Directions for the development of nursing. The main directions and events of reforming nursing in Russia

1. Changes in the education system, i.e. training and retraining:
   • introduction of a new educational standard;
   • transition to multilevel nursing education;
   • teaching new technologies from the standpoint of the new philosophy of S.D.
2. Changes in the labor sphere:
   • increasing the prestige of the profession - the possibility of professional growth;
   • motivation of nurses for independent research work;
   • revision of duties, pay scales, loads, list of positions;
   • implementation of nursing standards.
3. Creation of a regulatory framework for nursing.

In 1994, the All-Russian public organization "Association of Nurses of Russia". President - Sarkisova Valentina Antonovna. The Omsk association is represented by more than 10,000 representatives - one of the largest in the country. President - Zorina Tatyana Aleksandrovna.

Association tasks:

• active participation in the State health policy;
• support for scientific research in nursing;
• development and publication of methodological literature;
• managing the introduction of new nursing technologies;
• implementation of legal protection of nurses;
• defending the professional interests of nurses in the health care system;
• improving working conditions and raising wages;
• expanding the information space in nursing;
• the revival of the traditions of sisterly charity;
• the international cooperation.

The Russian Nurses Association has been a member of the European Forum of Nursing and Midwifery Associations and WHO for 10 years, and in 2005 was admitted to the International Council of Nurses. Since that moment, the Association has been actively involved both in the formation of global, world policy in the field of nursing, and in the implementation of strategic plans for healthcare policy in Russia.

FORMATION AND DEVELOPMENT OF NURSING IN RUSSIA. MAIN DIRECTIONS OF REFORMING NURSING.

Background, essence and main directions

nursing reforms in Russia.

Nursing is an essential part of the health care system. an area of ​​activity aimed at solving the problems of individual and public health of the population and changing environmental conditions.

It is known that the role and tasks of the nurse are determined by historical, social and cultural factors, as well as the general level of health of a particular society. As a science, nursing is based on knowledge tested in practice.

For several decades in Russia, nursing issues have not been given due attention. The development of nursing technologies, taking into account modern science in developed countries, has led to a sharp backlog of nursing in Russia.

The prerequisites for the reform of nursing, its development are: negative medical and demographic processes. in particular - the decline in the birth rate and the aging of the population; deterioration in the health status of the population; chronization of pathological processes in the body; the spread of new diseases. such as HIV; increase in the cost of medical services. Gradually, the provision of medical institutions (HCIs) with nursing staff is decreasing. the two-stage method of patient care (doctor, nurse) led to a decrease in the professional competence of nurses. performing functions that are not theirs. The supply of medical facilities with medicines, care items, tools is decreasing. There is a growing imbalance in the ratio between doctors and nurses. as a consequence - the deterioration of the quality of care and care (it is believed that the optimal ratio between doctors and nurses is 1:4).

The reform of nursing in Russia began in 1993. At the international conference "New Sisters for a New Russia", the philosophy of nursing was adopted, which laid the foundation for this process. Decree of the Government of the Russian Federation of 05.11.97 No. 1387 "On measures to stabilize and develop healthcare and medical science in the Russian Federation" provides for the implementation of the reform. aimed at improving quality. accessibility and economic efficiency of medical care to the population in the conditions of the formation of market relations.

The essence of nursing reform lies in the implementation of the necessary changes in personnel policy based on evidence-based approaches to planning, training and use of nursing personnel; ensuring a rational relationship and partnership between physicians and nursing staff; revival of the category of junior medical personnel; organization of new types of assistance related not only to diseases or pathological conditions, but also to the problems of maintaining and maintaining individual and public health. Currently, international experience is being studied in Russia. its in-depth analysis, correction and adaptation to socio-economic conditions are carried out, taking into account national traditions.

By order of the Ministry of Health of the Russian Federation No. 4 dated January 9, 2001, a sectoral program for the development of nursing in the Russian Federation was approved, reflecting the essence of the nursing reform. Nursing has significant human resources and real potential. Today in Russia there are about one and a half million paramedical workers. This is the most popular medical profession.

The main goals and objectives of the nursing reform are:

1. Formation of optimal conditions for increasing efficiency and strengthening the role of paramedical workers, improving the management system.

