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14https://doi.org/10.32921/2225-9929-2021-2-42- 63-68 UDC: 61:331.108; 614.253 IRSTI: 76.01.79
Letter to the Editor
Improving the system of training Nursing specialists.
Results of the strategic partnership between JAMK University of Applied Sciences, Finland, and medical colleges
of the Republic of Kazakhstan
Heikkila Johanna 1, Kivinen Eveliina 2, Naakka Hanna 3, Hopia Hanna 4
1 Senior Advisor of the JAMK University of Applied Sciences, Jyvaskyla, Finland. E-mail: johanna.heikkila@jamk.fi 2 Degree Manager of the LAB University of Applied Sciences, Lahti, Finland. E-mail: Eveliina.Kivinen@lab.fi 3 Senior Lecturer of the Hame University of Applied Sciences, Hameenlinna, Finland. 4 Principal Lecturer of the JAMK University of Applied Sciences, Jyvaskyla, Finland
Abstract
The material presents results of the strategic partnership between JAMK University of Applied Sciences, Finland, and medical colleges of the Republic of Kazakhstan.
The systematic annual process of starting the development of new nursing clinical guidelines and of leading and coordinating the adaptation as well as preparing the trainings of national trainers for each set of guidelines has slowed down or even stopped and needs immediate attention. In addition, the development of corresponding evidence-based Standardized Operational Procedures must be organized. Our recommendation is that the Ministry of Healthcare and the Republican Center of Health Development would strengthen the national coordination and create a systematic roadmap for translating nursing clinical guidelines into nursing practice. In addition, nurses' knowledge and skills in evidence-based nursing must be increased through capacity building activities.
Key words: standardized operating procedures, clinical guidelines, nursing, strategic partnerships.
Corresponding author: Johanna Heikkila, Senior Advisor, PhD, JAMK University of Applied Sciences, School of Health and Social Studies, Jyvaskyla, Finland
Postal code: FI-40100 Jyvaskyla Address: Piippukatu 2 Phone: 358408488623 E-mail: Johanna.heikkila@jamk.fi
J Health Dev 2021; 2 (42): 63-68 Recieved: 12-05-2020 Accepted: 24-05-2021
This work is licensed under a Creative Commons Attribution 4.0 International License
The "Comprehensive Plan for Development of Nursing in the Republic of Kazakhstan until 2020" was approved in 2014 [1]. As its key tasks, it highlighted the introduction of new competencies for nurses, institutional development of medical colleges in line with the nursing reform needs, the creation of scientific bases for strengthening nursing education, and the development of the nursing system.
The strategic partnership in development of nursing education between JAMK University of Applied Sciences (here in after JAMK) and 10 medical colleges and six medical universities of the Republic of Kazakhstan has been established by Memorandums of Understanding.
The objectives, tasks, and activities described here fulfil subcomponent 2.3 "Strengthening of human resources for health care based on strategic partnership" where the objective is to develop an effective human resources policy for the healthcare sector. This is a continuum to the earlier work under the Kazakhstan Health Sector Technology Transfer and Institutional Reform Project co-financed by the World Bank that aimed to establish an education system for nurses in line with the European directives by introducing a new model of training nurses that corresponds to level 5 of the National Qualification Framework of the Republic of Kazakhstan and according to the requirements of the directive covering the recognition of professional qualifications (2005/36/EC; 2013/55/EU) [2]. The program was launched in 2015 six medical colleges, all of which later reorganized themselves into higher medical colleges. The first cohort of applied bachelor nurses graduated from pilot colleges in 2018.
The contract of this project was signed in December 2017 with the objective of the consortium, led by JAMK and including
Hame and Lahti Universities of Applied Sciences, to provide technical and methodological assistance in the modernization of the training system for nursing specialists. The tasks were:
1) Improvement of educational system for nursing specialists;
2) Improvement of academic programs for nursing specialists;
3) Improvement of professional environment for nursing specialists;
4) Further institutionalization of clinical training of nursing professionals;
5) Development of educational programs for capacity building of teachers and nurses.
At the time of launching the project, the main weakness of the Kazakhstani nursing education system was that students were not trained to think critically and to work as independent professionals. Furthermore, students were still mostly trained by physicians instead of by educators with strong nursing backgrounds and degrees in nursing science. Since the teaching staff of the numerous medical colleges had been educating nurses at technical and vocational education level for years, it could be considered as potential human resource for the nursing education reform, where the estimated need for the new labour force was significant. Therefore, the capacity building of the staff members of the medical colleges as well as raising the level and quality in those vocational education institutions that had the willingness to invest and develop their pedagogy and content of nursing education was chosen as the approach.
