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Projects from Pleven, May 2002 PSBHN workshop: brief summaries

Projects from Gabrovo, June 2002 PSBHN Workshop: brief summaries

Projects from Varna, June 2002 PSBHN workshop: brief summaries

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A PSBH workshop was held in Rousse on October 14-16^th organized by Dreyfus Health Foundation and the Association for Better Health, in collaboration with the Rousse Regional Hospital.

Sixty-five participants – nurses, laboratory workers, doctors, psychologists and educators from the regional hospital, regional hygiene and epidemiology station, the psychiatric hospital and the nursing college developed 62 projects aiming to solve a variety of problems: substance use and abuse prevention, patient education, early diagnosis of cancer, prevention of nosocomial infections, improvement of quality of nursing care, social integration of disabled people, providing cost-effective hospital care, patients’ rights, STD/HIV prevention, increasing the numbers of blood donors, etc.

The local PSBH team is especially thankful to the international facilitators - Dr. Jan Sobotka, Ms. Shelagh Murphy, Dr. Daniel Levine, Mr. Mahmoud Alkam and Dr. Katarzyna Broczek who helped the participants to develop working projects – by mid-November most of the projects were implemented.

Special thanks to Dr. Mincho Vichev –Director of Rousse Regional Hospital, to Mrs. Evelina Vankova – chief nurse at the hospital, and Dr. Plamen Panayotov who were helpful in organizing the workshop and coordinating all activities in the follow-up of projects in Rousse.

During the workshop, representatives of Hygiene and Medical Industries – Veliko Turnovo, Bulgaria presented products and equipment suitable for the maintenance of hospital hygiene and in the prevention of in-hospital infections. The firm also covered some of the workshop expenses.

In November, there was a follow-up meeting with workshop participants. In November, there was a follow-up meeting with workshop participants. The following projects were implemented:

• A training program for mothers of 30 children with asthma to use drug inhaler correctly Krassimira Georgieva

• Health education for adolescents on ways to prevent HIV infection - Anton Antonov

• Remedial gymnastics and healthy diet for children aged 14-18 with spinal deformities, obesity and hypertension - Bisserka Petrova

• Teaching basic hygiene rules to 20 roma children and their parents - Daniela Velikova

• A training program for hygiene support workers in intensive care - Diyana Stefanova

• Reduction of rehospitalization rates among schizophrenic patients - Giouniul Hairedin

• SAY NO TO DRUGS - Mariana Fileva

• Reduction of stress level among children admitted to a paediatric ward - Pavlina Dilova

• Speech rehabilitation for stroke patients - Petranka Koleva

• Reduction of stress level among patients operated for colon cancer - Sevda Karachristova

• Training program to improve the effectiveness of drug abuse prevention - Stanislav I. Ivanov

• Differentiating unnecessary emergency from routine clinical laboratory tests - Tonka Karakasheva

• Prevention and early diagnosis of prostate cancer - Vesselina Tzoneva

• Improving the quality of nursing care for multiple sclerosis patients - Elena Panyotova

• Providing information about therapeutic and diagnostic procedures at the Rousse Regional Hospital to the general population and health professionals - Evelina Vankova

• Life free of drugs - Mladen Christov

• Improving life quality of children with mucoviscidosis - Petranka Trofilova

• An educational program for mothers of newborn babies - Stefka Lambeva

• Education for patients with tracheostoma cannula - Stoyanka Racheva

• Health education to prevent diabetic foot – Dimitrinka Slavcheva

• Antismoking program for schoolchildren - Vassilka Staikovska

• Educational program on sexual and reproductive health - Yordanka Kasseva

• Promotion of blood donation - Yordanka Mladenova

• Stress reduction among patients with anus praeter - Anichka Andreeva

• Educational program to increase the awareness of young people about adverse health effects of drug abuse - Christina Zaharieva

• Educational program to prevent premature death in patients with chronic renal failure - Daniela Stoyanova

• Improving the quality of nursing care - Detelina Markova

• Better control on diabetes for better quality of life - Dr. Julian Stefanov

• Sex education on STIs - Gyunseli Niyzi

• Prevention of drug abuse relapses - Dr. Stanislav Ivanov

• Health education for patients with lumbar hernia - Elenka Alexandrova

• Health education for adolescents to decrease smoking - Milena Mihailova-Georgieva

