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1
DOI 10.5281/zenodo.10903863
Inogamova D.R., doctor of philosophy of pedagogical sciences (Ph.D)
аcting professor
Department of "Clinical Foundations of Special Pedagogy" Tashkent State Pedagogical University named after Nizami
HISTORY OF THE DEVELOPMENT OF HOSPITAL PEDAGOGY IN DEVELOPED COUNTRIES AND IN THE REPUBLIC OF
UZBEKISTAN
Abstract. The article talks about an educational school in hospitals, teaching long-term sick children, which is called «hospital pedagogy», which has a long history and traditions, about its origins, about the first hospital schools created in different countries, about their main socio-pedagogical approaches. Also, the need to train personnel to work with long-term ill children «in advanced training courses or in pedagogical universities, where it will be possible to obtain information about the specifics of various diseases», however, not only in relation to this area, but also in matters of inclusion, the problem remains relevant to this day: «the pace and dynamics of the development of inclusive education are ahead of the training of teaching staff».
Key words: hospital pedagogy, hospital school, children's hospital, regular school, socio-pedagogical environment, individual needs, academic support, modern technologies, pedagogical support, therapeutic pedagogy, caring school.
The main law of the Republic of Uzbekistan - the Constitution - provides for the protection of children and mothers. In our country, the creation of a high-quality health care system, which ensures the preservation and strengthening of public health and the creation of conditions for raising a healthy generation, is a priority of state policy. The government is paying special attention to the creation and strengthening of the legal basis for the further development of health care based on the demographic processes and the priorities of the socio-economic development of the republic.
In 2015, in order to successfully implement the set tasks, an «Interagency working group» was formed to solve the problems of education of children undergoing long-term treatment in medical organizations. For the first time, experts are focusing on all issues in the complex, in addition to the main issues related to financing, licensing and other regulatory aspects:
• pre-school education in medical hospitals;
• development of psychological and pedagogical support services;
• education of children suffering from life-limiting progressive diseases;
• development of additional education;
• creating conditions for conducting state final certification in medical hospitals;
• to support talented students who strive for higher education, to develop Olympiads and competitive activities among children undergoing long-term treatment;
• personnel training and others.
Hospital education schools that educate children undergoing long-term treatment in medical organizations are called «Hospital pedagogy». The purpose of schools established in hospitals is to enable a child undergoing long-term treatment to acquire knowledge from the school curriculum and to be on par with peers. In addition, teaching in hospital schools helps to rehabilitate and adapt to the environment of sick children. This type of education gives a sick child confidence in the future, saves time in the hospital regime and distracts from unnecessary worries about the disease. First of all, it should be noted that hospital pedagogy has a long history and traditions. According to researchers (A.G. Rumyantsev, S.V. Sharikov), its origin is connected with the establishment of the first children's hospital in the world (Paris, France) in 1802 and the subsequent development of pediatrics in the second half of the 19th century.
The first hospital schools appeared in Ireland and Great Britain (for example, the Duke Children's Hospital School, founded in 1959 on the basis of the Durham public school system). In world practice, in the 2000, hospital schools were established under major medical research centers.
Often, hospital schools are based on the local public school, which implements educational programs that do not differ from ordinary schools. This allowed children in long-term treatment to achieve academic goals and to be able to return to their normal social and pedagogical environment after treatment.
In hospital schools in Australia, their main socio-pedagogical approaches to supporting learning for students with illnesses include:
• focusing on the child and his individual educational needs;
• flexible, convenient for the organization at home, school, hospital or other public places;
• creation of communication channels between doctors, teachers, students and their parents;
• providing appropriate academic support to students;
• providing opportunities for social and emotional support;
• is organized by a teacher or educational specialist, who is a link between the education and health sectors, but not the parents of students;
• use of modern technologies to engage students in learning and communicate with peers.
It should be noted that other hospital schools also follow these principles. For example, Children's Hospital of Philadelphia aims to help children develop and maintain academic skills. To provide appropriate educational services, the school is staffed by Pennsylvania-certified teachers who work with the student in the classroom and/or with the homeroom teacher and other health professionals involved in patient care.
For example, the experience of Finland is very interesting, where teaching in hospital schools is carried out by «special education teachers» - teachers who play several roles at the same time for different groups of patients, play in the hospital the nature of teaching is qualitatively different from teaching in a regular school has a restorative, corrective (healing) character. In such schools, teachers must have special knowledge to support and develop students, to increase their confidence in teachers, even if the learning opportunities are low and the learning process is limited.