The main achievements of cooperation
1. Improvement of educational system of nursing specialists
This task consistent of several structural and system level activities with advisory and methodological assistance based on international best practices and scientific evidence as well as a thorough analysis of the current situation in Kazakhstan.
The procedure and criteria for the assessment of medical colleges for their possible re-organization into higher medical colleges to be able to implement the applied bachelor's program were developed in 2016. In the first call, four (4) of the 16 evaluated self-assessments met the criteria and six (6) were at the level of excellent. The procedure and criteria were updated based on the feedback of the expert commission and the latest standards and criteria for institutional and program accreditation of the local accreditation agencies (//iaar.agency, //iqaa.kz/en,www.ecaqa.org/en). In 2018, the expert commission was trained to possess the understanding of the internationally set requirements for the educational institutions' development strategy, teaching staff, educational program implementation, approach to students, and infrastructure in the provision of nursing education in accordance with the EU-directive. The 11 members of the expert commission assessed four (4) calls of self-assessments by medical colleges, altogether 45 reports, out of which 27 colleges were evaluated to possess the institutional potential to launch nursing education at the level of the applied bachelor program. As a result, there presently exists at least one higher medical college in each region, 37 altogether, to produce nurses of the new generation.
The strategic planning of educational institutions, including their investments and strategic development plans, reflect their understanding of the educational and health policy requirements set for nursing education. Nursing education in medical educational institutions is a minor field by student volume and funding, and therefore, improvements for this education may understandably not receive the attention that they deserve. To analyse how well the development plans took the nursing reform into account, five (5) areas and 31 criteria were developed for analysis and improvement. The dedication of the educational institutions to the nursing reform showed variation at the strategical level.
with the Kazakh educational institutions
In order to support the introduction of a new management system in the practical healthcare system, two trainings were organized: one in 2018 and the other in 2019. In addition, an expert report based on international scientific literature and best practices on organizational structures, positions, job descriptions, staffing, and financing nursing services was delivered. As a result of these activities, changes in orders № 775 (2016) [3], № KP flCM-305/2020 (2020) [4], and № 1043 (2015) [5] as well as the methodological recommendations for implementations [6] and a policy brief [7] were made.
Expert reports with recommendations were prepared on the development of the professional register related to nursing specialties at different levels of training, the development of a documentation system of nursing, and on the training materials for the implementation of the applied bachelor's program. These all were utilised in the further development of the nursing education and in the legislative improvement for the new role and position of the nurse with extended practice (Kulanchieva et al, 2019).
2. Improvement of educational training programs of nursing specialists
In this task, the improvement of educational programs at the technical and vocational education level for the "Nursing" specialty was conducted in line with the International Council of Nurses' definition of the scope of a practical nurse as well as with the contemporary international competence domains. During the trainings, the basic and professional competence descriptions were updated, course descriptions with learning outcomes, contents, and assessment methods were described, and the course structure and division of hours were created. Altogether 34 courses were improved, including nine (9) clinical practice courses by 24 teachers from medical colleges in 2018.
At the level of higher education, the project concentrated on the development of the educational program for retraining nurses from applied bachelor to bachelor's degree in health care in educational programme "Nursing" (6B10101), modernising masters' degree nursing education, and creating a PhD in nursing science educational program. Through the comparison
of competences, course learning outcomes, and contents, the 10-month fast-track implementation of Bachelor of Health, Education Program "Nursing" was created. As for master level nursing education, core competencies with sub-competencies were created in collaboration with academic staff from all Kazakhstani medical universities. In addition, a program structure for 2-year master education with obligatory and optional courses divided by each semester was designed.
A doctoral educational program of nursing science was co-created with academic staff from every Kazakhstani medical university. The result was the creation of core competencies and sub-competencies for the PhD program in Nursing Science with detailed course descriptions with learning outcomes and contents. All the nursing educational standards were updated in 2019 to the ECTS system and the outcome is the approved new State Educational Standard for all levels of nursing professionals (here in after SES) (Order of the Minister of Education, 2018 [8]; Order of the Minister of Health, 2020 [4]).
