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КАЗАХСКИЙ
МЕДИЦИНСКИЙ
УНИВЕРСИТЕТ
НЕПРЕРЫВНОГО
ОБРАЗОВАНИЯ
UDC: 614.2
DOI: 10.24411/1995-5871-2019-10059
ON THE QUESTION OF RELEVANCE OF THE NURSING DEVELOPMENT
IN KAZAKHSTAN
N.A. Akhmetova
«Regional Infectious Diseases Hospital» West-Kazakhstan region, Uralsk
SUMMARY
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One of the components of the healthcare system is care, which involves the implementation of certain measures with the aim of strengthening public health, preventing various diseases, providing psychosocial assistance and supporting people with physical and mental illnesses, as well as people with disabilities. To date, there is a sufficient amount of data on different states and diseases, which indicates the advantage of this approach in comparison with traditional therapy under the guidance of a doctor, and this also leads to a reduction in financial costs. The above emphasizes the relevance of the development and further improvement of nursing in Kazakhstan.
Key words: nurse, nursing, preventive medicine.
Introduction.Today, in the structure of a healthcare organization, nursing service is a significant component that has certain components of medical personnel and includes sufficient prerequisites for the provision of medical services to the country's population.
In particular, nurses carry out activities to provide the necessary assistance to people with any illness or adverse health situation. In general, nursing involves the implementation of activities to improve public health, prevent disease, provide psychosocial assistance and care to those who have physical and mental illnesses, as well as disabled people of all groups.
The very concept of nursing, however, like the work of nurses, has changed over time. It is difficult enough to give a complete designation of this definition, which would include various aspects of the above activities and be interpreted similarly in different states. The literature provides a diverse number of definitions that were formed under the influence of various reasons, the latter include factors of the historical era, indicators of the socio-economic state of the society, the geographical location of the state, the healthcare organization present and the level of its development, structural features
of the nursing staff with some or functional responsibilities, the attitude of medical workers and society towards nursing, data of the national cult s, demographics, population needs medical care, in addition, the knowledge and the personal outlook of the person who formulates the definition of nursing science. It should be noted that the definition of nursing provided by a doctor, nurse, patient, his family, administration, insurance and legislative authorities, representatives of other professions will differ from each other.
Today, there are more than one hundred definitions of nursing, which indicates the absence of a definition that gives an exhaustive idea of this concept.
For example, the sister of charity Florence Nightingale, who was one of the founders of nursing, wrote in her Notes on Nursing (1859) that nursing was «an act of using the patient's environment to help him recover.» That is, the need was assumed to ensure the most optimal conditions under which recovery would occur. "Best conditions" means proper nutrition, cleanliness, fresh air. Moreover, Florence Nightingale separately differentiated nursing care and health care, since, in her opinion, nursing is "helping the suffering sufferer to live the most fulfilling, satisfying life," and
* n.axmetova@mail.ru
caring for healthy people is "maintaining a person's a condition in which the disease does not occur.»
The definition of nursing, which was proposed by an American nurse and teacher Virginia Henderson in 1961, received international recognition: "A unique task of a sister is to help a person, sick or healthy, in carrying out those actions related to his health, recovery or a calm death, which he would undertake himself, possessing the necessary strength, knowledge and will. And this is done in such a way that he regains independence as soon as possible. " A sister is "legs of a legless person, eyes of a blind person, support for a child, a source of knowledge and confidence for a young mother, the mouth of those who are too weak or too self-absorbed to speak."
Also the American Nurses Association (ANA) states "nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations" [1].
The International Council of Nursing gave the following definition: "Nursing is an integral part of the healthcare system and includes activities to promote health, prevent disease, provide psychosocial care and care to people with physical and mental illnesses, as well as disabled people of all age groups. Such help is provided by nurses both in medical and in any other institutions, as well as at home, wherever there is a need for it" [2].
The productive development of national health systems is largely determined by the level of professionalism and the quality of education, the rational location and use of nursing staff, which represents a fairly large part of the health workforce.
Material and methods. We conducted an electronic search for publications in the following databases Cinahl, Google Scholar, PubMed. The search was performed between the years 2000 and 2018. The study included only full-text publications in Russian and English that describe the problem of the formation and development of the nurse
profession in the international aspect and in the Republic of Kazakhstan. As a standard and criteria for inclusion in this study, we used a tool to analyze the problems of the formation and development of the nurse profession. The following key questions were used: "The profession of a nurse", "The history of the profession of a nurse", "The present profession of a nurse, the future", "Career development, care", "The profession of a nurse in Kazakhstan". After excluding duplicate publications and articles that do not meet the inclusion criteria, 28 publications were accepted in the study. The article is a review of literary sources.