Scientists from the Royal Australian Children's Hospital Education Institute came to the same conclusion. At the Royal Children's Hospital in Melbourne (Melbourne, Australia) they conducted a study to evaluate behavior and teaching strategies among 750 patients and their parents/guardians and the school, the sick child, his parents/guardians and the children described the most important points of contact between them.
The first children's hospital in the Russian Federation appeared 30 years later in St. Petersburg (Nikolayev Children's Hospital, 1834). This period coincides with the increasing attention of the state and society to vulnerable categories of childhood, «children at risk». In the second half of the 19th century, teachers and pedagogues of the «compassion society» worked with children in children's hospitals. At the beginning of the 20th century, a new understanding of accompanying a child undergoing long-term treatment was already formed: «The task of pediatrics is to ensure that the child's health allows him to fully realize his innate life potential». According to S.V. Sharikov, hospital pedagogy is a «late child» of pediatrics and pedagogy: «As soon as children's hospitals appeared, the practice of teaching children undergoing long-term treatment appeared». There are reports of such practices in various countries, but they are sketchy, mostly local in nature, and even now the subject has not been thoroughly studied in science.
In addition to medical care, we can see examples of educational support for children. Thus, at the end of the 19th century, the condition of patients in the «Hospital for the Mentally» was such that the regional leadership decided to invite the famous psychiatrist and public figure V.I. Yakovenko to «regulate the work», he headed the department for the mentally ill for 3 years (1890 from). Experts say that during this period, it became an example in creating the necessary conditions in institutions, approaching treatment based on humane principles, proper care of patients, nutrition, and organization of life activities. V.I. Yakovenko created the conditions for organizing an educational process «based on the principles of humanitarian pedagogy» for patients in the hospital, including children, in order to improve the conditions for keeping and caring for patients. According to the researchers on this issue, classes were organized in mathematics, Russian language and creative activities, including music. Today, in pedagogy, attention was paid to what is called «reality», creative evenings, meetings were held, reading books and newspapers took an important place.
The «therapeutic pedagogy» of V.P. Kashchenko, A.A. Dubrovsky, whose principles are based on human relations to patients, should also be highlighted. Many of its rules became the basis for the model of the «We teach; we know» project of hospital schools in Russia.
V.P. Kashchenko, the founder of the science of defectology of Russia, the creator of corrective (therapeutic) pedagogy in 1908, the creation of a private medical and educational institution «School-Sanatorium for Disadvantaged Children» (Moscow) is considered a unique heritage.
In the 1950, the system of education of children in tuberculosis hospitals in our country was characterized by the creation of so-called «sanatorium-forest schools». In the late 1960, the teaching of children in psychiatric hospitals began, and in the following decades, the practice of teaching children in long-term treatment at home and in children's hospitals spread. In 1981, the first interdepartmental document was adopted, defining the procedure for the education of children undergoing long-term treatment in children's hospitals and at home (Letter of the Ministry of Education of the USSR, 1981).
After the adoption of the Law on Education in 1992, a standard provision for educational institutions (of the sanatorium type for children in need of long-term treatment) appeared. According to the researchers, since the end of 1990s, an example is the existence of a «secondary general education school for the education of children undergoing long-term treatment in hospitals in the city of Orel». The team of teachers taught children to carry out harmonious treatment, taking into account not only their age characteristics, but also their physical, psychological and emotional state during training.
Despite the fact that this issue has been discussed in the professional community at individual local events, in general, this topic remains «in the shadow of the educational system» until now. This means that many issues of ensuring full education, socialization and integration into the educational environment at the place of residence after the end of long-term treatment have not been resolved in any way; for teachers, there were no methodological recommendations for appropriate support for such children, etc.
In 1997, the First International All-Russian Conference dedicated to «Social and psychological problems of children's oncology» was held in Moscow. Within the framework of this conference, for the first time, «Issues of hospital pedagogy», ways to solve the problems of socio-psychological support of children under special treatment, seriously ill patients, as well as their family members were discussed.
According to Professor L.A.Durnov, Honored Scientist of the Russian Federation, Director of the Center, Correspondent Member of RAMS, at the scientific event dedicated to cancer diseases held at the Children's Oncology Research Institute named after N.N.Blokhin of Russia, «the implementation of modern effective methods of cancer treatment in children has led to the emergence of an important category of persons treated from childhood malignant tumors».
As a result, there was a need to adapt them to society, return them to their former life, normal socialization, that is, to solve «occupation and employment, psychological, legal and many other problems».
