Bosnia and Herzegovina in the time of Covid-19

Dragan Trivun is the founder and president of the association for people with a performed stoma. He also has an ileostomy for 26 years (he was operated in 1994). The ILCO-STOMA RS association is the only association in Bosnia and Herzegovina. The state of emergency due to covid-19 didn’t prevent him from visiting new members. For family members help was necessary because the visit was forbidden from hospital, and they didn’t receive the necessary instructions and recommendations.

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Finilco – Means used for copying with the COVID-19 crisis

Finnilcos actions and work methods in the middle of corona – crisis:

  • We closed down all face to face activities and meetings in local chapters and nationally (immidiately in March)
  • The courses and training for stoma accomodation were cancelled and transformed to later (Some know this kind of activity as camps)
  • The formal meetings (for house of delegates?) in Finnilco and local chapters were moved to autumn. (The government did some changes in laws to allow this in all associations)
  • The visits of supportpersons in hospitals and elderly care were forbidden
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Actions dans le cadre de la Journée Nationale de la Stomie

1. Visioconférence ‘Osons parler Stomie’ Elle aura lieu lundi 4 mai après midi via la plateforme ZOOM et sera animée par : Dr Laury Beaubrun-Diant, Docteur en Psychologie de la Santé, Chercheur Centre CERPPS Toulouse  Martine Pagès infirmière stomathérapeute CHU Nîmes Chantal Vaurs, Patiente expert, Secrétaire de l’Union et Présidente de l’IAS Nord Dauphiné Myriam Teyssié, Patiente expert, Présidente de l’Union des Stomisés du Grand Sud (modératrice).  

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Awards for the Czech ILCO

Two awards within two months for the Czech ILCO

Marie Ředinová, who was in October for the fifth time elected head of the Czech ILCO, was awarded the Prize of the Minister of Health for work supporting handicapped people. This prize is being awarded to persons who render considerable and outstanding service to disabled or chronically ill people in the Czech Republic. Ms Marie Ředinová indisputably is such a person. She was decorated on 3 December 2019 in the Spanish Hall of the Prague Castle by the Minister of Health of the Czech Republic Mr Adam Vojtěch.

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European Council of Enterostomal Therapy – Rome, 23 – 26 June 2019

Fragments of the information presented to the ECET:

  • June 2019

After opening the event, the ECET board presented the programme and welcoming the participants.

  1. Luisa Salani, Italy – Caring gestures and thoughts from the voices of nurses – about a study and its phases: Starting point – A qualitative phenomenological study : 340 nurses – Method and data analysis – Caring for the other: dedicated time, paying attention, respecting other, trying to establish relationship with patient, satisfying the patient’s needs, being concerned with the emotional decision etc.
    1. Taking time for caring gestures and words – in the daily practice nurses have to decide to which kind of patient dedicate more time
    2. Paying attention – is the first caring action. Nurses should have an open mind..
    3. Acting with delicacy, Touching patient’s body – a wide range of caring actions emerged from nurses’ stories
    4. Being on the alert: nursing surveillance – while I was giving the medication I spoke to him ( patient) and I could feel a strange way of breathing , so I asked himself if he was having problems.
    5. Impacting on context to facilitate the act of caring.

Caring from Italian nurses’ perspective: it is a practice carried out through competent actions and willingness to intentionally take care of the patient. It involves an international and prompt care. Comparing our results with international studies. Caring generates caring – to support the ethical tension that nurse caring requires in contexts exposed to continuous suffering and to the cure of incurability.

  1. How research is helping or should help  caring / taking over nurses. Ermellina Zanetti,
    1. Experience a relationship of closeness with nurses
    2. To be informed
    3. Receive a continuous attention ; “caring for” behaviors that indicate to patients that nurses “care about” them.

Nurses – patient interactions: Virtually all nurse-patient interactions could be categorized into one of the following areas:

  1. Getting to know each other
  2. Translating (explain, informing etc.)
  3. Expert compassion (includes genuine concern ad a “ connection”)
  1. Patients’ concerns focus more on the availability of a nurse to attend to their specific requests than on “closeness’ with a nurse
  2. When nurses are readily available to “care for” patients this can potentially result in patients believing that nurses “care about” them

FROM NURSING SCIENCE TO PATIENT NEEDS: A LONG JOURNEY

Unversita degli Studi di Firenza, Mario Del Vecchio

Some fundamental steps:

  • Nursing science
  • Nurses capabilities and skills
  • Nurses number
  • The roles that nurses play and the tasks they perform

Four priorities in FNOPI ( 2017) document (Italian document):

  • To expand the scope of practice
  • To practice in a safe environment:
  • To practice in full partnership with physician and other health professionals/ high quality in multi-professional team
  • To be open to and ready for the future: in a changing world the choices of the professional community should be more “pulled by the future” than “pushed by the past”.