Results and discussion. At present, indicators of the state of nursing services in the Republic of Kazakhstan indicate that nurses do not always meet the needs of the times. Since at the current level of healthcare development, nurses must not only demonstrate significant professionalism, but also must meet the criteria for ethical and deontological interaction with work partners and patients.
The effectiveness of medical care is determined by a well-coordinated and competent nursing activity, which ensures an increase in the level of medical services through the implementation of standardized technologies of nursing care, prevention, diagnosis and treatment. Therefore, the importance of improving the system of productive use of nursing personnel depending on the level of education and the main specialty and, in addition, the use of an objective assessment of their work on the basis of the introduction of informative indicators and techniques [3].
Also, the effectiveness of health systems is determined by quantitative and qualitative indicators of human resources for health. For example, in 2016, the number of medical personnel in Kazakhstan amounted to more than 233 thousand specialists, of which more than 163 thousand were middle-level medical workers. More than 80% of the total number of personnel are those who are directly involved in treating patients. More than 16% of the total number of doctors and 30% of the middle-level medical staff work in rural areas. The
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average indicator of the number of doctors in the republic is 39.5 per 10 thousand of the population, middle-level medical workers -92.8 per 10 thousand of the population [4].
From literature data it follows that in comparing primary health care organizations (PHCO) and inpatient care, it is revealed that at the PHCO level there is also a shortage of personnel for nursing specialists. In the hospital, the most acute shortage of personnel is observed in Astana - 1,498 people, which is 28% of the due. The staff surplus is observed in the Kyzylorda and South Kazakhstan regions. The dynamics of the general shortage of nurses in the labor market of the republic over the past three years has shown that the total number of individuals since 2013 increased from 63,257 people. up to 67 297 people in 2015 (an increase of 6%), while the deficit of nursing staff decreased from 4,065.25 staff units in 2013 to 2,698 staff units in 2015, on average, the staff deficit decreased by 33% over three years [4, 5].
An analysis of the dynamics of the number of nurses over three years, both in general and in the context of primary health care / hospital, showed that the main increase in their numbers is due to primary health care, while the number of hospital nurses remains stable [4, 5].
The complexity of the insufficient productivity of the nursing service in the healthcare system of the Republic of Kazakhstan is determined by the fact that there is an underestimation of the importance of nurses in the process of providing medical care and the ongoing experience of subordinating nurses to the doctor, the mismatch of the existing system of nursing education, science and practice with international standards, the imperfection of the regulatory framework governing activities nurses [6]. While in European countries the work of nurses has a preventive focus, in particular, nurses provide counseling to patients and their relatives, have the authority to prescribe sick leave, prescriptions, can recommend a specific treatment regimen with drugs, etc. First, when visiting a clinic, patients consult with medical sisters performing an assessment of the
patient's condition, organizing the necessary examination. After this stage, patients are referred to a specialist [7, 8, 9, 10, 11, 12, 13, 14, 15].
To date, the preparation of: - Academic bachelors / masters in nursing is carried out by 7 medical universities (the annual graduation of academic bachelors is on average no more than 200 people, masters in nursing no more than 10 people); - Applied bachelors in nursing carry out 17 Higher Medical Colleges (graduation in February 2018 - 308 people); - Nurses of general practice at the level of technical and vocational education (TVE) are run by medical colleges (annual graduation on average 15,000 people) [16, 17, 18, 19, 20, 21]. When teaching nurses, it is necessary to place a greater emphasis on the development of important professional skills; the combination of theoretical and practical stages of preparation is also essential [16, 17].
According to the literature, certain measures are possible to solve the problem of insufficient effectiveness of nursing services in the Republic of Kazakhstan, for example, increasing the productivity of creating and managing nursing activities in medical organizations based on a reassessment of the role of nurses in the medical and diagnostic process, as well as improving the qualifications of nursing staff in unison with international requirements, in addition, the modernization of nursing practices in the country's healthcare through the introduction of national manuals, standards in the art [7, 22, 23, 24, 25, 26].
All the more encouraging is the fact that the Order of the Minister of Health of Kazakhstan was published, which was published on December 19, 2018 No. KP XM - 43. In accordance with the above document, the post of an extended practice nurse is established [27]. This order stipulates that nurses with advanced practice should carry out nursing examinations of patients, make certain diagnoses, outline plans for nursing intervention for patients, etc. [27].