E.A. Babenkova's special lecture was devoted to the issues of hospital pedagogy. Perhaps this is the experience of defining the goals and objectives, principles, specific methodological and didactic methods of putting such a concept into practice for the first time. Also, the need to train personnel to work with long-term sick children «in advanced courses or in pedagogical universities where you can get information about the specifics of various diseases», not only related to this field, but also in the issues of inclusion, the problem remains relevant to this day: «the pace and dynamics of the development of inclusive education is ahead of the training of pedagogical personnel».
During the 1997 conference, foreign experience was also mentioned, it was noted that the problems of psychological, medical and pedagogical rehabilitation have been solved in many countries for several decades. It is known that the European Hospital Pedagogy Organization (HOPE), which unites many countries with a more or less developed system of education and rehabilitation of sick children, appeared as an association in 1919, and in 1988, under the auspices of UNESCO and WHO, the European Hospital. The first congress of hospital teachers was held. Abroad, the practice of teaching individuals with special educational needs, including children with oncohematological diseases undergoing long-term treatment, is diverse.
Experts such as M. Papadimitru, M. Meister, J. Haverkate are studying these issues. Looking deeper into this issue, we can cite several examples, such as the creation of Treloar School & College in Great Britain from a long historical perspective, the more modern stage - Child Life Services (USA), and others. In the development of hospital pedagogy in Russia, after the events described above, several more events took place, which finally foreshadowed the emergence of a new stage related to the «We Teach We Know» project.
First of all, this is a breakthrough in children's hematology and oncology, which is associated with the beginning of the use of «unified clinical recommendations, medical-economic standards and collaborative multicenter clinical research to optimize the treatment of children with hematological and oncological diseases» in Russia. According to many scientists, «the problem of developing and implementing rehabilitation and adaptation programs that ensure adequate ontogenetic development and improve the quality of life of children was considered urgent».
In June 2011, the National Medical Research Center of Children's Hematology, Oncology and Immunology named after Dmitry Rogachev was opened, in 2012, teachers of school No. 109 in Moscow began to work with students undergoing long-term treatment, and in 2014, issues of hospital pedagogy of A.G. Rumyantsev, cancer and is determined separately in the context of the organization of medical and psychological-social rehabilitation of children
and adolescents with hematological diseases. The model of such an integrated modern system of rehabilitation of a sick child, based on the principles of continuity, continuity, individualization and personalization, already assumes the participation of teachers in the initial stages.
In 2015, all the problems that led to the creation of the «We teach, we know» hospital school project in Russia were described in detail by its author and director S.V. Sharikov. Clear normative frameworks in this area reveal the difference between the approaches of hospital pedagogy within the concept of «School of Care» and the existing models of teaching children in hospitals of medical organizations. At each stage of the child's stay in a medical hospital, the main tasks of school teachers (in accordance with the understanding of the integrated modern system of rehabilitation of a sick child) are also determined.
Every year, the number of children with any developmental disabilities, including serious health problems, is increasing. Every year, about 250,000 children (from birth to 18 years) undergo long-term inpatient treatment (more than 21 days) in children's hospitals.
The most important task of teachers and doctors working with children is to ensure that children receive quality education, that the child and his parents have direct access to a full-fledged educational environment, that they will stay for a long time. is to ensure their constitutional right. Due to current living conditions - in a medical hospital. School medical organizations are becoming the main concept in the formation of educational environment in hospitals (S.R. Varfolomeeva).
In 2015, an «Interdepartmental Working Group» was formed on practical solutions to the problems of teaching children undergoing long-term treatment in medical organizations. For the first time, experts are focusing on all issues in the complex, in addition to the main issues related to financing, licensing and other regulatory aspects:
• pre-school education in medical hospitals;
• development of psychological and pedagogical support services;
• education of children suffering from life-limiting progressive diseases;
• development of additional education;
• creation of conditions for state final certification in medical hospitals;
• to support talented students who aspire to higher education, to develop Olympic and competitive activities among children undergoing long-term treatment;
• personnel training, etc.
In 2019, a single interagency document titled «Methodological recommendations for organizing the education of children who are undergoing long-term treatment and cannot go to educational institutions due to health» appeared. The project «We teach, we know» is the main requirements and recommendations for the organization of the educational environment and educational process in the medical hospital. The conceptual apparatus used in this
field is unified, and specialists who organize the educational process should know, in particular, the concept of «hospital school» is clearly defined. «Students in need of long-term treatment and long-term treatment» clarify the definition of the condition of a long-term sick child. This specification is very important because when we talk about «children with special educational needs» we mean: 1) children with disabilities; 2) students with disabilities; 3) students who need long-term treatment.