• Dental hygiene program for children - Pepa Antonova

• Program to assist the professional adaptation of newly appointed nurses at Surgical Unit - Sevinch Ferad

• Regulating the rules for prescribing emergency lab tests - Tzvetelina Angelova

• Prevention of nosocomial infections in an intensive surgery unit - Vyarka Georgieva

• Information program for health-insured patients on their rights - Angela Stross

• An educational program to increase the number of patients who seek psychological help if they have problems - Greta Georgieva

• Information program for patients of the X-ray department regarding the effect of X-rays - Irena Ivanova

• Introduction of computerized control on utilizing human resources and consumables - Krassimira Gerova

• Health education on the importance of early detection of breast cancer - Mariika Ilieva

• Reduction of stress among children treated in a surgical ward - Natalia Penkova

• An educational program on healthy diet for girls aged 17-18 - Nelly Stoyanova

• A program to improve compliance among psychiatric patients - Petranka Vassileva

• Health education on hypertension control - Petranka Yordanova

• Prevention of xerothalmia of staff working on the computer in air-conditioned offices - Petya Stoikova

• Education on proper hygiene and diet in baby and child care for Roma mothers - Tatyana Atanassova

• Health education on the importance of early detection of breast cancer - Tatyana Malakova

• Training proper disinfection skills in hygiene support workers - Zhivka Galabova

• Computer training program for nurses - Albena Spasova

• Program to decrease the pre-analytical errors in the Regional Blood Center - Deana Dimova

• Program to help smokers stop smoking - Doushka Angelova

• What the families of mentally ill patients need to know about mental diseases - Dr. Petya Nestorova

• Educational program on adverse health effects of alcohol - Ivanka Denkova

• Providing information to patients with mental disorders and their families regarding day-care services - Lilia Ivanova

• Increasing professional skills of cardiological nurses - Maria Getzova

• Introduction of effective work schedule for orthopaedic nurses - Nina Minkova

• Parents against drug abuse - Penka Vassileva

• Rehabilitation program for stroke patients of active age - Svetla Ilieva

• Setting up a play-corner for children treated in hospital - Tatyana Draganova

• Organizing activities for children during their hospital stay - Verginia Petrova

• Organizing activities for patients at the hemodialysis unit - Teodora Todorova - Stoyanova

A follow-up workshop with participants in the June 2003 PSBHN workshop in Sofia is to be held in Sofia at the end of January 2004.

In April, a PSBH workshop is planned for medical students and nursing students in Pleven.

An educational program to prevent glaucoma

Mrs. Izabella Georgieva

A project team of four nurses and two ophthalmologists was built. Information leaflet on prevention of glaucoma was prepared. The materials were distributed among patients with eye problems at the Ophthalmologic Clinic and among out-patients. An educational meeting for 40 patients was carried out in May 2003. The final evaluation of the project will be done in six months.

Optimizing the rehabilitation of patients after hip and knee joint replacement

Mrs. Keti Georgieva

The project started according to the plan. A team was formed and target and control groups were selected. Patients were included into the groups on the basis of graft status and a period of at least three months after the replacement. The rehabilitation program of ten procedures was performed and the results were assessed by a trained kinesitherapist. With the study group, a veloergometer was used. The first run of the project included six patients with knee and hip replacement. Before and after comparison of the groups showed better results for the patients with Veloergometer-therapy. They have increased the volume of joint flexion and extension, by 30-40 degrees and 15-20 degrees respectively. The program will continue for six months with recruitment of new patients with joint replacement.

Establishment of Day Care Center for patients with acute psychoses

Mrs. Evlambiya Racheva

The project was successfully implemented. The Day Care Center was established as a part of the Regional Center for Mental Health. A psychiatrist, a nurse and a medical assistant work there. The Day Care Center helped to solve medical and some of the social problems of the patients with transient and mild psychoses. For a period of six months 59 patients regularly visited the Center, of whom only one was hospitalized.