In accordance with the Comprehensive Plan for the Development of Nursing in the Republic of Kazakhstan until 2020 of August 1, 2014 for 2020, the following goals were set:
• introduction of new nurses and their role in the public health system;
• institutional development of medical colleges and universities in accordance with the needs of nursing reform;
• creating a scientific base for strengthening nursing education and developing a system of nursing care;
• marketing and raising awareness of nursing care reform to create a positive image for the new medical profession of nursing;
• development and implementation of mechanisms for coordinating nursing reform in the republic [28].
Conclusion. Thus, in order to further improve nursing in the Republic of Kazakhstan, it is necessary to provide economic support for the implementation of nursing services, create financial incentives for nurses, provide good working conditions for nursing staff and conditions for research activities in the field of nursing. In the process of educational training of nurses to streng then the practical component.
A feature of the activities of a nurse, which differs from the work of a doctor, lies in another concentration of the area of attention and differences in main interests. All the activities of a nurse are focused on the patient and her desire is to reduce suffering to a greater extent, create comfort, appropriate care,
replenish psychological and physical ailments, and resist the disease intensely by nursing. A doctor, for example, performs amputation of a limb, and how a patient can live without it, how to adapt physically, mentally, socially to a given state - this is a question that a nurse decides.
In the interactions of the nurse and the patient, the same laws are implemented as in the activities of the doctor, but, of course, in a special refraction. The principles of justice, ensuring and maintaining personal autonomy, the significant medical law "do no harm", "do good", the condition of informed consent are equally important for a nurse. Nurses embody their assurance in the selfless care of patients, in the unconditional consolidation of the doctor's work, in adequate advice to patients regarding behavior, regimen, life style based on science and nursing experience.
For sisters of mercy, as well as for doctors, such factors as communication culture, upbringing, sincerity, ability to empathize, high spirituality, optimism, will, and mental stability are certainly significant. All of the above determines the importance and importance of the profession of a nurse and the image of this specialty, therefore, it is vital to support nurses, develop this profession and implement further reforms of nursing in Kazakhstan.
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КАЗАКСТАНДА МЕЙ1РБИКЕЛ1К 1СТ1 ДАМЫТУДЫН, 9ЗЕКТ1 МЭСЕЛЕЛЕР1
Н.А. Ахметова
«Облысты; жукпалы аурулар ауруханасы», Батыс-^азакстан облысы, Орал
ТУЙ1НД1
Денсаулы; сактау жYЙесiнщ курамдас белштершщ 6ipi - пациенттерге kytïm жа-сау, ол денсаульщ сактауды ныгайту, тYрлi аурулардыц алдын алу, психоэлеуметтiк кемек керсету жэне физикалы; жэне психикалы; аурулары бар адамдарга, сондай-ак мYгедектерге колдау керсету бойынша белгiлi бiр шараларды жYзеге асыруды камтиды. БYгiнгi кYнi эр тYрлi кYЙлер мен аурулар туралы мэлiметтер жеткiлiктi, бул дэр^ердщ басшылыгымен дэстYрлi терапиямен салыстырганда бул тэсшдщ артыкшылыгы жэне каржылы; шыгындардыц темендеуше экеледi. Жогарыда айтылгандар ^азакстандагы мешрбике iсiн дамыту мен одан эрi жетiлдiрудщ eзектiлiгiн кeрсетедi.
Клт свздер: мешрбике, мешрбике ici, профилактикалыц медицина.
К ВОПРОСУ АКТУАЛЬНОСТИ РАЗВИТИЯ СЕСТРИНСКОГО ДЕЛА
В КАЗАХСТАНЕ
Н.А. Ахметова
«Областная инфекционная больница», Западно-Казахстанская область, г. Уральск
АННОТАЦИЯ
Одной из составляющей системы здравоохранения является уход, который предполагает осуществление определенных мер с целью укрепления здоровья общества, профилактики различных болезней, оказания психосоциальной помощи и поддержки людей с физическими и психическими заболеваниями, а также лиц с ограниченными возможностями. На сегодняшний день имеется достаточный объем данных по разным государствам и болезням, что говорит о преимуществе подобного подхода в сравнении с традиционной терапией под руководством врача, также это приводит к уменьшению финансовых затрат. Вышесказанное подчеркивает актуальность развития и дальнейшего совершенствования сестринского дела в Казахстане.
Ключевые слова: медицинская сестра, сестринское дело, профилактическая медицина.