2. Creation of a new conceptual Russian model of nursing. Each model recognizes the basic principles of primary health and social care (PHC). Today, the medical (traditional) model, authored by F. Nightingale, still operates. In this model, one of the constituent elements is the role of the nurse as a physician's assistant with extremely limited professional autonomy.

3. Introduction of new technologies in nursing. bioethical professional approaches that can meet the population's need for affordable medical care.

4. Strengthening the preventive focus of health care.

5. Carrying out systemic transformations in nursing - in the field of education, scientific research. practical health care, promotion and development of nursing associations.

6. Raising the status of nursing staff, both professional and social. Ensuring social security of nursing professionals and much more.

The main directions of the reform of nursing, the implementation of the sectoral program are:

1. Regulatory support of nursing activities, labor protection in healthcare institutions.

2. Creation of standards (protocols of professional nursing activities), their approbation and further implementation into practice.

5. Revision of the method of remuneration for the specialty "nursing" depending on the quality of the volume of work performed and the level of education based on new nursing technologies.

Levels of training of nurses in Russia. Sister periodicals

By 1994, a three-level system of nursing education had been formed in Russia. Each level of training of specialists has its own State Educational Standard (requirements for the minimum content of training in the specialty). Disciplines will determine the main corrections

3rd level

Higher nursing education (university)

2nd level (college)

1st level (medical school)

Secondary medical vocational education

Levels of training of nurses in Russia

graduate training. Such an education system enables the average medical worker to realize himself in various fields of professional activity. Performing functions from performers to managers. The emergence of new positions makes it possible to save working time, for example, the introduction of the position of “coordinating sister” saves working time not only for the ward head nurse, but also for the head of the department. Order of the Ministry of Health of Russia dated February 26, 2002. No. 65 introduced the position of chief specialist in nursing. The first graduation of specialists with higher nursing education took place in 1995. By 2002, the number of Russian universities in which faculties of higher nursing education were opened. amounted to 34, and the total number of graduates - more than 2.5 thousand managers in the field of nursing.

The initiator of the creation of the Faculty of Higher Nursing Education at the Moscow Medical Academy. THEM. Sechenov is a GM. Perfilyeva, Professor, Dean of the Faculty of Higher Nursing Education.

Currently, new periodicals are being published in the Russian Federation for teachers of educational medical institutions, practitioners, nurses, paramedics, midwives, organizers and other health workers. This contributes to the accumulation of invaluable experience in reforming nursing, the study and implementation of innovations in practical health care, and the existing lack of information is filled.

Periodicals for paramedical workers are becoming more and more popular - these are:

Scientific and practical journal "Medical assistance", published since 1998;

The journal "Nursing" was published in 1995;

Journal "Medical Nurse", published since 1999;

Sister of Mercy magazine, published since 2001

And other periodicals.

Thus, the creation of a multi-level system of vocational education contributes to the career growth of nursing staff. enhancing the prestige of the profession,

and is a prerequisite for the rapid development of nursing. professional public associations.

Role, goals and objectives

Nursing care has all this time been considered within the framework of "nursing the sick." Nursing (SN) has entered the professional lexicon quite recently. For many decades in our country, a nurse was trained only to "perform various auxiliary functions prescribed by a doctor." The lack of scientific principles and approaches to the system of training and use of nursing personnel, unclear prospects for professional growth, difficult working conditions and low wages have led to the fact that in Russia the profession of a nurse has become less and less prestigious, and its social status has steadily declined.

In 1991, the Faculty of Higher Nursing Education was organized in Moscow (Sechenov State Medical Academy, headed by G.M. Perfilyeva) and Samara.

In 1992, the Moscow Association of Nurses was established - the first association in Russia.

In 1993, the International Seminar on the Reform of Nursing Education and Nursing Practice "New Sisters for the New Russia" was held in Golitsino. Goals and objectives of the seminar:

■ to form a new vision of DS in Russia through the world experience in studying the subject and the creation of training modules on nursing education;

■ familiarize Russian nurses with the international experience of DM;

to discuss the role of nursing staff in the Russian health care system and the need for education and SD reform to improve nursing practice.

The main directions of the nursing reform in Russia:

create a regulatory framework for nursing;

define the philosophy of nursing;

create a multi-level system for training nursing professionals;

to introduce the nursing process into nursing practice.