An educational program for patients with newly diagnosed Diabetes mellitus

The program was presented to the staff of endocrinology department. A team of nine nurses was built. Patients with newly diagnosed Diabetes mellitus were selected to participate in three groups according to the stage of their disease. Information brochure on diabetes and its complications was prepared. Educational sessions with patients were carried out. The principles of proper diet were discussed and patients were trained to control their nutrition. Patients were informed on prevention of acute diabetic complications. Since the start of the project 50 patients were trained and additional 20 were followed-up for a comparison. Patients who participated in the program had 20% reduction of hospitalization rate. The success of the project will be evaluated in six months comparing the rates of hospitalization before and after implementation of the program.

A prevention program to decrease the incidence of tuberculosis among population of Pleven

A team of two doctors and a nurse was formed to work on the project. Two information brochures on tuberculosis prevention were prepared and distributed in local schools, companies, elderly day centers, offices of general practitioners. The public interest to the problem was significant, especially among elderly people. On March 24th- the world day against tuberculosis, a happening was organized with students from the schools.

The results of the project will be evaluated next year on the basis of tuberculosis incidence of the target population.

Using occupational therapy as an integrated part of the treatment

Mrs. Andriana Chakalova

Nowadays is a difficult task to find a job for people with mental disease. The project team of six nurses working at the Psychiatric Clinic in Pleven aimed at organizing work therapy for psychiatric patients. The project coordinator contacted the local Labour Service for providing work activities for the patients and a promise was given by the authorities to include the group of patients in a National Program for employment next year. Patients participated in producing traditional souvenirs martenitza. They were also engaged in art therapy. The team prepared and distributed an information leaflet on work therapy asking help from local businessmen in provision of appropriate jobs. An article on the topic was published and a public discussion was initiated. The project results will be assessed in January 2004.

An educational program for patients treated with radiotherapy

The project coordinator performed a retrospective study of 100 cancer patients treated with radiotherapy for the first time. The statistical analysis of data proved the significant association of skin care, control over the Leucocytes and extent and duration of radiotherapy. The diet did not show such a relationship. A complete dossier form and hospital history form were worked out. Two educational brochures were prepared – Care for the skin during radiotherapy and Control over the Leucocytes. They have been distributing among patient at Cancer Day Care Center.

The final evaluation of the project will be done in January 2004 on the basis of number of patients completed a full course of radiotherapy.

Prevention of acute alcohol poisoning in childhood

Mrs. Stefka Kancheva

A project team of two nurses and a pediatrician was built. The project was presented to the Director and the teaching staff of Christo Smirnenski school in Pleven. The target group included 400 students aged 11-14. The knowledge and the educational needs of the group were initially assessed by a questionnaire. It revealed the main topics of interest and a lecture plan was developed. The lectures started and children were provided with teaching materials on acute alcohol poisoning. At the end of the project the effect will be measured by a questionnaire.

Increasing cost-effectiveness of nursing care at the Psychiatric Clinics of the University Hospital in Pleven

Mrs. Pavlinka Zhekova

The quality of care at the Psychiatric Clinics is reduced because nurses are not well informed about methods of cost-effective care. The project aimed at establishing positive attitude towards cost-effectiveness of care and at teaching psychiatric nurses in methods of effective nursing. A project team of two nurses and one expert on management of nursing care was built. All 40 nurses working at the Psychiatric clinics were included at the target group. For a period of three months, five educational sessions and a practical training were held. Certificates for attendance were issued to the participants in the project. Final assessment will be made by a questionnaire in one year.

An educational program to improve on pain control in cancer patients

Mrs. Viliyana Stoeva

The project started in October 2002, and two oncologists were included in the team. A literature review on pain control in cancer patients was made. An information brochure for the patient on pain relief in cancer was prepared and published. The team developed a questionnaire to measure the health-related quality of life of cancer patients. The brochures and the questionnaires were distributed among 50 patients with cancer.

Plans: To continue the enrolment of patients in the program and in January 2004 to assess the change in health-related quality of life due to improved pain control.

An educational program for cancer patients on chemotherapy to improve their quality of life

Mrs. Meliana Al Shargabi

The project coordinator in collaboration with two doctors-oncologists identified the most important care issues for cancer patients on chemotherapy. An educational brochure on effects of chemotherapy was prepared and distributed among patients. The project team developed a questionnaire to measure the quality of life of the patients. Thirty two patients were enrolled in the program for five months.

