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J Health Dev 2018; 2 (27) Supplement:3-6
LEADERSHIP IN NURSING CARE: NEW APPROACHES TO THE MANAGEMENT OF NURSING CARE
STAGES OF REFORMING THE NURSING SERVICE IN THE REPUBLIC OF KAZAKHSTAN. PLANS AND PROSPECTS
Heikkila Johanna1, Tiittanen Hannele2, Katja Valkama3
1RN University of Applied Sciences JAMK, Senior Advisor Finland 2RN Lahti University of Applied Sciences, Principal Lecturer, Finland 3Hame University of Applied Sciences, Principal Lecturer, Finland
Abstract
The collaboration between the Ministry of Health and the Finnish Universities of Applied Sciences (UAS) started already in 2013. This long term collaboration and partnership ensures successful results as understanding of the operating environment is comprehensive. In this manuscript, the stages of development - forming, storming, norming and performing-will be used to construct the current situation as well as the plans and prospects for reforming the nursing services in the Republic of Kazakhstan. Key words: reforming, nursing care, international cooperation, Kazakhstan
Казахстан Республикасында мейiргерлiк $bi3Memmi реформалаудьщ Ke3eqóepi. Жоспары мен перспективасы Тужырымдама
Цазакстан Республикасыныц Денсаулык сактау министрл1г1 мен Финляндия колданбалы гылымдар университеттершц (UAS) арасындагы ынтымактастык 2013 жылы басталган болатын. Осы узак уакыттык ынтымактастык пен сер1ктест1к мешргерл^к цызметт! жеттд1руде cammi нэтижелерге жетуге MYмкiндiк бердг Макалада Цазакстан Республикасында мешргерлж кызметт! реформалаудыц жоспары, кезецдерi мен перспективасы усынылган.
Krnrnrni свздер: реформалау, мейiргерлiк кызмет, халыкаралык ынтымактастык, Цазакстан.
Этапы реформирования сестринской службы в Республике Казахстан. Планы и перспективы
Резюме
Сотрудничество между Министерством здравоохранения Республики Казахстан и Финскими университетами прикладных наук (UAS) началось уже в 2013 году. Это долгосрочное сотрудничество и партнерство обеспечило достижение успешных результатов в области сестринского дела. В этой рукописи представлены этапы разработки, планы и перспективы реформирования сестринской службы в Республике Казахстан.
Ключевые слова: реформирование, сестринская служба, международное сотрудничество, Казахстан.
УДК 61:001.83(100)
Recieved: 03.06.2018 Accepted: 12.06.2018
Corresponding author: Heikkila Johanna, Senior Advisor PhD (Health Sciences/ Nursing Science), RN University of Applied Sciences JAMK, Finland
Address: P.O. Box207 FI-40101 Jyvaskyla, Finland Phone: +358 20 743 81 00 E-mail: Heikkila. [email protected]
Introduction
In the 2016 «Comprehensive Plan of Nursing Development in Kazakhstan until 2019» [1] the key objectives for reforming the nursing services were set. The plan was designed to position Kazakhstan's nursing care system in line with the international level, in accordance with the needs of modern Public Health to improve the quality, efficiency and safety of Public Health in the Republic of Kazakhstan. This development of nursing services was systematically planned and has already been implemented on many levels for several years. The vision for nursing services 2019 is demanding, but attainable. The objectives set for 2019 are
1. Introduction of new competences and roles of nurses in the public health system.
2. Institutional development of medical colleges and universities in accordance with the needs of nursing care reform.
3. Creation of scientific foundation to strengthen nurses' education and the nursing care system development.
4. Marketing and awareness raising on nursing care reform to create a positive image of new medical nurse profession.
5. Development and implementation of nursing care reform coordination mechanisms in the republic. Finnish experts have had the privilege to
collaborate on and support this work during the last six years. The collaboration between the Ministry of Health and the Finnish Universities of Applied Sciences (UAS) started already in 2013. This long term collaboration and partnership ensures successful results as understanding of the operating environment is comprehensive. In this manuscript, the stages of development - forming, storming, norming and performing -will be used to construct the current situation as well as the plans and prospects for reforming the nursing services in the Republic of Kazakhstan.
Stage 1. Forming Contemporary Nursing Services for Kazakhstan
The Comprehensive Plan of Nursing Development expresses the future goals to not only the governmental officials, state and private educational institutions and health care facilities, but to all stakeholders, such as professional associations, research centers etc. The prerequisite for the reform of the nursing services is the high quality of workforce with a new scope of work. High quality professional nurses with extended practice skills and competences can only be achieved by the modernization of educational system of nursing specialists. Therefore, reforming the nursing services also creates a need for a deep reform of the education system and its volumes all the way from vocational education to PhD level. When advanced nursing roles are launched in practice, changes in regulation and payment policies are also required. In addition, organizational level support will be required [2].
