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

1. Changes in the education system, i.e. Preparation and retraining:
   • introduction of a new educational standard;
   • transition to multi-level nursing education;
   • training new technologies from the position of the new philosophy S.D.
2. Changes in the work sphere:
   • increasing the prestige of the profession - the possibility of professional growth;
   • motivation of a nurse to independent research work;
   • revision of responsibilities, tariff nets, loads, list of positions;
   • the introduction of nursing standards.
3. Creating a regulatory framework of a nursing case.

In 1994, a all-Russian public organization was created "Association of Medical Sisters of Russia". President - Sarkisova Valentina Antonovna. The Omsk Association is represented by more than 10,000 representatives - one of the most numerous in the country. President - Zorina Tatiana Aleksandrovna.

Objectives of the Association:

• active participation in public health policy;
• support for scientific research in nursing business;
• development and publication of methodical literature;
• management of the introduction of new nursing technologies;
• implementation of legal protection of medical sesters;
• upholding the professional interests of nurses in the health care system;
• improvement of working conditions and wages;
• expansion of information space in nursing;
• revival of the traditions of nursing mercy;
• the international cooperation.

The Russian Medical Sisters Association for 10 years is a member of the European Forum of Nursing, Obstetric Associations and WHO, and in 2005 was adopted at the International Council of Medical Sisters. From this point on, the Association is actively involved in the formation of global, world politics in the field of nursing, and implements strategic health policy plans in Russia.

The formation and development of nursing business in Russia. The main directions of the reform of the nursing business.

Prerequisites, Essence and Main Directions

the reforms of the nursing business in Russia.

Nursing is the most important component of the health care system. An area of \u200b\u200bactivity aimed at solving the problems of individual and public health of the population with 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 overall level of health of a society. As science, nursing is based on knowledge, proven in practice.

For several decades in Russia, nursing issues did not pay due attention. The development of nursing technologies, taking into account modern science and developed countries, led to a sharp lag of a nursing business in Russia.

Prerequisites for the reform of the nursing case, its development are: negative medical and demographic processes. in particular - a decrease in fertility and aging of the population; deterioration of the health of the population; chronization of pathological processes in the body; Distribution of new diseases. such as HIV; Increase the cost of medical services. Gradually decreases the security of therapeutic and preventive institutions (LPU) by nursing staff. The two-stage method of servicing patients (physician, nurse) led to a decrease in the professional competence of nurses. Perform the functions that are not characteristic. The provision of LPU drugs, care objects, tools is reduced. The imbalance increases in the ratio between doctors and medical sisters. As a consequence, the deterioration of the quality of the assistance provided is to care (it is considered. That the optimal ratio between doctors and medical sisters is 1: 4).

The reform of nursing in Russia began in 1993. At the international conference "New Sisters for New Russia" was adopted by the philosophy of the nursing case, which marked the beginning of this process. Decree of the Government of the Russian Federation of 05.11.97 No. 1387 "On measures to stabilize and develop health and medical science in the Russian Federation" is provided for the implementation of reform. aimed at improving quality. Availability and economic efficiency of medical care to the population in the context of forming market relations.

The essence of the reform of the nursing case is to implement the necessary change in personnel policy on the basis of scientifically based approaches to planning, prepare and use of nursing personnel; ensuring a rational relationship between doctors and nursing staff; revival category of junior medical personnel; Organizations of new types of assistance related not only with diseases or pathological conditions, but also with problems of preserving and maintaining individual and public health. Currently, international experience is being studied in Russia. Its deep analysis, correction and adaptation to socio-economic conditions, taking into account national traditions, are held.

Order of the Ministry of Health of the Russian Federation No. 4 of January 9, 2001 approved the sectoral program for the development of nursing in the Russian Federation, reflecting the essence of the reform of the nursing business. Nursing business has significant personnel resources and real potential. Today in Russia there are about one and a half million secondary medical workers. This is the most massive medical profession.

