity_in_ Merovingian_Gaul>. He is considered to be of the last generation of church leaders of Gaul that worked to promote extensive ascetic <https://en.wikipedia. org/wiki/Ascetic> elements into the Western Christian tradition. According to William E. Klingshirn’s study of Caesarius presents him as having the reputation of a “popular preacher of great fervour and enduring influence”.

Among those who made the greatest influence on Caesarius were St. Augustine of Hippo <https://en.wikipedia.org/ wiki/Augustine_of_Hippo>, Julianus Pomerius <https://en.wikipedia.org/ wiki/Julianus_Pomerius>, and John Cassian <https://en.wikipedia.org/wiki/ John_Cassian>.

“As often as some infirmity overtakes a man, *let him who is ill receive the body and blood of Christ*; *let him humbly and in faith ask the presbyters for blessed oil, to anoint his body*, so that what was written may be fulfilled in him: “Is anyone among you sick?

Let him bring in the presbyters, and let them pray over him, anointing him with oil; and the prayer of faith will save the sick man, and the Lord will raise him up; and if he be in sins, they will be forgiven him. . . . *See to it, brethren, that whoever is ill hasten to the church, both that he may receive health of body and will merit to obtain the forgiveness of his sins*” (*Sermons* 13[325]:3 [A.D. 542]).

Sacrament of the anointing

“Concerning the departing, the ancient canonical law is still to be maintained, to wit, that, if any man be at the point of death, *he must not be deprived of the last and most indispensable Viaticum.*” (canon 13 [A.D. 325]).

g

The fourth patristic author, which speaks about the anointing of the sick, is Bishop Serapion of Antioch. Serapion was a Patriarch of Antioch <https:// en.wikipedia.org/wiki/Patriarch_of_ Antioch> (191“211). He is known both in Church history and patristic study primarily through his theological writings. Unfourtunately all but a few fragments of his works have survived.

“

The patristic tradition, immersed as it is in the Word of God, took at heart the theological and pastoral relevance of this powerful biblical verse coming from the catholic epistle of St. James the Apostle.

”

The third patristic source for the Sacrament of the Anointing of the Sick is the Council of Nicea. This was a council of Christian bishops convened in the Bithynian <https:// en.wikipedia.org/wiki/Bithynia> city of Nicaea <https://en.wikipedia.org/ wiki/Nicaea> (now Ä°znik <https:// en.wikipedia.org/wiki/%C4%B0znik>, Bursa province, Turkey) by the Roman

Emperor <https://en.wikipedia.org/ wiki/Roman_Emperors> Constantine I <https://en.wikipedia.org/wiki/ Constantine_the_Great> in AD 325.

This ecumenical council <https:// en.wikipedia.org/wiki/Ecumenical_ council> was the first effort to attain consensus <https://en.wikipedia.org/ wiki/Consensus_decision-making> in the Church through an assembly <https:// en.wikipedia.org/wiki/Legislature> representing all of Christendom <https://en.wikipedia.org/wiki/ Christendom>. Its main achievements were agreement of the Christological <https://en.wikipedia.org/wiki/ Christological> question regarding the divine nature of God the Son <https://en.wikipedia.org/wiki/God_ the_Son> and his relationship to God the Father <https://en.wikipedia.org/ wiki/God_the_Father#Christianity>, the construction of the first part of the Nicene Creed <https://en.wikipedia. org/wiki/Nicene_Creed>, establishing uniform observance of the date of Easter <https://en.wikipedia.org/wiki/ Easter>, and the promulgation <https:// en.wikipedia.org/wiki/Promulgation_ (canon_law)> of early canon law <https:// en.wikipedia.org/wiki/Canon_law>.

“*We beseech you, Savior of all men, you that have all virtue and power*, *Father of our Lord and Savior Jesus Christ, and we pray that you send down from heaven the healing power of the only-begotten [Son] upon this oil, so that for those who are anointed . . . it may be effected for the casting out of every disease and every bodily infirmity . . . for good grace and remission of sins* . . . ” (*The Sacramentary of Serapion* 29:1 [A.D. 350]).