Today, nursing is defined as "the provision of health care to individuals, families, or populations for the purpose of restoring or maintaining health." Unfortunately, in In our country, at the center of nursing and healing is not a person with his needs, but his illness, i.e. until now, physicians are forming an attitude to treat the disease without taking into account the personality of the person.

In 1994, the Interregional Association of Nurses of Russia was established.

Organization tasks:

■ increasing the role of the nurse in the health care system, raising the prestige of the profession;

■ protection of professional rights;

■ improving the quality of medical care;

■ improving working conditions and wage increases;

■ improving the skills of nurses and their education;

■ revival of the traditions of sisterly mercy.

In 1995, the journal "Nursing" was published.

In 1997, the Association of Nurses created the Code of Ethics for Russian nurses.

In 1998, the 1st All-Russian Congress of Paramedical Workers took place in St. Petersburg. The draft State Program for the Development of Nursing in the Russian Federation was approved.

A multi-level training of nursing professionals has been introduced - basic level, advanced level, higher nursing education (HSE):

There are 3 stages in the development of DM:

Stage 1 - the sister plays a guardian role (charity, assistance to the disabled, mentally ill, dying, orphans). The main function of the sister is hygienic care.

2nd stage - associated with the Crimean campaign. The role of the sister is the doctor's dependent executor.

3rd stage - the end of the 90s of the XX century. - the beginning of the XXI century. - the sister performs the role of an independent specialist within her competence.

Modern nursing in this period is undergoing a stage of active reform. The activity of modern nursing service is carried out in certain directions, which are developed and set out in the program for the development of nursing in the Russian Federation. In 1997, in accordance with the Order of the Russian Federation of December 31, 1997 No. 390 "On measures to improve nursing in the Russian Federation", a program for the development of nursing in Russia was drawn up.

Nursing personnel make up the dominant part among health workers. The ongoing reform of nursing education has yielded positive results. In Russia, since 1995, the training of nurses with higher education has been carried out. The development program formulates modern concepts and terms. Nursing is considered as one of the main components of health care. It includes activities to promote health, prevent diseases, provide psychosocial assistance to those in need. Nurses provide medical care in special medical institutions, as well as at home. Nursing staff must have education in the specialties: "Nursing", "Obstetrics", "General Medicine (paramedic)". In the implementation of the nursing development program, 2 stages were identified.

1st stage: from 1998 to 2000: the legal framework and material and technical base for the work of nurses were developed and adopted.

Stage 2: 2000 to 2005: implementation of cost-effective ways of nursing services in the health system.

The program for the development of nursing is provided through funding from the federal budget, funds from the budgets of the constituent entities of the Russian Federation and extra-budgetary sources attracted for its implementation. Quality control during the implementation of this program is carried out directly by the Ministry of Health and Social Development of the Russian Federation.

The program for the development of nursing indicates the objectives of the development of nursing in the Russian Federation.

1. Creation of conditions for the development of nursing and the provision of assistance at the federal level and directly in the subjects of the Federation.

2. Promoting more efficient use of resources in health care.

3. Development of new methods of organization and technologies of nursing care.

4. Improved qualification training of nursing staff.

5. Ensuring high quality nursing care for all segments of the population.

6. Improving the legal framework and management system of nursing service.

7. Raising the status of the nursing profession.

8. Maintaining the social security of nursing staff.

9. Development of nursing associations.

The program for the development of nursing in Russia is based on clear, defined principles.

1. The principle of universality. Medical assistance should be provided to all people in need, regardless of their social affiliation, gender, age, religion.

2. The principle of accessibility. Medical assistance should be available to everyone, regardless of the place and area of ​​​​residence and other factors.

3. The principle of prevention and timely promotion of the health of each person.

4. The principle of efficient use of labor, material and economic resources.

If earlier the nurse was considered as an assistant to the doctor and was obliged to fulfill all his appointments exactly, then at the present stage of development of healthcare, the powers of the nurse have expanded: she has the right to make decisions independently when providing assistance to the population.

The activity of a modern nurse has certain directions and tasks.