Internationally, the title registered nurse is used
to refer to the main workforce of the health care service. Similarly, in the future nurses in Kazakhstan will possess the corresponding competence and scope of work. In the Tuning project, a working definition for the professional first cycle registered nurse has been created already in 2003, namely, «This registered nurse is a professional person achieving a competent standard of practice at first cycle level following successful completion of an approved academic and practical education. The registered nurse is a safe, caring, and competent decision maker willing to accept personal and professional accountability for his/ her actions and continuous learning. The registered nurse practices within a statutory framework and code of ethics delivering nursing practice (care) that is appropriately based on research, evidence and critical thinking that effectively responds to the needs of individual clients (patients) and diverse populations» [3].
For launching the required educational reform and starting the production of high quality workforce, in 2014 the contract on «Partnership in development of nursing service» between the Ministry of Health of the Republic of Kazakhstan and JAMK UAS in consortium with Hame, Laurea and Lahti UAS was signed. In the framework of this contract, a competence-based educational programme on applied bachelor's degree in «Nursing» specialty was created according to international recommendations, including the Directive on the recognition of professional qualifications [4]. In contrast to a traditional educational system, the new programme is practice-oriented. This programme was then launched at six medical colleges of Kazakhstan: Medical College of Astana, Pavlodar College of Medicine, Kyzylorda Medical College, Republican Medical College for training and retraining of paramedical and pharmaceutical personnel (Almaty), West-Kazakhstan Medical College, and Kokshetau Medical College. The first cohort of this programme has now graduated. This pilot educational programme as well as a fast trajectory programme from nurse to applied bachelor nurse were both approved in 2017. The 1.5 year programme gives experienced nurses a career opportunity and produces high capacity workforce for reforming nursing services faster and more cost efficiently.
The support for organizational development of educational organizations towards 21th century pedagogy and internationally valid programmes is part of the forming stage. In 2016, the quality criteria for assessing Medical Colleges were developed and the first assessment of medical colleges was conducted in order to be able to identify those medical colleges that could be reorganized into higher medical colleges and start to train applied bachelor nurses in accordance with this new competence-based educational standard. In addition to the afore-mentioned six medical colleges, four others passed the assessment. From those four, «Turkestan» multi-specialty medical college has reorganized itself to a higher medical college and started the applied bachelor education in nursing.
Global standards for nursing education faculty set the requirement that teachers that educate nurses are
nurses [5]. As the number of the students will increase and the level of the education will be higher, the demand for nurse teachers educated at Master's level is evident. Therefore, the fourth area belonging to the stage of forming was planning a joint Master degree programme in nursing. During 2015-2017, the programme was planned, and in August 2017, JAMK University of Applied Sciences signed a contract with the «Kazakh Medical University of Advanced Education» (KazMUCE) on the creation of a Jointly implemented two-degree program enabling the graduate student of Nursing specialty in KazMUCE to obtain a degree of a Master of Healthcare in the program «Advanced Nursing Practice» (90 ECTS) at JAMK. In September 2017, the first cohort of 20 students started their studies. The cohort will graduate in 2019.
Stage 2. Storming SHIP for Modernization of Education System for Nurses
It was planned that the reform would be supported by the Social Health Insurance Project starting from the beginning of 2017 [6]. However, the whole year 2017 was required for preparation. Finally, in December 2017, the Finnish consortium of JAMK, Lahti and Hame Universities of Applied Sciences signed a contract with Social Health Insurance Project subcomponent 2.3., which aims to develop an effective human resources policy for the sector, ensuring the provision of high-quality health services through strategic partnership. The strategic partnership concentrates on the Modernization of Education System for Nurses.
The Modernization of Education System for Nurses - project's actions are divided into five large tasks, with clear aims in each task with several activities. The five task areas are:
1. Improvement of educational system of 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.
Stage 3. Norming the bases for Reforming Nursing Services
Once the modernization project started in December 2017, due to the profound planning and tight timetable, the project team has successfully managed to compete several task activities. The existing medical colleges need to develop their working curriculums, capacity of their teachers, their collaboration with clinical practice as well as facilities and resources for selection to be upgraded to become Higher Medical Colleges for implementation of applied bachelor's program in nursing. The improvement of the educational system of nursing specialists has proceeded by assessing 15 more medical
college during this spring and 16 more will be assessed in autumn. As Medical colleges Higher medical colleges and Medical universities create strategic development programmes as a part of their management system, these programmes should contain relevant and sufficient plans and activities for the development of nursing education in accordance of the reform. The criteria for assessment of development programs of educational institutions was created for the use of Ministry of HealthCare as well as the institutions themselves.