Plans: To continue with patient education and to assess the success of the project on the basis of quality of life measures in January 2004..

A reintegration program for patients with multiple sclerosis

Mrs. Maria Sankova

The names of patients eligible for the program were extracted from the hospital-based register of MS patients. Out of 56 invited 20 patients agreed to participate in the project. An information brochure on MS was produced by the team and distributed among all registered patients with the disease. A room for regular meetings of the target group was appointed. The group started different activities as sending greeting cards, meetings, birthday parties. Final assessment will be made by a questionnaire in March 2004.

Establishment of a sector for treatment of women with substance dependency

Recently, an increasing incidence of alcohol and drug dependency among women has been observed. The Clinic for treatment of substance dependency had 25 beds for male patients only. To meet the needs for hospital treatment of female patients with substance dependency the project was started. A hospital room with five beds and a separate bathroom were established. The sector was supplied with appropriate medical equipment and furniture.

Dimitar Dimitrov

The project aimed to raise the level of knowledge in the Gabrovo region population on exogenous poisoning. After the educational campaign, organized in collaboration with Dr. Petar Boyadjiev – a toxicologist at Gabrovo Regional Hospital, and Dr. Veselin Dimitrov and Mrs. Ivanka Rouseva of the Regional Hygiene and Epidemiology Station, the following results were achieved:

the number of the cases registered dropped from 63.3/1000 in the year 2000, to 47.3/1000 in the period July 2002 – July 2003;

the death rate decreased from 0.30% to 0.10%.

The project aimed to decrease the number of rehospitalizations of asthma patients.

The 42 newly diagnosed asthma patients were divided in to 6 groups and lectures and practical training was carried out.

Posters were prepared for the ward, and brochures were prepared for the patients.

The assessment of their skills after the training showed that 40% had the skills to apply proper ventilation techniques. The rehaspiatilzations among these patients had decreased too. Their breathing function was also assessed, and was found improved. .

Future plans include training of families of patients who cannot be trained in the groups.

Training COPD and asthma patients to use spirometers at home

Irina Grozeva

.The group included 30 patients who had been admitted for treatment at the hospital more than two times, and volunteered to participate in the project. The brochure prepared for them was distributed by the hospital staff, and the staff follow-up consulting room. Before the project, sixteen patients had been admitted for treatment three times, ten - two times, and four – four times.

Over a period of one year, nine of these patients were admitted to hospital only once. As compared to previous period, the improvement is by 30%.

An educational program for patients with lung diseases on the advantages of bronchoscopy

Dr. Ivo Stanchev

The team – one doctor and four head nurses of the Gabrovo lung disease hospital started the project in July 2002. The nurses were trained how to prepare patients for bronchoscopy, a video demonstrating the procedures was provided, and brochures for the patients were prepared. The team also prepared an informed consent form for the patients.

Individual talks with the patients and discussing the procedure have helped to increase the number of patients who complied with undergoing bronchoscopy by 20.7 %, as compared to the same period before implementing the project.

The number of patients diagnosed with pulmonary tuberculosis and early stages of lung cancer was raised by 20.9%

Lyubka Dimitrova

The project was started with the support of the hospital staff responsible for prevention of infections.

The level of knowledge of 60 nurses and 30 hygiene support workers on the problem was assessed before training was started.

Standard protocols for proper nursing and disinfection in a tuberculosis ward were prepared, in compliance with the standards required by Hygiene and Epidemiology station in Gabrovo. For four months, the nurses attended courses and were introduced to the standards/

In October 2003 and February 2003, and the hygiene support workers were trained.

Posters with the standard protocols and hygiene standards were put up in every ward.

The end-of-project assessment showed raised level of knowledge among the nurses and the support workers.

Antismoking educational program for middle school children

Nelvena Pencheva

The program was carried out in collaboration with the school authorities of St.St Cyril and Methodius school in Gabrovo. Sophisticated methods of training and experience of other antismoking projects were applied. The end-of-project inquiry showed that 100% of the children had learned about the harmful effect of cigarette smoking on the systems and organs of the human body, 100% had learned that smoking is strongly addictive, and quitting is very difficult, 92% had learned about the latest national and world health statistics regarding cigarette smoking.

The opinion of 93% оf the children was that the program was useful.

