Dreyfus Health Foundation
DHF, 205 East 64 Street, Suite 404
New York, NY 10021
Fax # 212-371-2776
Web page: http://www.dhfglobal.org
On June 2nd, 2004 a follow-up workshop was held in Gabrovo, attended by participants from the June 2003 PSBHN workshop in Stara Zagora. In three groups, projects completed and in progress were discussed. More details on these projects you can find in this issue.
From June 3rd to 5th, a PSBHI workshop was held, organized by Dreyfus Health Foundation, Association for Better Health, Medical University – Pleven, and Gabrovo Regional Hospital. Other organizations in Gabrovo also helped organize the workshop and were committed to send participants and collaborate in the implementation of projects: Gabrovo Municipality, The Union of Disabled People, the regional Hygiene and Epidemiology Center, and the Regional Lung Disease Hospital.
The workshop was opened by Dr. Stefanov, Director of the Regional Health Center, and Dr. Jan Sobotka, Dreyfus Health Foundation Regional Coordinator for Europe and the Middle East.
Divided into five groups and assisted by international facilitators Dame Sheila Quinn (UK), Mr. Sebastian Milardo (USA), Dr. Jan Sobotka (Poland), Mr. Mahmoud Alkam (Jordan), and the local facilitators Mrs. Yanka Tzvetanova, Assoc. Prof. Angelika Velkova, Mrs. Polya Zhivkova, Mrs. Gergana Momova and Ms. Evgenia Dimitrova, the participants prepared the following plans of action:
Most of the projects were started shortly after the workshop.
On June 16th-17th, 2004, a PSBHN workshop was held for nurses from crèches and kindergartens in Pleven. It was organized by the Pleven Municipality Health Department, Dreyfus Health Foundation and the Association for Better Health and the Medical University. The workshop budget was covered by the municipality. Projects are to be followed up by the organizing parties, and supported by sponsors and the municipality.
In his address to the participants, Dr. Keremedchiev, Deputy Mayor of Pleven underlined that programs such as Problem Solving for Better Health are of great value to encourage problem solvers to take the initiative and set up new practices to improve health.
Assoc. Prof. Angelika Velkova presented on health promotion and health promotion techniques.
The following projects were prepared with the assistance of Dr. Elza Pacheva, Mrs. Yanka Tzvetanova, Mrs. Polya Zhivkova and Assoc.Prof. Angelika Velkova:
In the next issue, read about the PSBHN workshop in Pleven, organized by Dreyfus Health Foundation, Pleven Municipality Health Department, Association for Better Health and Medical University – Pleven.
TO ALL PARTICIPANTS IN WORKSHOPS SINCE THE INTRODUCTION OF THE PSBH PROGRAMS IN BULGARIA IN 1994: Write to us about your projects – we will be glad if you could share your experience with all participants in the program.
Contact addresses: email@example.com; or
5800 Pleven, 1 St. Kl. Ochridski Street, Association for Better Health
Note: our phone number now is *359/64/833-118
A program for education and rehabilitation of expecting and young mothers in Sliven
Mrs. Rosalina Spasova, Sliven Regional Hospital
The project was started in July 2003. The team worked out a detailed program, including topics for talks, and complexes for kinesitherapy suitable for exercising before and after delivery. In August the brochure advertising the project activities was printed and distributed. By December, the rehabilitation facilities were renovated and the staff was trained to work on the project.
After serious steps taken by the team, 19 pregnant women and 9 young mothers were enrolled for participation.
Results: Six of the young mothers had a normal delivery, with no complications. In those who were included in the program, recovery took less time, and the postpartem period was shorter.
Talks with the young mothers showed their willingness to participate in the program during the hospital stay.
The program continues with the rest of the pregnant women.
The results encouraged the project team to put more efforts into activities with minority women.
Future plans are to organize a school for parents, involving fathers.