The main goals and objectives of the reform of the nursing case are:

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

2. Creating a new conceptual Russian model of the nursing business. Each model recognizes the basic principles of primary health care (IPP). Today there is still a medical (traditional) model, the author of which is F. Plantgel. In this model, one of the components of the elements is the role of nurse as an assistant doctor with extremely limited professional independence.

3. The introduction of new technologies in nursing business. Bioethic professional approaches that can meet the population needs in affordable medical care.

4. Strengthening the prophylactic health care.

5. Conduct system transformations in nursing business - in the field of O6Pomen's research, scientific research. Practical health care, promotion and development of nursing associations.

6. Improving the status of nursing staff both professional and social. Ensuring the social security of specialists of nursing and much more.

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

1. Regulatory support for nursing activities, labor protection in healthcare facilities.

2. Creating standards (protocols of professional nursing activity), their testing and further implementation into practice.

5. Revision of remuneration of remuneration of the specialty "Nursing case", depending on the quality of the work performed and the level of education based on new Nursing technologies.

Levels of training nurses and Russia. Nursing periodicals

By 1994, a three-level sister education system was formed in Russia. Each level of training specialists complies with its state educational standard (requirements for minimum preparation content in the specialty). Disciplines will determine the main fixes

3rd level

Higher Nursing Education (university)

2nd level (college)

1st Level (Medical School)

Medical professional education

Levels of preparing nurses and Russia

preparation of graduates. Such an education system makes it possible to realize yourself in various fields of professional activity. Performing functions from performers to managers. The emergence of new posts makes it possible to save work time costs, for example, the introduction of the position of the "sister coordinator" allows to save the costs of working time not only the ward senior nurse, but also the head of the department. Order of the Ministry of Health of Russia of 02.26.02. No. 65 introduced the position of chief specialist in nursing. The first edition of specialists with higher nursing education took place in 1995. By 2002, the number of Russian universities in which the Faculties of Higher Nursing Education are open. amounted to 34, and the total number of graduates - over 2.5 thousand managers in the field of nursing business.

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

Currently, new periodicals are published in the Russian Federation for teachers of educational medical institutions, practical doctors, medical sisters, paramedics, midwives, organizers and other health workers. This contributes to the accumulation of invaluable experience in reforming nursing, studying and implementing innovation into practical health, the existing information deficit is replenished.

Periodic editions for medium-sized medical workers are becoming increasingly popular - this is:

The scientific and practical magazine "Medical assistance" has been published since 1998;

The magazine "Nursing" was published in 1995;

Magazine "Medical sister", published since 1999;

Magazine "Sister Mercy", published since 2001

And other periodicals.

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

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

Role, goals and objectives

Nursing assistance all this time was considered in the framework of "patient care". Nursing business (SD) entered the professional lexicone recently. For many decades, in our country, the nurse was prepared only for "performing different auxiliary functions appointed by the doctor." The lack of scientific principles and approaches to the system of training and use of nursing staff, unclear prospects for professional growth, severe working conditions and low labor payment led to the fact that in Russia the profession of nurse became less prestigious, and the social status was steadily declining.

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

In 1992, the Moscow Medical Sisters Association was established - the first association in Russia.

In 1993, Golitsyno held an international seminar on the reform of the nursing education and the nursing practice "New Sisters for New Russia". Objectives and objectives of the seminar:

■ to form a new Vision of SD in Russia through world experience in examining the subject and the creation of training modules for nursing education;

■ familiarize Russian nurses with international SD experience;

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

The main directions of the reform of nursing in Russia:

create a regulatory framework of the nursing case;

determine the philosophy of the nursing case;

create a multi-level system of training specialists of nursing;

introduce the nursing process in nursing practice.

Today, nursing business is defined as "providing individuals, families or populations with medical care associated with restoring or maintaining health." Unfortunately, inour country in the center of Nursing and Healing is not a person with his needs, but his illness, i.e. Until now, physicians have an installation on the treatment of illness without taking into account the personality of a person.

In 1994, the Interregional Medical Sisters Association of Russia was established.