Polya Dacheva

During 2001, 337 patients had been treated at the hospital, of whom 128 (38%) had left the hospital before completion of treatment. Of those, 92 had to be readmitted to the hospital.

As a result of the training for the nurses, and the information program for the patients, of the 449 treated at the hospital, the ones who discontinued treatment on their own will were 68 (15.1%). In other words, the number of patients who completed their treatment was increased by 22.9%.

An additional inquiry on the quality of nursing care carried out among 94 patients showed that 78 of them are satisfied with the nursing care at the hospital.

Health education for early detection and prevention of osteoporosis

Two information brochures were prepared and distributed. In December and January 2003, new sixteen women of the risk group were examined, and those in need of treatment were referred for that.

At the end of April 2003, an inquiry among the women included in the project showed that 62% of them have focused their attention on the health problem after the project, and are well informed about the risk factors and prevention of osteoporosis. The inquiry also showed that women were more aware of the responsibility they have for their own health.

The project was presented to the teachers of  “Capitan Petko Voivoda” school in Varna, and they were involved in realization of the main goal – to decrease aggression of children by organizing alternative forms of activity during the free time of the children. Sports activities were the first choice to re-direct the energy of the children. Equipment to play volleyball, basketball and football after classes was provided. Several tournaments in basketball and football were organized, and a karate-club was initiated.

Another important part of the project was the health educational program. It included the distribution of health information materials, video-films, discussions and a lecture course. In collaboration with the Regional Hygiene and Epidemiology Station, a course of 11 video-films and discussions on important health issues was organized. The lecture course informed the children how to prevent accidents and how to give first aid in trauma accidents.

The project achieved a fifty-percent reduction of accidents in the children involved, as compared to the same period of the previous year. More than 2/3 of the students remained accident-free during the school year. The success of the project was due to the co-operation of the teachers – Velichkova, Nikolova, Bukova, Stoikova, Karova and the enthusiastic participation of children.

A program to reduce the number of students with overweight in two schools in Varna

At the beginning of the school year, a target group of 20 students with overweight was selected among the eligible children from “N. Vaptzarov” school and “Sofronii Vrachanski” school in Varna. The weight and the height of the children were measured and BMI was calculated at the start of the project. A school dietician prepared an appropriate diet and a weekly menu for each student in the target group. The ten rules of healthy eating were discussed in the group. The children received brochures on balanced diet for each age group. Three lectures on healthy eating habits were held in collaboration with the specialists from Health Promotion Department of the Regional Hygiene and Epidemiology Station. Regular sports activities were organized.

The weight of the students was measured three times. For a period of 9 months, an average weight reduction of 4 kg was achieved.

Stress reduction in talented children from the Arts School in Varna

The project started in October 2002. The school authorities were introduced to the desired objective of the project and helped to accomplish it. The level of anxiety of children was determined by a psychometric test. The level of stress was assessed in three different situations – related to school and teachers, self-actualization and communication. The school psychologist was informed about test results and after analyzing them three groups of students with the highest anxiety level were set up. The team chose the individual counseling as the most adequate methodology according to the type of problems and engagements of the students. Counseling was carried out by the psychologist and a trained nurse. The project covered 7 lectures, 7 practical sessions and psycho-physical relaxation. Audio-visual materials and tapes on stress control were provided.

The project will continue with the enrollment of new students age below 15 in the groups for stress reduction.

An educational program on the problems of sexual health

Among 50 students in the 8^th grade at the machine-building vocational school in Varna, an inquiry was used to evaluate the initial knowledge of the group about sexual problems. The students visited the Museum of Health and participated in a discussion on human anatomy. Monthly lectures on different topics on sexual health were held by specialists of the Regional Hygiene and Epidemiology Station. The lecture covered problems of puberty, sexual transmitted diseases, prevention of unwanted pregnancy. Students received information brochures and other educational materials. The final assessment of the results was made by a questionnaire. It was found that the main goal of the project was achieved - 80% of the target group acquired a good level of knowledge on the problems of sexual health.