1. Provision of primary health care. Implementation of preventive work among the population. The nurse should actively carry out health education of patients: to form a healthy lifestyle for each patient, to carry out primary and secondary prevention of the population. Primary prevention is aimed at preventing the development of the disease in a healthy person. Secondary prevention is interventions to reduce relapses in a person with a chronic disease. The nurse should participate in solving the issues of sexual education of the population, in family planning.

2. Provision of medical and diagnostic assistance to patients, highly qualified patient care. Polyclinics, hospitals, feldsher-obstetric stations for better work should be provided with modern equipment and a sufficient amount of medicines, dressings, injections and other medical products.

3. Provision of rehabilitation and medical and social assistance to those in need: the chronically ill, the disabled, the elderly.

4. Provision of palliative care for cancer patients. Creation of hospices and nursing hospitals for people in need. Establishment of a service for patronage of patients and their care at home.

5. The principle of providing quality medical nursing care to the entire population.

6. The principle of involving the population in active participation in solving health issues.

In modern conditions, the requirements for the professional training of nurses are increasing. There is a growing need for nurses who are able to work on modern medical and diagnostic medical equipment: electrocardiograph, X-ray units, physiotherapy devices, resuscitation and patient monitoring devices. In addition, a nurse must know the basics of psychology, know the nursing process and be able to apply knowledge directly in practice. A nurse must know the basics of the legal framework and be able to correctly fill out medical documentation.

An important role in organizing the work of the nursing service belongs to the heads of nursing services at various levels: the head nurse, the head nurse, medicine managers. For more efficient work of the nursing service, there must be close professional communication and cooperation of nurses with doctors, the administrative part, the Ministry of Health and Social Development, other specialists and departments.

Currently, there are many shortcomings and shortcomings in the organization of the work of the nursing service. It is important to further improve its organization and management in the Russian Federation. It is necessary to develop and introduce general principles and approaches to the organization of the work of nursing personnel into the activities of nurses. Currently, there is no common, unified management system. This has a negative impact on the work of nurses, and therefore directly on the health of patients. For a more efficient organization of nursing service, it is necessary to organize a multi-level management system. The main thing here is the emergence of nursing specialists in the Ministry of Health and Social Development of the Russian Federation, as well as in the health management bodies of the constituent entities of the Russian Federation.

The head nurse must know the basics of management and have a higher education in the specialty "Medicine Manager". Better, better organization of the work of the nursing service will ensure the development and implementation in practical work of standards for the professional activity of a nurse in the outpatient area and hospitals. In order for a nurse to perform her work qualitatively and satisfy the needs of the patient (according to Maslow), she must not only clearly and professionally perform the prescribed manipulations. The basis of the professionally performed work of a nurse should be the observance of the culture of deontology, ethical standards, and respect for each patient.

Ministry of Health of the Russian Federation
BOARD

Development of nursing in the context of healthcare reform

The collegium of the Ministry of Health of the Russian Federation notes that the industry is constantly improving work on the implementation of the tasks defined by the Concept for the Development of Healthcare and Medical Science in the Russian Federation, in terms of the development of nursing in the context of healthcare reform.

In the period from 1994 to 2001, the issues of training and use of nursing specialists were discussed at 6 boards of the Ministry of Health of Russia, at the 1st All-Russian Congress of Nursing Workers and the 1st All-Russian Congress of Midwives, meetings of the Council on Personnel Policy under the Minister of Health of the Russian Federation and the Council Ministry of Health of Russia on nursing. The Doctrine of Secondary Medical and Pharmaceutical Education in the Russian Federation, the Sectoral Program for the Development of Nursing in the Russian Federation were approved. The work carried out made it possible to improve the quality of training of nursing specialists at all stages of professional education and to use them most effectively in practical healthcare.

The Board notes the growing role of nursing personnel as the largest category of health workers in providing affordable and qualified medical and medical and social assistance to the population of the Russian Federation, strengthening the preventive focus.

The Ministry of Health of Russia provides organizational and methodological guidance to 450 secondary medical and pharmaceutical educational institutions, in which more than 230 thousand students study.

In order to regulate educational activities and ensure the quality of training of medical personnel, the Ministry of Health of Russia, together with the All-Russian Educational, Scientific and Methodological Center for Continuous Medical and Pharmaceutical Education, developed and approved by the Ministry of Education of Russia State educational standards for secondary vocational education of a new generation in all 10 specialties assigned to the industry " healthcare". The introduction of standards in all secondary medical and pharmaceutical educational institutions of the Russian Federation is provided for from September 1, 2002.