The last patristic contributor regarding the Sacrament of the Anointing of the Sick is surely the great Origen of Alexandria (c. 184“ c. 253). He was also known as Origen Adamantius. Being an early Christian <https://en.wikipedia. org/wiki/Early_Christianity> scholar, ascetic <https://en.wikipedia.org/wiki/ Ascetic>, and theologian <https:// en.wikipedia.org/wiki/Christian_ theology>, who was born and spent the first half of his career in Alexandria <https://en.wikipedia.org/wiki/Early_ centers_of_Christianity#Alexandria>, Origen dedicated himself to theological reflection. In fact, he was a prolific writer who wrote extensively, roughly 2,000 treatises in multiple branches of theology <https:// en.wikipedia.org/wiki/Theology>, including textual criticism <https:// en.wikipedia.org/wiki/Textual_ criticism>, biblical exegesis <https:// en.wikipedia.org/wiki/Exegesis> as well as biblical hermeneutics, homiletics <https://en.wikipedia.org/wiki/ Homiletics>, and spirituality. Origen

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continued on page 30

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Sacrament of the anointing continued from page 29 was one of the most influential figures in early Christian theology, apologetics <https://en.wikipedia.org/wiki/ Christian_apologetics>, and asceticism <https://en.wikipedia.org/wiki/ Christian_asceticism>. John Anthony McGuckin, in his book *The Westminster Handbook to Origen, *described Origen as “the greatest genius the early church ever produced”. “[The penitent Christian] does not shrink from declaring his sin to a priest of the Lord and from seeking medicine* . . . [of] which the apostle James says: “If then there is anyone sick, let him call the presbyters of the Church, and let them impose hands upon him, anointing him with oil in the name of the Lord; and the prayer of faith will save the sick man, and if he be in sins, they shall be forgiven him.” (*Homilies on Leviticus *2:4 [A.D. 250]).

What can we conclude from these patristic contributions concerning the Sacrament of the Anointing of the Sick? First, it is the ordained priest who

has received the power from Christ, through his Church, of treating the spiritual uncleanness.

This he does with the help of prayer.

Furthermore, it is the ordained priest who has received the authority to forgive sins.

Secondly, the sick person is greatly encouraged to receive the Eucharist, the Body and Blood of Christ, “the last and most indispensable Viaticum”.

Third, when knowing that s/he is sick the person plagued by sickness is urgently encouraged to hasten to the Church to receive the Anointing of the Sick and to obtain the forgiveness of his sins. Fourth, the Sacrament of

Confession is medicinal indeed.

It is my fervent humble prayer that you, dear nurses, when you page us, hospital chaplains, to administer to the patients the Sacrament of the Anointing of the Sick, these powerful and healing insights come into your minds and hearts and, lovingly and caringly, you introduce Jesus Christ to our brothers and sisters the sick, in the person of the priest, who direly need his healing loving touch through the Sacraments of the Anointing of the Sick and Confession.

Fr Mario Attard OFM Cap

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Probiotics, defined as live strains of bacteria with documented health effects, have become a wellrecognized option to support the composition of a beneficial microbiota in infants and children. Different strains of a specific species have different probiotic properties and effects. Hence the benefits of one specific strain cannot be extrapolated to the effects of other probiotics.

Scientific evidence

Limosilactobacillus reuteri Protectis is special

Clinical effects of L. reuteri Protectis in infants with colic, constipation and regurgitation include reduction in crying time, increase in bowel movements and reduced number of regurgitations in both breast-fed and formula-fed infants.

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

Numerous trials have shown the safety and significant effects of L. reuteri Protectis on functional gastrointestinal disorders and protection of infections in infants and children.

Clinical guidelines support the use of L. reuteri Protectis The use of L. reuteri Protectis in paediatrics is supported by a number of international guidelines. Indications with a recommendation are infantile colic, functional abdominal pain, treatment of acute gastroenteritis, as adjunct to oral rehydration solution and prevention of common infections.

BioGaia Protectis baby drops can be given from birth and do not affect breast-feeding or the taste of food.

References: Reuter G. The Lactobacillus and Bifidobacterium microflora of the human intestine: composition and succession. Curr Issues Intest Microbiol 2001;2:43-53.

Valeur et al. Colonization and Immunomodulation by Lactobacillus reuteri Protectis in the Human Gastrointestinal Tract Applied and environmental microbiology.

2004;1176-1181.

Chung TC et al. In vitro studies on reuterin synthesis by Lactobacillus reuteri. Microb Ecol Health Dis, 1989;2:137-144.

Hojsak I et al. Guidance on the use of probiotics in clinical practice in children with selected clinical conditions and in specific vulnerable groups. (EPA/UNEPSA) Acta Paediatr.