Before the new system of nursing service in healthcare settings can be launched several orders and other legislative documents needs to be developed and changed. The nursing management system will be piloted in primary health care and in hospitals with those organisations that will employ the new applied bachelor graduates with rights to extended practice. Simultaneously the documentation of nursing care by nursing professionals must be launched.
During spring 2018, first half year of the project, a giant leap has been achieved in the improvement of academic programmes (Task 2). Two new educational programmes have been developed: retraining of nurses from the applied bachelor to the academic bachelor degree in Nursing specialty; and nursing specialists at PhD level for the «Nursing» specialty. In addition, two programmes have been revised: the Technical and Vocational Education level for the «Nursing» specialty; and Master level in the «Nursing» specialty. The implementation of the joint Kazakh-Finnish dual-diploma Master's program in nursing is in process.
In task three (3), the development work with the clinical nursing guidelines is still in progress. The first five clinical nursing guidelines concerning hypertension, diabetes type 2, heart failure and asthma nursing are going to be ready for implementation during the autumn 2018. Trainings in the methodology of development, evaluation, and continuous update of evidence-based clinical nursing guidelines have been provided. In addition, capacity building programs for practicing nurses of clinical facilities about the new clinical nursing guidelines are going to be provided.
The development of clinical training of nursing professionals was the focus of task four (4), which was mainly completed during spring 2018. The criteria for assessment of clinical bases for applied and academic bachelor training of nurses were defined and the assessment completed. Mentorship was also developed at clinical bases by training of nurses through training of national trainers in spring 2018. The training will also be provided in autumn 2018 and spring 2019.
Task five (5) focused on providing capacity building for teachers and nurses. At the beginning of spring 2018, two capacity building trainings using competency-based approach were provided; one for the faculty of the 7th semester of study in the «Nursing» specialty 3.5 years, and one for the faculty of the 3rd semester of study in the «Nursing» specialty 1.5 years. Later during the spring, the capacity building program «Teacher of Nursing» for
faculty staff of medical colleges, Higher nursing colleges and universities was provided. Altogether 344 faculty members and nurses were trained during the first half a year in the project.
Three more capacity building trainings are being prepared, and will be implemented during autumn 2018. The coming trainings are introducing an educational program with specialization in management of nursing for chief and senior nurses as part of the reform of nursing; specialization in individual admission of patients by a nurse of applied and\or academic bachelor's degree in general practice and by priority nosologies; and a capacity building program «Evidence-based nursing practice and researches in Nursing» for nurses.
This norming stage will cover systemization of nursing service processes in state level as well as in health care institutions. The hospitals and Primary health care will compete in the future to recruit the best graduates. It can be foreseen that there will be identified barriers and problems that need still solving by norming before the new reformed nursing service is effective and there is evidence on its wide results.
Discussion Stage 4. Towards performing and further development
How to support the development to the fourth stage to reach the performing nursing system in the Republic of Kazakhstan? The actions has to be made to the fourth stage in order to reach the performing nursing system in the republic of Kazakhstan. First, the nurses themselves must take the responsibility to show their professional competences. Convince the multidisciplinary care teams of their knowledge and skills as well as their clinical decision making skills. Nurse empowerment means that the nurses have the ability and power to act professionally, has a sense of confidence. It has been reported that that nurse empowerment is positively related to quality of performance and patient care. Nurse empowerment is characterized by the ability to engage in positive and productive behaviors as a result of competence to meet the demands of the job.
Engagement to nursing profession means that one has a positive work-related state of mind that is characterized by dedication, persistence to do great work [7]. This mean also that the nurses should be encouraged to join to the national nurses associations and be active in their community in order to develop the future nursing service to Kazakhstan. Strong nursing community will create positive image also to the population, and increase the status of nursing profession.
The development education system and a critical mass of nursing academics on the level of Masters and PhD in Kazakhstan that are engaged in nursing research and evidence-based practice will create knowledge base for teaching nursing and managing nursing services. This will expose the future students in Medical Universities and Higher medical colleges both to the academic but also to the clinical sphere of nursing. To enhance this link is needed for the future innovations. The development collaboration between the education and the practice is supported through international multicenter project that is cofunded through Erasmus+. ProInCa - project that promotes the innovation capacity of higher education will establish a Center of Nursing Excellence that will promote the reform of nursing service [8].
Where there is a will, there is also a way. The participants of Master Class from educational institutions regard the future nursing in Kazakhstan as follows: Nursing is respected profession with prestige and career. All students can English and are able to use nursing databases. All teachers are masters in nursing. There is governmental support to nursing science and research. Profiles for each university to enhance the development nursing science and research - Family nursing, cancer nursing, etc. International research projects to develop nursing are conducted. Research clinical centers support to apply research to practice. There are research groups of nursing with international cooperation. Results of studies are published in the Nursing Journal of evidence-based nursing in Kazakhstan and in international refereed publications. Center of Nursing Excellence is widely used.
References
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