To implement the requirements of the State Standard, creative teams of educational institutions developed and approved by the Russian Ministry of Health curricula that provide the educational process of the 1st year of study according to the new SES. Recommendations on educational, methodological and logistical support of the educational process have been approved. Currently, the development of new curricula for subsequent courses in all specialties of training is being actively continued. Work has been organized to create groups of authors for the preparation and publication of textbooks, educational and methodological literature, and manuals.

Over the past decade, the Ministry of Health of Russia, together with the territorial health authorities, has done a lot of work on the training and use of nurses with higher medical education in practical health care. The health authorities of all constituent entities of the Russian Federation consider this practice to be extremely important and necessary.

To date, there are 30 faculties in higher educational institutions of the system of the Ministry of Health of Russia, where about 7 thousand students study, of which more than 4.5 thousand are part-time. dated November 22, 1997 and is being actively implemented in Russian universities, which makes it possible to use this form of training for trained nurses, midwives and paramedics.

Improving the system of staffing the industry, employing graduates of educational institutions, depending on the level of education received and securing them in the workplace, is currently one of the main tasks in reforming the industry.

All educational institutions of the system of the Ministry of Health of Russia have retained the system of employment of graduates. In secondary medical and pharmaceutical educational institutions, departments have been created to assist in the employment of graduates. In most regions, health authorities, together with trade unions of health workers, have developed and approved sectoral programs to promote the employment of medical and pharmaceutical workers.

The most important direction of the nursing development program is the improvement of all forms of postgraduate education.

Standards for postgraduate training in areas according to the approved nomenclature of specialties for paramedical workers have been developed and approved.

Higher nursing education continues to develop and improve, which will create a potential for scientific research and modernization of nursing care, provide the industry with highly qualified managerial and pedagogical personnel.

Recently, there has been an active activity of the regions to fulfill the tasks aimed at reforming nursing.

In 60 territories, regional programs for the development of nursing have been developed and approved, problem commissions or councils for nursing have been created, meetings of collegiums have been held. To manage nursing activities in 73 health authorities of the constituent entities of the Russian Federation, the positions of chief specialists in nursing have been introduced.

To revise the current standards for nursing staff in 11 territories, work is underway to study the differentiated workload on the nursing staff of medical institutions, taking into account the reform of nursing activities.

The Centers for Medical Prevention are operating, a network of medical and social departments, nursing homes for the treatment and rehabilitation of the elderly, the disabled, incl. at home.

Experimental work on the introduction of the nursing process in health care facilities is expanding.

Programs of interaction between educational and medical institutions have been developed.

Structural transformations in health care provide for the development of primary health care for the population; in many territories, paramedics and nurses are being trained for general medical practice.

The Ministry of Health of Russia has developed and submitted for discussion a draft model of nursing care for the health care system of the Russian Federation.

In order to form a system for managing the activities of nursing professionals, the position of chief specialist in nursing was introduced (Order of the Ministry of Health of Russia dated February 26, 2002 N 65).

There are also a number of unresolved problems in the development of nursing: insufficient regulatory and legal support and imperfection of the system for managing the activities of nursing personnel, ineffective use of nursing personnel in practical health care, their performance of unusual functions of junior medical personnel, uneven provision of the population with nursing professionals, imbalance in the ratio doctor/nurse. Issues related to the low social and professional status of nursing staff need to be addressed. There are practically no scientific studies in the field of nursing, as well as scientific developments on the regulation of the work of a nurse. The most acute problem is the employment of graduates of the faculties of higher nursing education.

Unfortunately, at present, in practical healthcare, an environment has not been formed for the activities of a nurse of a new formation. Heads of medical institutions do not fully use the potential of nursing staff, taking into account their professional competence. First of all, this concerns the introduction of a modern nursing care system into the work of a nurse in disease prevention, health promotion, rehabilitation, home care and care, and palliative care.

It should be noted that today the pace of development and implementation of modern nursing technologies in practical healthcare is insufficient, which requires the development of a special model for the activities of nursing professionals, taking into account the reform of the industry, the restructuring of inpatient care, the organization of nursing care departments, the expansion of outpatient care and the redistribution of existing medical services. .