2018;107:927-937.

WGO: World Gastroenterology Organisation Global Guidelines Probiotics and Prebiotics. Review team: Guarner F et al. Feb. 2017.

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Press Information Communiqué de presse Comunicado de prensa

Finnish nurses call for improved salaries and working conditions to address nursing shortage and patient safety 4 April 2022 - On 1 April 2022, 25,000 healthcare professionals, including registered nurses, went on strike in six hospital districts in Finland to protest for decent salaries and working conditions.

The strike is led by trade unions, Tehy, the Union of Health and Social Care Professionals in Finland and SuPer, the Finnish Union of Practical Nurses. The Finnish Nurses Association, a member of the International Council of Nurses (ICN), is not a negotiating partner, but closely collaborates with Tehy and fully supportsthe strike.

Tehy and SuPer called for the strike, which will run until 15 April and includes a ban on overtime work for those not involved in the strike, to protest the lack of improvement in working conditions and salaries, despite the hard work and stress endured by health workers during the pandemic. Pay increases offered by employers fell far short of the rises requested by staff representatives. Tehy and SuPer have proposed a rescue programme to tackle the shortage of social and healthcare professionals and to improve working conditions, including an extra 3.6% increase annually over the next five years on top of the standard pay increase. A further strike

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of 40,000 healthcare professionals will take place mid-April unless an agreement is reached.

While some hospital managers and chief medical officers have expressed their concern that the strike will affect patient safety and the health of patients, many nurses on social media have said that, due to the protected work rules in place during the strike, they are experiencing better staffing than usual. One nurse in a paediatric intensive care ward said they now have nine nurses per shift which is much higher than in the past three months. Another nurse in the dialysis treatment centre of Turku University Hospital, said thatcontrary to reports, they currently have five nurses in the protected work, which is more than in normal times, and that all the needed dialysis treatments have been done, with no one left without treatment.

Nina Hahtela, President of the Finnish Nurses Association said: ”In recent years on many occasions, we have raised our deep worry about the increasing lack of nurses, and its effect on patient safety and healthcare services, but this has not been heard. Salary and working conditions are the key factors to solving the situation. Nurses’ salary at the moment does not correspond to the demands and responsibilities of the job

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and the level of education, and is far from the colleagues in the other Nordic countries, for example. The politicians and leaders have not raised concerns about patient safety before the strike, even though it has been in danger daily because of too few nurses. Nurses have been incredibly flexible, but there is a limit to that. Many of our nurses are really exhausted. This strike is to correct the situation, not to worsen it - to find ways to recruit and retain nurses now and in the future. None of us wants the strike, but this is now the only solution left. Nurses were praised as invaluable during the pandemic and now it is so sad to read the news and witness the lack of support by the hospital leaders.

‘Furthermore, the health ministry is now preparing legislation to force more nurses to work during the strike. This is totally unacceptable. The strike is legal and negotiations on necessary protected work are held according to the law.”

The Finnish Nurses Association reported that the average monthly basic wage of nurses in Finland (including supplements for evening, Sundays etc.) is ¢3183 compared to ¢3527 for the average monthly wage in Finland in general. According to the Professional Barometer published in September 2021,registered nurses were number one on the list of occupations experiencing labour shortages in Finland.

Commonwealth Nurses and Midwives Federation

25%

increase in anxiety and depression due to

photo | intermountainhealthcare.org

Covid 19

The World Health Organisation (WHO) have issued a wake-up call to all countries to step up mental health services and support. According to a scientific brief released by the WHO March 2022, in the first year of the COVID-19 pandemic, global prevalence of anxiety and depression increased by a massive 25%.

Concerns about potential increases in mental health conditions had already prompted 90% of countries surveyed to include mental health and psychosocial support in their COVID19 response plans, but major gaps and concerns remain.

One major explanation for the increase is the unprecedented stress caused by the social isolation resulting from the pandemic. Linked to this were constraints on people’s ability to work, seek support from loved ones and engage in their communities.

Loneliness, fear of infection, suffering and death for oneself and for loved ones, grief after bereavement and financial worries have also all been cited as stressors leading to anxiety and depression. Among health workers, exhaustion has been a major trigger for suicidal thinking.

The brief, which is informed by a comprehensive review of existing evidence about the impact of COVID19 on mental health and mental health services, and includes estimates from the latest Global Burden of Disease study, shows that the pandemic has affected the mental health of young people and that they are disproportionally at risk of

suicidal and self-harming behaviours.