In addition, capacity building of two medical universities (KazMUCE and Astana Medical University) through jointly implemented programs was conducted. The idea was that through co-teaching with Finnish experts, the Kazakhstani staff would gradually learn the content and the requirement level, and furthermore absorb the knowledge and practices of contemporary pedagogy. Firstly, two cohorts of the jointly implemented Kazakh-Finnish two-diploma Master's program in nursing were launched in 2017 and 2018, respectively, and secondly, the pre-PhD nursing science program in 2020. As for the master education, the graduates (39) also obtained a Finnish master's qualification from JAMK University of Applied Sciences that greatly improved their career prospects. They also gained strong research skills which are needed in doctoral degree education. In the pre-PhD in nursing science program, the participants (5) acquired specific academic skills and knowledge to develop a strong research plan to help them access nursing science PhD education in the future, whether in Kazakhstan or in universities abroad.
3. Improvement of professional environment for nursing specialists
The main goal of the task was to educate and mentor a working group of health care experts from Kazakhstan to initiate a national development process of introducing evidence-based information to nurses. The aim was to adapt 15 international clinical guidelines with evidence-based recommendations for nurses. A detailed plan for a period of three years was drawn for the development work.
During the process, two 5-day methodological trainings for scientific guideline development were organized and a total of 16 guideline developers were trained. In addition, a process description and a manual on the adaptation of evidence-based guidelines were created. A total of 39 Kazakh health care experts participated in 15 clinical guideline adaptation processes (Republican Center of Health Development) [9]. A well-defined working group was set up for each adaptation, and the adaptations were carried out under the guidance and mentoring of Finnish experts. Each nursing clinical guideline development process included information retrieval, translation work, obtaining a permit, adapting the recommendations to local conditions, and finally a review and approval process.
Evidence-based condensed data alone does not change clinical practice. To this end, hands-on implementation training for nurses including lectures and practical exercises was built for six (6) nursing clinical guidelines. In addition, national trainers were trained to conduct this guideline training for nurses. A total of 102 national guideline trainers (ToT) were trained during the project. These trainings should be systematically organized in each region to take the nursing clinical guidelines into use.
4. Development of institutionalization of clinical training of nursing professionals
This task was targeted to support the institutionalisation of the mentoring system for the clinical learning of nursing students through the development of criteria and training of mentor trainers. Mentoring of nursing students by a nurse
in clinical practice includes the facilitation of learning and strengthening of professionalism of the students. Trained nurse mentors provide mentoring during clinical practice to ensure that students gain basic and professional nursing skills.
In Kazakhstan, the requirement for clinical studies in nursing education varies between 750-2300 student working hours depending on whether the program is 3.5 or 4 years of full-time studies or a fast-track program for nurses who already have working experience [10]. Firstly, in 2018, the Evaluation Criteria for Clinical Practice in Nursing Programs in Kazakhstan was produced based on international literature review to describe the seven essential components needed to ensure high quality clinical practice. The quality components are tutor teacher, mentor (nurse), nurse student, healthcare department, and organizational co-operation, and the process-based quality factors are the assessment of learning process and the development of clinical practice. The evaluation criteria can be used to develop clinical practice in cooperation with educational and medical institutions to ensure competence-based learning possibilities for modern nursing education.
Three one-week mentor trainer trainings (ToT) were implemented in Nur-Sultan during 2018-2019. In total 101 persons were trained as "mentor trainers" from eight (8) medical universities and 26 higher medical colleges. The mentor trainer education was produced to ensure a consistent way of educating nurse mentors by a cascade system in each region of Kazakhstan.
5. Capacity building of teachers of medical schools in modernization of the educational system of Nursing care specialists
In this task, altogether eight masterclasses were organized to increase teachers' knowledge of modern nursing education and to support them in adopting the new approach to teaching. A total of 89 deans, heads of departments, teachers, assistants, and methodologists of higher medical colleges and medical universities were trained in two masterclasses in 2020. The participants raised their awareness and obtained specific knowledge on competence-based nursing education and the changes needed for the transition from discipline-based education to the competence-based education. The participants gained the ability to critically evaluate the Kazakhstani nursing education and to consider the changes that should be done to improve the quality of the nursing education, and thus fill the gap between the Kazakhstani nursing education and international nursing education.
A capacity building program "Teacher of Nursing" was created with 31 teachers from medical colleges, higher medical colleges, and universities. The outcome was an action plan on how to systematically develop the competencies of nursing educators and to strengthen the nursing faculties' capacity to provide high quality nursing education. This educational program has served as a starting point and been further developed by the national project.