Profession’s strategies – a wider perspective:

  • In designing their strategies nurses, as any other professional, tend to adopt a strict disciplinary perspective

SIMPOSIUM

Pier R. Spena ( FAIS Italy) attended and held an welcome speech session, with entero-stoma therapist Natascia Tonarelli and Sarah Rusell ( Clinical Exercise Specialist)

Me + recovery programme

  1. Recovery after stoma surgery – what does recovery look like ? exercise guidelines and research; what do nurses say? What do the patients say?
  2. Ostomate , own experience surgery diverticulosis , no information about exercises for abdominal ;

Importance – confidence

What advice do you give your patients about physical activity and exercise after stoma surgery?

Confidence spiral: urgery, rebuilding confidence, increased activity, no loss muscle, less pain, more confidence.

What are the benefits of physical activity?
How much physical activity should you do?
Percentage of respondents NO meeting guidelines for physical activity (150 minutes of moderate activity per week).
Physical Activity after surgery with hernia

Patient Comments 2018:

  • Need more advise about abdominal exercises “I wish I’d been advised and how to prevent them”
  • I am scared to do exercise in case  I get a hernia
  • Exercises is so important in the recover process, But it is never discussed.

Do you think patients should be given specific information about physical activity? Patients answers – yes

Guidelines – Patients should be advised to commence core abdominal exercises 3 – 4 days post surgery

Exercise and cancer – exercise is safe – before, during and after treatment – it helps to combat side effects and reduces risk of recurrence, may help body fight cancer 7 aid treatment.

Suggested guidelines:

Everyone is different – people with stoma can make any exercise they want, Appropriate core /pelvic floor exercises , Regulate intra-abdominal pressure ( IAP)

Goals of me recovery (Sarah Rusell speaker)

  • Return to normal activity , work and life soon
  • Rebuild confidence – physical and mental
  • Core muscle and pelvic floor function
  • Empower – enable – focus on positives
  • Increase physical activities

3. Natascia Tonarelli – Enterostomal therapist – Cisanello Hospital Pisa

Event in Pisa with the support of Convatec for patients for exercises, patients do exercises all together

After finding out about the  “Me+ recovery” – patients have learned movements, started to do exercises etc.

25 JUNE 2019

Welland symposium

Manuka Honey Workshop – Hydrocolloid containing Manuka honey as a first line defence in maintaining peristomal skin health.

Speaker: Dr. Duale Mahdi, research scientist

Why skin integrity is at the Heart of Stoma Care?

  1. Skin – the interface

Protection – mechanical impact, fluids, radiation, infection; thermal regulation; endocrine function/ Vitamin D; sensation

  • Skins structure – formed by  hypodermis,  derma, epidermis – 3 lays

Structure of the Epidermis:

  • Stratum Corneum Structure:

Key components: 1) Corneocytes contain keratin and compounds referred to as natural moisturizing factor ( NMF), b) Intracellular Lipid bilayer

Skin hydration ( moisture- associated skin damage)

Consequences of Moisture Damage:…(..)

  • The pH of human organs is tightly regulated by acid- base homeostasis varying between 1 to 8
  • “normal” pH skin is acidic in range of 4.1 – 5.8
  • Skin pH bacterial growth in particular staphylococcus aureus which has an optimal pH of 7.5

Peristomal Skin Complication
– common – estimated to be  approx. 70 %
– expensive – treatment cost for severe case of Peristomal skin complication
– is the flange simply an adhesive plate? It has a huge impact on peristomal skin protection
– why have an additive such as Manuka honey in the baseplate? = natural, safe ( ingestible), strong etc

High level of MGO are present in Manuka Honey from the nectar of the flower of the Manuka bush ( Leptospermum Scoparium) , indigenious to New Zeeland.

UMF trademark is giving for the original of the honey , on the content pure.

  • Low pH, High sugar content, hydrogen peroxide,
  • Reported benefits of Medicinal Honey ( anti-inflammatory activity, is used in wound dressing to stimulate and rapidly heal skin, used in burns etc)

Peristomal skin in study ( for flat appliances, not convex)

  • 61 % saw improved peristomal skin and increased in their QOF
  • 93% comfortable
  • 88% felt secure
  • 68% Improved or healed

Conclusions:

  • Honey is safe
  • String positive clinical results
  • Leading core research that will be continued to share

26 June 2019

Information about colostomy for people with limited health literacy, by NL

Purpose

Development of information that helps doctors and nurses to give better explanations to people who are getting a colostomy, but are experiencing difficulty in understanding medical information.

Method:

  • Desk research among ostomy nurses which showed that people with limited health literacy are getting less extensive information
  • Simplifying existing texts in proper consultation with ostomates and stoma-nurses
  • Providing the texts with simple medical illustrates
  • Submitting the texts and drawings to people with limited health literacy.

Results:

  • A set of colostomy-cards “colostomy after colon cancer” which are presented to ostomy nurses
  • A training for ostomates and stoma-nurses about health literacy and communication
  • Plans and commitment to develop more similar information in 2019.

Isabella Grosu