It also indicates that women have been more severely impacted than men and that people with pre-existing physical health conditions, such as asthma, cancer and heart disease, were more likely to develop symptoms of mental disorders.

This increase in the prevalence of mental health problems has coincided with severe disruptions to mental health services, leaving huge gaps in care for those who need it most.

Services for mental, neurological and substance use conditions were the most disrupted among all essential health services reported by WHO Member States. Many countries also reported major disruptions in life-saving services for mental health, including for suicide prevention. Unable to access face-toface care, many people have sought support online, signalling an urgent need to make reliable and effective digital tools available and easily accessible.

WHO and partners have developed and disseminated resources in multiple languages and formats to help different groups cope with and respond to the mental health impacts of COVID 19.

For example, WHO produced a story book for 6-11-year-olds, My Hero is You, now available in 142 languages and 61 multimedia adaptations, as well as a toolkit for supporting older adults available in 16 languages.

WHO’s most recent survey on continuity of essential health services indicated that 90% of countries are working to provide mental health and psychosocial support to COVID-19 patients and responders alike.

At last year’s World Health Assembly, countries adopted the updated Comprehensive Mental Health Action Plan 2013-2030, which includes an indicator on preparedness for mental health and psychosocial support in public health emergencies.

However, this commitment to mental health needs to be accompanied by a global step up in investment. WHO’s most recent Mental Health Atlas showed that in 2020, governments worldwide spent on average just over 2% of their health budgets on mental health and many low-income countries reported having fewer than 1 mental health worker per 100 000 people.

The time for action is now.

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The Investor Lifecycle Investing is a lifelong process. Unfortunately, sometimes financial planning is left on the back burner, however, it is best to start saving and investing as soon as you start earning a regular income stream.

The discipline learned by putting aside a small amount of your monthly pay check will benefit you for the rest of your lifetime. No matter in which stage of life you are, it is important to start thinking seriously about saving and investing - it is never too late to start.

One needs to develop rigid savings habits, in order to reach goals which may be saving for retirement, a new house or car, or to set aside money for our children’s higher education. As we age and progress through our careers, our financial goals continuously evolve.

Understanding current and future goals, and planning ahead in order to achieve these goals, are two important elements of financial planning. Regular contributions to savings and investment vehicles are often the most effective.

These may be automated through standing orders, thus making life much easier.

All investments involve a certain amount of risk. One needs to analyse how well one tolerates price fluctuations, however one must keep in mind that return from investment will depend on the risk the investment carries. As a rule of thumb, the higher the risk the higher the expected return. An offsetting factor to risk is time. If you plan to hold an investment for a long time, you may tolerate more risk because you have the time to potentially make up for any losses incurred due to market volatility.

For a shorter-term investment, such as saving to buy a car or a house, you probably want to take less risk to ensure to have liquidity and ease of access to funds when a deposit or full payment is required.

During the start of our careers, we might have relatively low income but a long-time horizon until retirement.

With over thirty to forty years ahead until retirement, this might be the ideal time to build an aggressive portfolio aiming towards capital gains.

An ideal investment vehicle in those circumstances are equities, since these boast higher return potential. Their long term horizon allows them to ride out periods of short term volatility that markets experience from time to time.

Individuals in the age bracket of fifty and over, would likely be within their peak earning years, and thus have a greater capacity to save and invest.

At this stage, whilst equities may still play a role, portfolio allocation will be geared towards safer securities such as investment grade bonds.

As we reach retirement age, our risk profiles become more conservative.

Capital preservation and steady income are top priorities, and at this point, investment portfolios become predominantly weighted towards fixed income and liquid securities, in order to avoid market volatility and ease of access to funds.

Each lifecycle stage is associated with a set of distinct objectives, that when taken all into consideration and incorporated

into a long-term investment plan, will guide the investor from the present day up to one’s retirement. These agesensitive objectives will ultimately shape and assist the advisor in establishing the investor’s risk profile, who will be provided with recommendations and portfolio allocations.

Finally, one cannot stress enough the importance of taking an active interest in one’s investments by monitoring the investment portfolio and regularly checking that it has maintained the right asset mix which should always be on track with the ultimate goals.

Through five Investment Centres strategically located in Malta and Gozo, the Bank offers free financial planning consultation with qualified and experienced Financial Advisors. To set up an appointment with a Financial Advisor simply fill in this online form (link: https://www.bov.com/Assistants/ set-an-appointment or send an email bovic@bov.com.