Educational program for patients of the hematology clinic with oncohematological diseases
Mrs. Yanka Kryakovska, Stara Zagora University Hospital
The project was started in September 2003, with building a team, collecting information and adapting it to the information needs of patients, namely prognosis, complications, radiotherapy and chemotherapy.
Then patients were selected and their level of knowledge assessed. Regularly, information materials were given to the patients and their families. A meeting was organized attended by patients treated and discharged from the clinic and those undergoing treatment
Results from later assessment of patients’ level of knowledge showed they were better informed about the diseases.
In addition, there was a change in the attitude of the patients to the disease, better compliance with treatment procedures and increased willingness to cope with the disease.
Prevention of decubital ulcers in elderly bed-ridden patients
Mrs. Milena Bazadjieva, Stara Zagora University Hospital
The main objective of the project was to follow up and prevent decubital ulcers after discharge from hospital in all patients aged 60 and over, who had been treated at the clinic of orthopedics in June 2004.
The program was presented and approved by the staff of the clinic and a team started working on the project.
Results: in 70% of all these patients decubital ulcers were prevented in the home.
Organizing an educational and training program on the proper collection of hospital waste for nurses, midwives, clinical lab technicians and orderlies in Gabrovo regional hospital
Mrs. Nelly Todorova, Gabrovo Regional Hospital
The project was started in July 2003, and 365 employees were included in a variety of training and educational activities.
Together with the members of the commission for control of nosocomial infections, a program was prepared and distributed. Special training sessions were organized for the staff responsible for collection and transportation of hospital wastes to the incinerator.
Collaboration between senior nurses, midwives and lab technicians with the Hospital Nursing Council and the Hospital board made it possible to achieve the following results:
Additional results: the incinerator is in good condition, and the staff has been trained to take the next step in the program: introduction of processing of biologically contaminated wastes.
A program to increase the number of blood donors in Stara Zagora
Mrs. Stanka Dineva, Stara Zagora Regional Hospital
Using all available resources of the regional hemotransfusion center, various activities were organized to persuade people to donate blood.
Current results are encouraging – there is an increase of numbers, though not what is wished for. It should be noted that health professionals from the center were among the first to donate.
Final results are to be reported in December 2005.
Improving on patient compliance to prevent decubital ulcers
Mrs. Galina Delcheva, Stara Zagora University Hospital
The project was started in June 2003, with a group of 20 patients with multiple traumas treated at the clinic of orthopedics and traumatology of the University Hospital in Stara Zagora. Its aim was to prevent decubital ulcers in all such patients admitted for treatment during a period of one year.
The positive attitude of both the governing body and the staff of the clinic was of great help. A brochure on decubital ulcers and their prevention was prepared, and was handed to all patients with multiple traumas admitted for treatment. Regularly, nurses checked if patients followed the instructions.
Results: Until June 2003, 10% of the patients developed ulcers (compared to the 55% for the previous one-year period. Additional results: patients became aware of the importance of prevention-oriented procedures and their active participation in them.
Health education on prevention of teenage abortions pregnancies in schoolgirls aged 15-17
Mrs. Maria Karadjova, Smolyan Regional Hospital
The health education program on the risks of abortions and prevention of pregnancy was started in October 2003 with a group of 20 schoolgirls from the High School of Economics in Smolyan.
The project team included a gynecologist, two midwives and the school nurse. After assessing the level of knowledge of the target group, the topics for discussions on sexual and reproductive health were determined, and materials prepared.
Rooms for the sessions, teaching aids and materials were provided with the assistance of the Health Promotion Department of the Hygiene and Epidemiology Station in Smolyan. The department also provided brochures that were distributed among all students.
The variety of teaching methods and materials that were used stimulated the interest of the students, and they actively participated in the sessions. Final results are to be assessed in October 2004.
Training asthma patients to properly use inhalants
Mrs. Mima Nikolova, Stara Zagora University Hospital
The one-year project was started at the Clinic of Internal Diseases at Stara Zagora University Hospital in July 2003, aiming to reduce the number of rehospitalized asthma patients by 50%.