Altogether 165 teachers from higher medical colleges were educated to build their capacity to realize the applied bachelor program in the nursing care specialty by the semesters [10]. A capacity building training with a more specific focus was organized in 2018 to help and support teachers to plan and realize the competency-based courses for the 7th semester nursing students. The second training concerned the fast-track implementation where three courses of the 3rd semester were updated. Moreover, different types of collaborative learning methods were introduced to the teachers.
In 2020, a set of three trainings was organized for newly re-organized Higher Medical Colleges. The first training supported the teacher-participants' knowledge and skills in competence-based education and built their qualifications to meet the requirements concerning international nursing education and the Republic of Kazakhstan State Educational Standard on applied bachelor's degree education. The second training increased the teachers' knowledge of e-learning methods and their overall awareness of future trends regarding competence-based nursing education. The third training focused on improving
the implementation of the last year studies in the bachelor level education.
In addition to nurse educators, the other main target group of the capacity building activities were the practicing nurses. In total 88 nurses were trained in three different master classes that built their capacity and equipped them with essential skills to respond to the request to provide high quality nursing for the Kazakhstani people and for the modernization of healthcare services. During the first training, the main aim was to support the nursing management development in the pilot organizations
by developing 51 indicators for the quality and effectiveness of nursing care. In the second training the standardized operational procedures were developed for the management of patients with hypertension, congestive heart failure (CHF), and diabetes. The capacity building program "Evidence-based nursing practice and research in Nursing" was created and piloted with 29 nurses in the third training, where the participants deepened their awareness and understanding of nursing research and gained specific skills to practice evidence-based nursing.
Current challenges and Recommendations for further development of the nursing practice and the nursing professionals' education system
During 2018-2020, a total of 965 Kazakhstani participants were trained in 38 masterclasses, workshops, and seminars by a team of 24 Finnish experts. However, despite the structural and legislative improvements conducted in the form of modernised orders concerning positions, qualifications, educational standards ect., approved nursing clinical guidelines, methodological guidelines, and national strategy and policy papers as well as the wide education of staff members of nursing departments, some problems prevail in 2021 that make the realisation of the nursing reform difficult.
The ongoing discussion of nurses' low competency and their assistive role and image as middle level medical workers as exhibited in the old educational standards shows that there is still lack of full understanding about the modern healthcare system and the importance of nurses' position in reaching the goals set in strategies as well as lack of knowledge on the changes and improvements made. Our recommendation is that the Ministry of Healthcare, the Republican Center of Health Development, and rectors and management of all medical educational institutions together confirm the new role and duties of different levels of nurses and, above all, promote the prestige of nursing in the society as an appreciated academic profession.
The slow progress of some educational institutions in taking full responsibility in the society of the quality of nurse graduates' competence level and of the competency needed for work is exhibited in maintaining old disciplines and in not using the jointly developed course descriptions with new contents while implementing the new SES. This causes further variation on the quality of nursing education and in the competency of the future graduates. Our recommendation is to continue the assessments of the medical colleges to be able to acknowledge the high-quality institutions and to systematically monitor the quality of the implementation of nursing programs at higher medical colleges as well in medical universities. In addition, educational institutions should ensure their nursing teachers'
sufficient capacity in nursing science and competence-based pedagogy by continuous professional development. It is also recommended to organize the trainings of mentor trainers jointly for medical universities and higher medical colleges.
One of the apparent problems is that there is not yet an adequate number of staff members who are equipped with master and PhD in nursing science degrees as well as nursing experience to have a nursing faculty of a sufficient size for implementing post-graduate nursing education in the medical universities efficiently and with high quality. Our recommendation is to fund a jointly implemented Master Program in Nursing with a foreign strategic partner with large (15-20) student cohorts, a Pre-PhD in Nursing Science Program with an internship abroad, and internationalization activities for nursing teachers with research internships.
Furthermore, as one relevant challenge appears to be the lack of nursing research to provide evidence on the status of nursing and clinical practice, our recommendation is to launch and fund strategic nursing research by introducing a competition for nursing research projects.
It seems that the systematic annual process of starting the development of new nursing clinical guidelines and of leading and coordinating the adaptation as well as preparing the trainings of national trainers for each set of guidelines has slowed down or even stopped and needs immediate attention. In addition, the development of corresponding evidence-based Standardized Operational Procedures must be organized. Our recommendation is that the Ministry of Healthcare and the Republican Center of Health Development would strengthen the national coordination and create a systematic roadmap for translating nursing clinical guidelines into nursing practice. In addition, nurses' knowledge and skills in evidence-based nursing must be increased through capacity building activities.