This article is not, and nothing in it should be construed as a recommendation in respect of investment products or services offered by the BOV Group.

Any views, assumptions or opinions expressed in this article are those of the author. Value of investments may go down as well as up and may be affected by changes in currency exchange rates.

Past performance is not a guide to future performance. Issued by Bank of Valletta p.l.c., 58, Triq San Ÿakkarija, il-Belt Valletta VLT 1130. Bank of Valletta p.l.c. is a public limited company regulated by the MFSA, licensed to carry out the business of banking and investment services in terms of the Banking and Investment Services Acts (Cap. 370, 371 of the Laws of Malta).

photo | roadtoabrighterlife.com

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35 13/04/2022 12:02

I feel helpless when patients are not relieved from their pain - palliative care nurse

by Sabrina Zammit - Independent Nurses in Malta have been recently advocating for better working conditions, as many have been left feeling burnt out, particularly at the height of the pandemic. Some hospital vacancies are harder to fill than others, as the type of job could not be endured by many. One of these is in the palliative care section at the oncology centre, which caters for the needs of cancer patients who are in their final stages.

The Malta Independent on Sunday sat down with a palliative care nurse, who wanted to anonymously share his firsthand experience in the field. Like most student nurses he never imagined that at the end of his studies he would end up working as a palliative care nurse by choice.

“In the beginning of my career they would not let us settle in one ward, but they would make us do the rounds and help where needed; that is how I ended up as a reliever in the palliative care section,” he said.

He said that he liked it mainly because of the way in which treatment was being given, as patients in this section are treated “holistically”. This means that staff also pays close attention to how

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the patients are feeling emotionally, not just the pain and side effects left by cancer.

Although this is always the goal of every nurse, and not just those working in the palliative care section, he said that this might be easier to see in this section specifically, simply because each nurse has a smaller number of patients allocated than if they were to work in the main hospital.

Since palliative care nurses spend more time with their patients, they are also more aware of their mental health status. When they witness a deterioration, they let doctors know so if needed they can also be referred to a psychologist. “You end up developing a kind of friendship with them, obviously without crossing the professional line,” he said.

He said that such relationships would have a stronger sense of relatability, when the nurse’s assignment would know the patient from before their admission, as they would feel more for them. He added that despite this there are other factors which might affect this kind of relationship, such as the age as “in my case I think I would relate a little bit more with younger patients, even more if they are within my age group”.

Speaking about how his emotions are affected by this profession, he said

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that in the beginning, when he used to attend to these patients’ needs, he used to feel these emotions deeper, although he never continued to dwell on them when his shift ended. He added that apart from the patients’ emotions, it is also the relatives’ reactions to seeing a loved one deteriorate that affects palliative care nurses “as they are mostly in denial”.

More often than not, this denial stage brings with it its own challenges as certain delicate discussions might not have been broached by doctors.

“If we see they are nearing the end we have to talk to them,” he said.

He said that in such cases they would first ask patients, together with their family, what they have been told by doctors. Asked how he has learned to deal with these situations, he said that mostly he has learnt through experience and observing other nurses who have been there for a longer time.

He added that during his university years, students were not given much information on palliative care, as “we were only given maybe two to three lectures on the subject”.

He said that his perceptions on life have changed since he started working with palliative care nurses. People make a fuss about a broken finger when the pain of a dying cancer patient is so much on a higher level. Speaking about the patients’ age range, he said he has seen an increase in patients being admitted in their 40s.

Palliative care nurse The nurse said that although he finds no problem working with adult patients, he would feel very uncomfortable to work with palliative care patients who are under the age of 18. “I don’t feel comfortable working with kids and having to witness them endure such hardships; with adult patients it’s different as it does not affect me that much,” he said.

He added that apart from having to witness such suffering in children, it is also hard for nurses to see their family cry from being so heartbroken, “especially their parents”.

Asked how he deals with such emotions, he said that although such instances are rare, he just talks it out with his partner who also happens to be a nurse. Speaking about other palliative care nurses, he said that he “knows others who have been affected a lot by particular cases, which makes them sad”. He said he always tries to keep himself and others in a good mood during working hours, by simply cracking an innocent joke to lighten the mood and the atmosphere; a technique which he suggested might be a coping mechanism, “although I am not sure about it”.