After building the team, provding peakflowmeters and teaching materials for the program, training sessions were carried out with each patient admitted to the clinic. All 36 patients in the group volunteerd for participation after individual talks which were helpful to motivate them.
After discharge, the team maintained contacts with all patients – a phone line was open round the clock.
Assessment of results was made through registering readmissions of patients who participated in the program.
Results: of the 36 patients who participated in the program, only two (5.55%) were readmitted for treatment during the period of one year.
Additional results: all patients are convinced that the program has helped to improve their quality of life. .
Health education on proper hygiene of breast feeding and baby care for young mothers
Mrs. Pavlina Veleva, Etropole Hospital
The project team aimed to improve the level of knowledge of young mothers and their skills and confidence in taking care of themselves and their babies after discharge from the maternity ward of Etropole hospital.
The project team was supported by the hospital board and the ward staff. After preparing the materilas necessary for the sessions, actual training started in January 2004. The project team also made it possible for the young mothers to seek advice whenever they needed it.
Results: 50 young mothers participated in the program. Their skills and level of knowledge were improved. Also, compared to a previuos period in 2003, the number of in-hospital infections was reduced by 50%. The team is proud, that the program has increased the number of women who want to deliver at their ward.
The results achieved are convincing enough for the program to become routine practice at the ward, and can be implemented in other maternity wards in the region.
A training program for 22 nurses to work with hospital computer information system
Mrs. Nedyalka Venisnska, Smolyan Regional Hospital
The project at the Smolyan regional hospital was started in June 2003, and the expected date of completion is September 2004. The first group of 22 nurses completed a training course and awarded certificates for Word, Windows, Exell, Internet.
Plans are to include all nurses in the training courses.
Training patients undergone laryngectomy and their families
Mrs. Mariana Kotlarova, Stara Zagora University Hospital
The project was implemented at the clinic of ENT diseases of the University Hospital in Stara Zagora to train patients and their families to adapt to a new life style, and skills to manage after laryngectomy.
The project was approved by the governing body of the hospital, and the whole staff volunteered to participate in the program.
Materials were prepared by the staff. The target group of 17 patients and their families were included after they were informed about the goals of the program.
Activities included providing participants with information on the condition, problems arising in everyday life and how to cope with them, how they can adapt to the new condition. Follow-up meetings with these patients, and meeting previous patients who had adapted to the new way of life were organized by the team. During those meetings, problems and different ways of coping were discussed.
Current evaluation of results show high satisfaction with the program in over 50% of the patients and families with the training program.
Improving physical fitness among hospital staff
Mrs. Vanya Georgieva, Stara Zagora University Hospital
The project was implemented in Stara Zagora Uiversity Hospital in October 2003, and completed in June 2004. The target group included thirty health workers, divided into two groups: the first included only healthy people, and the second – such with health problems.
Different approaches were used to motivate the participants to enter and stay with the program. Various physical activities were organized – swimming, walking, individual fitness programs. Small groups were formed according to interest in the activities organized.
The effect from the program were assessed based on:
- attendance rates;
- investigations to assess health status of participants.
At the end of the projects, the health status of the participants was as follows: 100% of those in the first group had retained their health status, and 56% of the second were found to have improved their health. As a side result, motivation among health workers to participate was increased.
An educational program for stroke patients and their families on proper regimen and nursing after discharge from hospital
Mrs. Darina Toteva, Stara Zagora University Hospital
The main objective of the project implemented at the neurology clinic of the University Hospital in Stara Zagora in October 2003 was to provide information to stroke patients and their families about the disease, and diet, nursing care after discharge from hospital.
The project was approved by the hospital board and the clinic staff. The patients in the target group were all volunteers.
The project team prepared a leaflet with information and instructions on proper care in the home, which was handed to each stroke patient upon discharge from the clinic..