Three groups, three special statuses, each of which has its own definition, are consolidated in the relevant regulatory legal documents that regulate rights and opportunities, determine the requirements for creating special conditions, and determine state support measures. However, in actual practice, the status of normative "protection" of each of the groups is different, and according to a number of experts, the group of «pupils in need of long-term treatment» is currently the least protected.
Currently, the urgency of the problem is increasing, which is evidenced by the attention of experts from all over Russia and the world. Issues of hospital pedagogy are being discussed at major conferences and forums, including in Uzbekistan. Researchers in the field of hospital pedagogy say that today there is a natural process of «development of community care for children who need long-term treatment», which should, among other things, move away from stereotypes and stigmatization. This includes assumptions that a child with cancer may be dangerous to others, likely to be infected.
From the first days, it was an important task for experts and researchers in the field of hospital pedagogy to solve the problems of explanatory and educational activities, as well as informational and methodical provision of the educational process. Today, methodical manuals and collections are being published, which include specific instructions for various subjects, educational stages and directions, dedicated to the advanced work experience of the teacher of the hospital school.
The most important vector for the development of the project of hospital schools is the creation of a special department - hospital pedagogy - in the general pedagogic system. The analysis of the current practice of teaching children in long-term treatment provides a basis for conducting serious scientific research, attracting scientific forces to develop methodological bases for predicting the development of hospital pedagogy, and justifying priority directions for the development of theory and practice in this field.
In cooperation with scientific organizations and leading universities of the country, the project is currently developing the main research topics in this direction, for example:
• theory and methods of education and upbringing of children undergoing long-term treatment (by educational fields and levels);
• educational activities at the hospital school;
• pre-school education at the hospital school;
• designing the educational environment of the hospital school for the well-being of children undergoing long-term treatment;
• personnel training for the hospital school, including scientific personnel;
• development of professional self-determination of students undergoing long-term treatment;
• correctional and developmental classes with children undergoing long-term treatment;
• education of children with progressive diseases and uncertain life prognosis.
In cooperation with higher education institutions, research programs were opened for the first time in Uzbekistan within the framework of scientific and scientific-pedagogical personnel training, special master's programs, professional retraining programs, and complex research projects are being implemented. Production internships are being organized for students of specialized educational fields of higher education institutions.
It is important to consider the functions of teachers as members of an interdisciplinary team that implements an interdisciplinary approach to the medical and social rehabilitation of children. The school program for a long-term sick child is part of a comprehensive rehabilitation program, and in this regard, attention is paid to professional communication between teachers and medical personnel, the availability of minimum required knowledge in the relevant fields, and similar issues. relevant components are integrated into the training programs of future specialists.
A separate topic is the selection of personnel, the definition of requirements for qualifications and competencies, personal qualities and values of a hospital teacher, the creation of an internal system of continuous professional development and methodological support. The powers, mission and values, special tasks and working conditions of the hospital teacher also become the subject of research. One of the most relevant methodological and research topics in this regard is differentiation, individualization and personalization in working with students in long-term treatment.
Individualization and personalization as a vector of educational development at the current stage require the experience of hospital pedagogy for teachers of general educational organizations implementing an inclusive approach. The ability to work with children with different learning abilities is a mandatory competence of a modern teacher, but in real practice, working with a child with special educational needs inevitably leads to problems. They may experience that the teacher is not ready to move away from the general attitude towards success and educational success, they do not know who and how to ask for help, or they do not have such an opportunity, they may experience a breakdown. treating the child with compassion and undeserved praise instead of acceptance and participation, not knowing the appropriate forms and methods for working with children who require a special approach. It is a difficult path from
the stage of accepting and changing personal attitude in working with children with special educational needs to high professionalism and pedagogical skills, and many problems still need to be solved.