Despite all the drawbacks which might push other nurses not to work in this particular section, the nurse said that he has until now not experienced any burnout symptoms. Unlike him, there were others who, in the short time he has been working in the palliative care section, have resigned as there were too many circumstantial elements which stressed them out.

Depressive emotions are also felt by patients who are first admitted to the palliative care section as they would be in a poor condition. He said that the first thing that nurses do to try and make them feel better and more comfortable is to treat the cancer side effects.

“We try to welcome them with a certain kind of love and care, so they feel more comfortable and at ease, especially considering that this is the final stage of their life.” He said they were not taught how to deal with such situations during the nursing course, but he added that they were taught to always show compassion towards

any patient. He added that this kind of behaviour needs to be more present in the palliative section as patients, and their family, tend to be in a much more vulnerable state.

Apart from nurses, patients’ relatives can also have an active role in the caring of patients, if they are stable enough to go home. Mentioning the services offered by Hospice Malta, he said that when such time comes, relatives are given a referral for them to be given the necessary equipment for the patient to live comfortably at home. At such a stage training would also be given to the patient’s family so that they operate it themselves.

“We try to equip the family to cater for these needs directly at home as much as possible as we want them to stay comfortable, as long as the wishes of the family coincide with that of the patient, that is, for him or her to remain and pass away at home comfortably.”

He said it is not the first time that patients have no one who comes to visit, even though they have families who supposedly care for them. He said that such situations make him feel uncomfortable as he asks himself why nobody cares enough to come visit such patients in their final stage in life.

He added that when this happens some patients are visibly sad and that makes him pity them even more. Despite this, nurses are still obliged to update relatives on the condition of the sick family member. Mentioning a case, in which the patient was not being visited by anyone because he had some family issues, he explained how he, together “with other nurses, stayed near him as he passed away”.

Asked how he feels when a patient passes away, he said that it has never

affected him that much as he has always seen it as being a part of the job. “I think since it is given that we see a lot of these things happening in front of our eyes, we have developed some kind of barrier so as such things do not affect us that much,” he said.

He said that one of the things which leave an impact on him is when treatment given to patients does not help to ease the suffering. This makes him feel helpless.

Although there are patients with other conditions, who might benefit from a section dedicated to palliative care, such as heart failure, only cancer patients have a special palliative care section. Currently these patients are treated in hospital.

Despite these shortcomings, he pointed out that such a section would be difficult to maintain as currently there is a shortage of nurses. Secondly, it could also be the case that it is not used so often as, unlike cancer, where the patient is admitted into palliative care following many failed treatment attempts, the decision is not easy to take for other patients.

He said that it is already very difficult for palliative care nurses having to explain to cancer patients that they cannot continue to force treatment such as IV fluids as in some cases it would be making such patients feel worse, especially as they near the end, thus he cannot imagine having to explain to families of patients suffering from other conditions, where the line is not so much clear.

Speaking about the kind of stress that nurses have to endure, he said that during the height of the Covid19 pandemic when the section was given specific instructions not to let in any visitors, “it was very hard on us as they wrote several articles about us saying that we are not compassionate, when we were just doing our jobs”. He added that during the time they were trying to do their best as they were even handing tablets to patients to video chat with their family.

He added that it was thanks to a psychological meeting between nurses, organised by the concerned entities, that they managed to vent it all out.

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by Geoffrey Axiak - Clinical Nutrition Senior Practice Nurse - PART 1

Nursing Competence or Nursing Competency?

We are hearing and talking about nursing competence and about nursing competencies but do we know what they mean? Is there a difference between them? Are they different ways of naming the same thing?

Various authors discuss competence, each giving their own interpretation of what they understand by it. Camelo & Angerami (2013), Müller (2013), Campbell (2006) and Meretoya et al.

(2002) identify ‘Competence’ as the ability of a nurse (or any other worker) to be able to fulfil his role effectively.

Wilkinson (2013) gives it two meanings, one linked to performance and another as a personal quality. Melnyk et al.

(2014) agree with these definitions in that they state that competence implies the ability to do something of high quality. In fact, Dellai et al. (2009) emphatically state that “competence is an essential factor for assuring quality, safety and cost-effective health care” (p. 783). They also state that “competence”, “performance” and “capability” are often terms which are used interchangeably, as traditionally, competence was based on techniques, skills and behaviours. This approach is referred to by Murrells et al. (2009) as the ‘behaviouristic’ approach that depends on direct observation of performance.