Then selection of patients treated at the clinic was started, inviting patients after the 30th day after the stroke incident, and patients not referred for physiotherapy and rehabilitation.
In June 2004 of the 150 patients invited, 72 (48%) turned up for a check-up examination. Of these, 60 patients (83%) were satisfied with the brochure and had found it useful. Only five patients (6.9%) did not use the leaflet.
Some of the patients declared that they needed more information on the diet and possibilities for rehabilitation.
Plans are to continue working with stroke patients and include patients with other conditions in such a program.
Providing information for colostomy patients and their families
Mrs. Nedka Staikova, Stara Zagora University Hospital
The health education program included 11 patients with colostomy operated on for colon cancer at the Clinic of Surgery at the University Hospital in Stara Zagora. It was planned for 8 months (June 2003 – January 2004), and aimed to provide patients and their families with advice how to maintain proper hygiene and diet after discharge from hospital.
The project activities included: coordination of program with the staff of the clinic; preparation and printing a brochure with advice concerning hygiene and diet. One month after discharge from hospital, patients came back for a follow-up check-up and were asked to fill in a questionnaire aimed to assess the quality of instructions in the brochure and length of adaptation of patients and their families to the new circumstances in view of the colostoma. Apart from the brochures handed to each patient, the staff was available to give advice in case problems arose.
Results: answers to questionnaires showed that all patients found the instructions extremely useful, and the adaptation period after discharge was shorter.
Plans for the future: in view of the results, the staff will continue working on the project.
Educational and training program for proper hand washing and disinfection for medical staff at a surgery clinic
Mrs. Silvia Taneva, Stara Zagora Nursing College
The project was implemented in June 2003. The level of knowledge of staff on hospital hygiene requirements and nosocomial infections was measured, and results showed that it was not satisfactory.
The project aimed at increasing their level of knowledge on the problem, and specially motivate both staff and student nurses to improve practices on prevention of nosocomial infections associated with improper hand-washing.
Standard protocols on the techniques of hand-washing and disinfection were prepared, and posters with those displayed in appropriate places in the clinic.
Starting September, all student nurses attended lectures. Tests after these showed the following results: level of professional information – 100%, and 85% of the students were motivated to stick to standard protocols.
The incidence of nosocomilal infections was reduced by 50%, as compared to a previous one-year period.
Prevention of acute upper respiratory infections in crèche children
Mrs. Stefka Bozhinova, Stara Zagora Municipality
The aim of the project was to reduce the incidence of upper respiratory tract infections in 50 children aged 1-3, attending “Stastie” crèche in Stara Zagora by 20%. With the assistance of 18 nurses, a doctor and a pedagogue, the following activities were organized:
Observations on the group of 50 children were compared to a control group of 50 children not specially involved in such a program during the previous year. Results showed that:
The results achieved by the team have proved the activities effective, and the program will be continued, and implemented in other crèches in Stara Zagora.
Organizing additional individual rehabilitation for stroke patients after discharge from hospital
Mrs. Anna Pantova, Stara Zagora University Hospital
The aim of the project was to achieve higher level of independence in performing daily activities in stroke patients through organizing individual rehabilitation at home, after discharge from hospital.
After assessment of the rehabilitation potential of stroke patients with severe locomotor deficiency, individual rehabilitation plans for were prepared by the project team of doctors and rehabilitation specialists at the clinic of physiotherapy at the University Hospital in Stara Zagora.
The team was in close contact with the families, and provided guidance with the program whenever necessary.
In June 2004, the patients were assessed using the specialized scales of Brunnstroem, and in 100% the maximum level of independence in performing daily activities had been achieved.
An information program for primary health care providers on the documentation and investigations required for admission for hospital treatment
Mrs. Rodinka Christova, Popovo Hospital
The project aimed to provide all general practices in Popovo with information about the regulations set by the National Health Insurance Fund exactly what documentation should be prepared and what investigations performed to patients referred for hospital treatment. The project was implemented by the head nurse of the hospital, the computer specialist at the hospital, in collaboration with the hospital management and the Regional Health Center and Regional Health Insurance Fund.