The following issues are currently in urgent need of resolution:

- development of a system for planning and forecasting the training of nursing professionals, their employment in accordance with the needs of healthcare institutions;

- improvement of the regulatory and legal framework and the system for managing the activities of nursing personnel;

- preparation of professional standards/protocols of nursing activities;

- introduction of the State educational standards of higher and secondary vocational education and the publication of educational and methodological literature, textbooks, visual aids;

- scientific support for the development of nursing.

In order to further improve and develop nursing in the Russian Federation in the context of healthcare reform

College

decides:

1. Consider the strategic goal of developing nursing in the context of healthcare reform in the Russian Federation to be to increase the efficiency of activities and strengthen the role of nursing personnel in providing medical and medical and social assistance to the population.

2. Department of educational medical institutions and personnel policy (Volodin N.N.):

2.1. Ensure control over the implementation of the state educational standards of higher and secondary vocational education of the new generation.

2.2. By January 1, 2003, to analyze the activities of assistance services in the employment of nursing professionals at educational institutions and prepare methodological recommendations in order to increase the efficiency of their work.

2.3. By August 1, 2002, prepare a draft order on the introduction of the specialty "Management of nursing activities" into the Nomenclature of specialties of healthcare institutions.

3. By November 1, 2003, the Department of Educational Medical Institutions and Personnel Policy (Volodin N.N.), the All-Russian Educational, Scientific and Methodological Center for Continuous Medical and Pharmaceutical Education of the Ministry of Health of the Russian Federation (Dushenkov P.A.) develop and approve training programs for educational implementation of the State standards of the new generation.

4. Department of educational medical institutions and personnel policy (Volodin N.N.), Department of organization and development of medical care to the population (Khalfin R.A.):

4.1. By February 1, 2003, submit for approval the model of nursing support for the healthcare system of the Russian Federation.

4.2. By December 1, 2002, develop Regulations on the All-Russian Competition for the Best Nurse.

5. Department of organization and development of medical care to the population (Khalfin R.A.), Department of medical problems of motherhood and childhood (Korsunsky A.A.), Department of economic development of health care, financial and material resources management (Putin M.E.), Department educational medical institutions and personnel policy (Volodin N.N.):

5.1. By December 1, 2002, submit proposals for the creation of standards/protocols for professional nursing in health care facilities.

5.2. By December 1, 2002, finalize and submit for approval methodological recommendations for studying the differentiated workload on nursing staff in medical institutions.

6. Department of Health Economic Development, Financial and Material Resource Management (Putin M.E.), Department of Organization and Development of Medical Assistance to the Population (Khalfin R.A.), Department of Educational Medical Institutions and Personnel Policy (Volodin N.N.):

6.1. By November 1, 2002, to consider the issue of clarifying the names of positions entered in health care institutions in relation to the specialty "Management of nursing activities" and develop tariff and qualification characteristics for them with subsequent submission to the Ministry of Labor of Russia.

6.2. By October 1, 2003, consider the issue and submit proposals for revising the current standards for nursing staff.

7. Until January 1, 2003, the Department of Medical Research Institutions (Tkachenko S.B.), the Department of Educational Medical Institutions and Personnel Policy (Volodin N.N.), rectors of higher medical educational institutions, directors of research medical institutions to develop a promising a plan for conducting scientific research on the development of nursing.

8.1. Provide conditions for the implementation of the State educational standards of higher and secondary vocational education in subordinate educational institutions.

8.2. Constantly improve work on the formation of a contingent and employment of graduates of institutions of secondary vocational education.

8.3. Before January 1, 2003, take measures to staff the health management bodies of the constituent entities of the Russian Federation with chief specialists in nursing.

8.4. By January 1, 2003, develop a long-term plan for the training of nursing specialists with higher and advanced levels of education in order to fill the positions of chief and senior nurses in medical institutions.

8.5. Before January 1, 2004, develop an action plan for the introduction of modern nursing technologies in medical institutions and monitor the progress of its implementation.

Chairman of the Board
first Deputy
Minister of Health
Russian Federation
A.I. Vyalkov

Board secretary
I.V. Pleshkov