Both Dellai et al. (2009) and Murrells et al. (2009) continue by stating that the more modern approach is more ‘holistic’, and would include knowledge, skills, attitudes and values that are utilised while a person is carrying out his work and that are linked in concept to the practice of nursing skills. This more holistic definition of competency agrees wholly with the earlier writings of the Australian Nursing and Midwifery Council (ANMC) (2005, p. 8), Black et al. (2008, p. 173) and the ICN (International Council of Nurses, 1997).

It also agrees with a report presented a year later by the Nursing and Midwifery Council (UK) (2010) when presenting their required standards for the registration of Registered Nurses. Gillespie & Hamlin (2009)

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actually specify that “it is an eclectic concept and incorporates a myriad of capabilities – not merely technical skills” (p. 252). Jormsri et al. (2005) go further in breaking down nursing competence into three sub-divisions: 1. clinical competence – including clinical skills, assessment, intervention and judgement, 2. general competence – including communication, critical thinking and problem-solving and 3. moral competence – including practicing while maintaining morals and responsibilities within one’s practice.

Benner (1984, cited in Dellai et al., 2009) in her book “From Novice to Expert”, emphasises that nurse competence grows with each nurse throughout their work life, changing him from novice to expert.

In his systematic review, Watson et al.

(2002) mention various authors whose definitions ranged from the earlier ‘behaviouristic’ definition discussed by Dellai et al. (2009) and Murrells et al.

(2009) to their later ‘holistic’ definition, with Gonczi (1994) presenting a ‘midway’ ideology of viewing competence as signifying the personal attributes that make a practitioner perform effectively. This idea is again very empirical and behaviouristic due to the problems presented by direct observation – that will be reviewed in more detail at a later stage – and also by generic competencies that tend to be subjective and on which a total general consensus is difficult to obtain. A very comprehensive definition of competence has been given by Camelo & Angerami (2013) where, while discussing competence in relation to organisations as a whole, divide competence into the following three dimensions: 1. Essential competence – dealing mostly

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with managerial and organisational survival and management of an organisation 2. Functional competence – dealing with skills needed for the functioning of specific areas or sectors within an organisation 3. Individual competence – attitudes and behaviours needed by individual practitioners to fulfil their professional roles.

All this demonstrates that the quest to define “competence” throughout the ages has been no easy task and there was and even presently is still no single accepted definition (Ääri et al., 2008; Cowan et al., 2005; Kiljunen, 2019; Lurie, 2012; Muller, 2013; Redfern et al., 2002; Tabari Khomeiran et al., 2006; Takase & Teraoka, 2011; Taylor et al., 2021; Vatnøy et al., 2020). As a matter of fact, Bradshaw (2000) argued that now there is too much professional freedom when defining competence related to nursing, explaining that, according to her, nurses can decide on what they need to know and what they do not. She insists that because of all this, defining nursing competence will be a major issue for the 21st century (Bradshaw, 2000).

Melnyk et al. (2014) defines “Competency” as a mechanism that supports nurses and other healthcare professionals to provide high-quality care. Benner (1982) defined it as “the ability to perform a task with desirable outcomes under the varied circumstances of the real world” (p.

303). McCready (2007) and Whelan (2006) then specify that it entails performing skills or tasks according to a job description. She adds that apart from the proper definition of competency, it also includes a list of criteria which are created, developed and updated regularly based on a whole consultation process between educators, leaders and other stakeholders in nursing.

continued in next issue

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THE FUTURE OF DIABETES MANAGEMENT IS HERE The new Dexcom G6® Continuous Glucose Monitoring (CGM) System is the first real-time diabetes management system approved with zero* fingersticks.

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* If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions. † Previous CGM systems have shown to lower HbA1c. JAMA. 2017; 317(4): 371-378.

References: 1. Beck RW, et al. DIAMOND - JAMA. 2017. 2. Soupal J et al. COMISAIR, Diabetes Technol Ther. 2016. 3. Heinemann L, et al. HypoDE, Lancet. 2018. 4. Reddy M et al. iHart CGM Diabet Med. 2018. 5. Lind M, et al. GOLD JAMA. 2017. 6. Shah VN, et al. Diabetes Technol Ther. 2018. © 2018 Dexcom UK & Ireland. Dexcom UK (Distribution) Limited, Watchmoor Park, Camberley, GU15 3YL (10040080). VAT 241 2390 40. LBL016669 Rev001.