Instructions with the requirements to be met for timely admission of patients referred to hospital, and these instructions were presented, discussed and handed to general practitioners during a workshop. The workshop was also attended by the director of the hospital, heads of the hospital ward, the deputy mayor of Popovo, and the directors of the Regional Health Center and Regional Health Insurance Fund in Turgovoste region, where Popovo municipality is situated.
Three months after the implementation of the project and improved practices in referring patients, the following results were achieved during the three-month period (January - March 2004) , as compared to the same period of 2003: 32.85% increase in the number of patients treated at the hospital in Popovo, and the increase of funds transferred to the hospital was 48.5%. The sums spent on unnecessary investigations were reduced, and timely admission provided for 546 patients.
The program can be adapted to eventual changes in health insurance practices in 2005, and implemented in other places. So far, the hospital management in Omourtag have planned to introduce the program for collaboration between primary and hospital care providers.
Early diagnosis of hearing disability in newborns
Mrs. Katya Christova
The project was started in July 2003 and completed in July 2004. In coordination with the hospital management and the staff, two nurses were trained to carry out investigations on newborns to test hearing abilities. Babies were examined after parents had signed an informed consent forms. Despite difficulties to investigate all newborns, such as discharge from the maternity hospital before the investigation had been performed and lack of time to do it during the working hours, results achieved are:
- 95% of all children born in Stara Zagora were examined;
- 1910 newborns were examined, and 168 were examined twice;
- 10 babies were diagnosed with hearing problems and referred for early rehabilitation;
- one child was referred for cochlear implantation.
Organizing training for hygiene support workers within the national program for providing jobs for unemployed people
Mrs. Slava Rousseva, Stara Zagora University Hospital
The project team included an epidemiologist, three senior nurses and a representative of safety regulation department.
Training sessions began in July 2003, with a target group of 15 volunteers registered at the regional unemployment office in Stara Zagora. The six-month program included theoretical and practical training, aimed to provide the trainees with the skills and knowledge necessary to work at the hospital. Working with the staff already employed, the trainees also helped improve the hygiene of the hospital.
At the end, trainees were tested, and the results were comparable to those obtained with hygiene workers already employed.
On the basis of levels of knowledge and skills acquired by the trainees, the project coordinator proposed that 14 of them be hired for one year, and included in the schedules for clinical staff. Despite the initial suspicions on behalf of management that they would not manage to work on their own, everything went well. Moreover, after a while, observation led to proposals that all hygiene workers should be retrained as well.
Setting up criteria for assessment of performance of nursing staff
Mrs. Evelina Vankova, Rousse regional hospital
The project was started in September 2003 and completed in April 2004, with the assistance of the hospital management and the hospital nursing council. The latter appointed a committee to work on the criteria.
Representatives from all hospital wards participated in the preparation of the criteria. Before introducing the criteria for assessment and taking the results into consideration when dispensing funds received for nursing care from health insurance funds among the nurses.
Criteria and process of assessment were made known to all nurses. Evaluation of the process was made using a questionnaire, which nurses and patients filled in before the introduction of criteria as routine practice, and after six months. Percentages quoted below show results from the inquiry, carried out with nurses and patients.
Positive answers in nurses’ questionnaires:
Patients (over 50%) were positive that:
In addition, nurses expect better payment to also correlate with the working load, and night hours at work. They agreed that further criteria should be introduced, and more attention paid for paraclinical departments.
During the six months, the criteria were approved by 91.57% of staff, and considered as a more objective approach to distribute funds, and as an incentive to improvement of nursing care quality.
Further steps include setting up criteria for assessment of health care provided by other hospital staff. The criteria can be also used for the yearly attestation of staff.
The project coordinator is grateful for the support of the hospital management, heads of wards, senior nurses and all nursing staff at the hospital.