Now experimental schools are being opened at the Children's Hematology, Oncology and Clinical Immunology Center (Center) of the Republic of Uzbekistan under regional and regional children's hospitals. Experience in hospital pedagogy has been accumulated in our country: in 2022, the first «Mehrli maktab» will be opened in order to provide preschool and general secondary education to children undergoing long-term treatment, which will have complex changes in their health. children are receiving education. They are provided with social adaptation at school and activities are conducted taking into account the characteristics of their diseases. Education in this educational complex starts from a preschool educational institution and continues in a general education school. Child's health, intellectual and physical capabilities are taken into account in education. Children study in small groups or individually, depending on their illness. Children with the following diagnoses are enrolled in this school: bronchial asthma, heart disease, epilepsy, diabetes, hemophilia, malignant tumors, cerebral palsy, etc. The number of children in the school is more than 100 people. The chief doctor of the National Medical Research Center of Children's Hematology, Oncology and Immunology, in cooperation with the Ministry of Public Education, established a school called «Mehrli maktab» for sick children. All teachers have a higher education and have undergone special training and professional development in hospital pedagogy (7 of them have a bachelor's degree, 12 have a master's degree, 1 has a postgraduate degree).
From May 11, 2022 to March 27, 2023, the number of patients at the Center was 1,928. During this period, the number of children who received education in groups was 1153. 650 of them are preschoolers, 503 are school-age children. The remaining 775 patients were educated individually in the wards. Today, more than 130 children study in the school every day. As of March 27, 2023, there are 61 children of preschool age in «Mehrli maktab», of which 33 are girls.
The project was supported by the Ministry of Education and Health of Uzbekistan. In this school, the curriculum is designed taking into account the recommendations of doctors, and psychologists work with children. Psychologists also work with the parents of these children. The time of operation is recommended by doctors. Teachers for such schools are not trained anywhere. Teachers who come to work in the conditions of hospital pedagogy in Uzbekistan use their experience and exchange experience with each other. Taking into account that hospital pedagogy is being formed in our country, it is necessary to ensure the training of such teachers in higher educational institutions of pedagogy.
Perhaps, the country does not need a large number of such teachers, but the necessary number of them should be trained in universities: small groups should be organized in different faculties of pedagogical institutes. It is necessary to prepare a special curriculum for such groups, taking into account psychological
and pedagogical training and including medical sciences. Teachers of «Hospital pedagogy» work together with doctors in the hospital, but doctors are busy with their work, they can give recommendations on how to raise a child. But the doctor may not have time to explain the characteristics of the disease that the child has. In the walls of the Pedagogical University, future teachers of «Hospital pedagogy» will receive information about the diseases they may encounter during their work, which will create the basis for achieving good results. Medical sciences should be taught taking into account pedagogical education.
The curriculum of all faculties of pedagogical universities includes the study of «Age-related anatomy and physiology of the child, hygiene», where the student receives information about the normal development of the child. This knowledge will later help the teacher to better understand the characteristics of the child depending on his age. Medical subjects, for example, can be taught within the «Medical and biological foundations of hospital pedagogy» subjects. The content of the subject «Medical-biological foundations of hospital pedagogy» can cover diseases that require long-term treatment, such as cancer, tuberculosis, cerebral palsy, diabetes, epilepsy, bronchial asthma, tuberculosis, burns, etc. These diseases should be clearly explained to the future teacher.
In our country, the practice of training defectologists, which includes a number of medical sciences, has been established for a long time. Teacher-defectologists provide the teacher with a lot of information on medical subjects in an open form. After graduating from university, a speech pathologist works with disabled children. Disabled children are children who have experienced a serious illness, and as a result of the illness, its complications have persisted. Many children attend special schools. Recently, some children with disabilities have been studying in comprehensive schools in the inclusive education system, which is being introduced in Uzbekistan («On measures to further improve the system of education and upbringing of children with special needs» October 13, 2020).
In conclusion, it should be noted that when introducing «Hospital pedagogy» in Uzbekistan, it is necessary not only to rely on the foreign experience gained in European countries or the Russian Federation, but also to take into account the experience gained in defectology education of our country. In our country, defectological education has been formed for a long time and is of high quality. Along with pedagogical and psychological sciences, medical sciences should also take a proper place in the training of specialists. During training sessions, teachers should help hospitalized children catch up on time lost during prolonged illness, overcome knowledge gaps, and complete the program. It should be noted that the educational process not only performs the function of teaching, but also helps the child's rehabilitation, adaptation and socialization after illness or injury, and creates an incentive for quick recovery.
Medical sciences should occupy a worthy place in the training of specialists for the discipline of «Hospital pedagogy». Some knowledge about children's diseases that lead to long-term treatment will help the teacher to find the right
approach to the sick child and his parents. Knowledge of diseases gives the teacher more confidence in working with sick children. Of course, the teaching of medical sciences should be understandable to a student of a pedagogical university.
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