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Мейiргерлердi дайындау ЖYЙесiн жетiлдiру. Финляндияньщ JAMK копданбапы гылымдар университет мен Казахстан Республикасыньщ медицинапык колледждерi арасындагы стратегияпык серштестштщ нэтижелерi
Heikkilä Johanna 1, Kivinen Eveliina 2, Naakka Hanna 3, Hopia Hanna 4
1 JAMK колданбалы гылымдар yHueepcumemiw^ ага кеце^а, Ювяскюля, Финляндия.
E-mail: johanna.heikkila@jamk.fi 2 Багдарлама жетекшiсi, менеджер LAB колданбалы гылымдар yHueepcumemiHiц менеджер, Лахти, Финляндия.
E-mail: Eveliina.Kivinen@lab.fi 3Хяме колданбалы гылымдар yниверcитетiнiц ага оцытушысы, Хямеэнлинна, Финляндия 4 JAMK колданбалы гылымдар yниверcитетiнiц ага оцытушысы, Ювяскюля, Финляндия
Туйшдеме
Материалда Финляндияныц JAMK колданбалы гылымдар yниверситетi мен Цазацстан Республикасыныц медициналык колледждерi арасындагы стратегиялык серiктестiктih| нэтижелерi усынылган.
Цазiргi тацда мейiрбике ici бойынша жаца клиникалык нусалыктарды эзiрлеy бейiмделy процеан Yйлестiрy сондай-ак, эр н¥cкаyльщтар жиынтыгы бойынша улттык жаттытырyшыларды дайындаy вте баяyлаrаны байкалады. Ягни бул процесс minmi токтап калды деyге де болады жэне аталмыш мэселеге жедел назар аyдарy кажет. Сонымен катар, дэлелденген стандартты операциялык процедyраларды эзiрлеyдi уйымдаcтырy кажет. Бiз Н,азакртан Реcпyбликаcыныц
Денсаулы; са;тау министрл1г1 мен Республикалы; денсаулы; сактауды дамытудыц орталытна ултты; Yйлеcтiрудi KYшейтуд!, мейiрбикелiк ic тэжрибеане клиникалы; нус;аулы;тарды енгiзудih| ЖYйелi жол картасын эзiрлеудi усынамыз. Сонымен катар, мейiргерлiк !с саласындагы мамандардыц 6rniMi мен тэжiрибелiк дагдылары потенциалды жогарылатуга багытталган с-шаралар ар;ылы жетiлдiрiлуi тшс.
Туши свздер: стандартталган операциялы; процедуралар, клиникалы; нус;аулымейiргерлiк с, стратегиялы; се^кте^к.
Совершенствование системы подготовки медицинских сестер. Результаты стратегического партнерства между Университетом прикладных наук (Финляндия) и медицинскими колледжами Республики Казахстан
Heikkilä Johanna 1, Kivinen Eveliina 2, Naakka Hanna 3, Hopia Hanna 4
1 Старший советник Университета прикладных наук JAMK, Ювяскюля, Финляндия. E-mail: johanna.heikkila@jamk.fi 2 Руководитель программы, менеджер LAB Университета прикладных наук, Лахти, Финляндия. E-mail: Eveliina.
Kivinen@lab.fi
3 Старший преподаватель Университета прикладных наук Хяме, Хямеэнлинна, Финляндия 4 Старший преподаватель Университета прикладных наук JAMK, Ювяскюля, Финляндия
Резюме
В материале представлены результаты стратегического партнерства между Университетом прикладных наук ММК (Финляндия) и медицинскими колледжами Республики Казахстан.
Систематический ежегодный процесс начала разработки новых клинических руководств по сестринскому делу и руководства, а также координации адаптации, а также подготовки национальных инструкторов по каждому набору руководств замедлился или даже остановился и требует немедленного внимания. Кроме того, должна быть организована разработка соответствующих стандартизированных операционных процедур, основанных на фактических данных. Мы рекомендуем, чтобы Министерство здравоохранения Республики Казахстан и Республиканский центр развития здравоохранения усилили национальную координацию и разработали систематическую дорожную карту для внедрения клинических руководств по сестринскому делу в сестринскую практику. Кроме того, знания и навыки медсестер в области сестринского дела, основанного на фактических данных, должны быть повышены за счет мероприятий по наращиванию потенциала.
Ключевые слова: стандартизированные операционные процедуры, клинические руководства, сестринское дело, стратегическое партнерство.