An educational program on appropriate diet and regular physical activity for children with obesity

Mrs. Rousinka Todorova

The program started at the beginning of the school year. The anthropometric measurements were done to all 600 students at the school and 88 children with obesity of II and III degree were detected. Initially the target group included 20 children but soon after the start of the regular sport activities the project expanded and 52 children with obesity participated till the end. A new fitness equipment was provided for the group and a program for regular exercises was prepared by two specialists in sport medicine. The weight of each participant was followed up and registered in a special card. An educational brochure on weight control by a diet and physical activity was distributed among children. The group held monthly meetings with discussions on healthy eating, the weight was regularly controlled and a dietician gave individual counseling how to keep the reduced weight by a diet. The team reached an agreement with the company providing breakfast for the children to introduce dietetic bread and fresh fruits and vegetables to the menu. In May the students answered a questionnaire on healthy eating habits and 85% showed excellent knowledge on the topic. At the end of the project 50 out of 52 students achieved weight reduction, one student maintained the same weight and only one gained more weight.

An educational program on harmful effects of drugs for the students of a vocational school in Varna

Mrs. Radka Mileva

The project started in October 2002. A target group of 52 students from II and III year of the vocational technical school was formed. A questionnaire was prepared to assess the level of knowledge on harmful effects of drugs. It was found that 19 (36.5%) of the target group had been experimenting with soft drugs and the level of knowledge on the topic was not good. Twice in a month lectures and discussions were carried out with the help of specialists from the Regional Drug Abuse Prevention Centre and Regional Hygiene and Epidemiology Station. An information board with different materials on drugs was placed in the school. Students could ask questions anonymously and they received answers from medical professionals on the board. A group of 25 students attended a lecture course on harmful health and social effects of the drugs. The lectures were delivered by Dr. Borislav Stanchev. At the end of the project another inquiry was made to assess the success. In the group of 19 students experimenting with drugs 12 (63.2%) wanted to stop the use and other 4 (21.1%) reported they had quitted. None of the participants was inclined to switch over to hard drugs.

Stop aggression at school

Mrs. Stanka Manolova

The high number of accidents at school due to the increased aggression among students requires new educational approaches. The project started at “St. Mihailovski” school in Varna with the aim to achieve positive behavioural change, decrease of aggression and related accidents in children aged 11-12 by health education, pedagogical and psychological work. A team was formed of a school nurse, pedagogical adviser, class teachers and a group of 8-grade students who were popular and respected by the younger students. All the teaching staff was informed about the on a special meeting and the planned project activities were included in the annual plans of the teachers. Two groups - each of 15 students were set up for comparison. They participated in health educational course on accidents and first aid methods. At the end of the course the level of knowledge and acquired practical skills were evaluated and the students showed very good results. Students from the target group participated in the training activities of a newly established Club for better interpersonal communication. The Club held training sessions aimed at developing of communication skills twice a month. A Day of friendship at school was organized. The program included anonymous postal discussion on aggression and violence, friendship and communication and the children attended all the activities with enthusiasm. In February a meeting on aggression was organized for the parents. Children also received personal counseling on solving conflicts by the pedagogical advisor and the school nurse.

In May the final evaluation of the project was made by a questionnaire measuring the attitude of children towards violence and aggression. Most of the children developed a negative attitude. For the period of the project 14 accidents with mild injuries happened. Only four of them resulted from an aggressive behaviour.

Over the years of practice as a school nurse, the project leader had noticed a significant increase in the number of children with spinal deformities: check-ups had shown that 25-30% of the children had been affected.

Early detection, corrective and prevention measures were included in her project, which was approved by the school authorities and teachers. Parents were also involved

The children in the 1^st grade (65) at Yordan Yovkov primary school in Varna were her target group, and her aim was to have not more than three children diagnosed with deformities at the end of the school year.

At the beginning of the school year, four children were diagnosed with deformities by their family doctors.

The project included the following activities:

leaflets for the parents with information on the essence and prevention of deformities;

remedial gymnastics classes once a week, organized for the children with deformities by the physical education teacher Mr. Zlatev;

special exercises the children performed at home according to written instructions and under the supervision of parents;

talks with the children on proper posture once a week, using posters, pictures, videos;

special exercises (5-10 min) within each class in physical education with all the children (three times a week);

sports activities in the free time;

proper arrangement of school furniture;

a picture test on proper posture.

The test in March showed that all children had correct answers. The check-up in May showed that there was only one child newly diagnosed with a deformity.