Objectives of the organization:

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

■ Protection of professional rights;

■ improving the quality of medical care;

■ improvement of working conditions and salary;

■ raising the level of qualifications of nurses and their education;

■ Revival of the traditions of nursing mercy.

In 1995, the magazine "Nursing" is published.

In 1997, the Association of Medical Sisters creates the Ethical Code of the Medical Sister of Russia.

In 1998, the I All-Russian Congress of Middle Medical Workers in St. Petersburg was held. The draft State Program for the Development of Nursing Cases in the Russian Federation has been approved.

Multi-level training of nursing specialists is introduced - the basic level, elevated level, higher sister education (NDO):

In the development of SD, it is conventionally distinguished by 3 stages:

The 1st stage - sister plays a guardian role (winning, help disabled, mental patient, dying, orphans). The main function of the sister is hygienic care.

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

3rd stage - the end of the 90s of the XX century. - The beginning of the XXI century. The sister serves as an independent specialist within its competence.

Modern nursing case in this period is experiencing a stage of active reform. The activities of the modern nursing service are carried out in certain areas that are developed and set out in the Nursing Development Program in the Russian Federation. In 1997, in accordance with the order of the Russian Federation of December 31, 1997 № 390 "On measures to improve the nursing case in the Russian Federation" was drawn up a program for the development of a nursing business in Russia.

The average nursing staff is the dominant part among health workers. The reform of nursing education gave positive results. In Russia since 1995, the preparation of nurses with higher education began. Modern concepts and terms are formulated in the Development Program. Nursing case is considered as one of the main components of health. It includes health promotion, prevention of diseases, providing psychosocial assistance to those in need. Medical sisters exercise medical care in special medical institutions, as well as at home. Nursing staff should have education in the specialties: "Nursing", "obstetric matter", "Therapeutic case (Feldsher)". In the implementation of the Nursing Development Program, 2 stages were allocated.

Stage 1: From 1998 to 2000: The regulatory framework and the logistical base for the work of nurses are developed and adopted.

2nd stage: from 2000 to 2005: the implementation of cost-effective ways of work of nursing services in the health care system.

The Nursing Development Program is ensured by financing from the federal budget, the funds of the budgets of the constituent entities of the Russian Federation and the extrabudgetary sources attracted to it. Quality control in 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 the Nursing Case indicates the tasks of the development of nursing in the Russian Federation.

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

2. Protection to more efficient use of resources in health care.

3. Development of new methods of organization and technology of nursing assistance.

4. The more advanced qualification training of nursing staff.

5. Ensuring high quality nursing assistance to all segments of the population.

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

7. Improving the status of the profession of a medical sister.

8. Supporting the social security of nursing staff.

9. Development of nursing associations.

The Nursing Development Program in Russia is based on clear, defined principles.

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

2. The principle of availability. Medical assistance should be available to every person regardless of the place and area of \u200b\u200bits residence and other factors.

3. The principle of prevention and timely strengthening of every person's health.

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

If earlier the nurse was considered as an assistant doctor and was obliged to fulfill all his appointments, then at the present stage of health development, the powers of a medical sister expanded: it has the right to independently make decisions when assisting the population.

The activities of the modern medical sister has certain directions and tasks.

1. Provision of primary health care. Implementation of preventive work among the population. The medical sister should actively implement sanitary education of patients: to form a healthy lifestyle for each patient, produce primary and secondary prevention of the population. Primary prophylaxis is aimed at preventing the development of the disease in a healthy person. Secondary prevention is measures to reduce recurrence in humans with chronic diseases. The medical sister should participate in solving issues of sex education, in family planning.

2. Provision of therapeutic and diagnostic assistance to patients, highly qualified care for patients. Polyclinics, hospitals, Feldsher-obstetric items for better work should be equipped with modern equipment and enough drugs, dressings, injection and other medical facilities.

3. Provision of rehabilitation and medical and social assistance in need: chronic patient, disabled, elderly.

4. Ensuring palliative care oncological patients. Creating hospices and nursing hospitals for people need. Creating pattering service patients and their maintenance at home.

5. The principle of providing high-quality medical nursing assistance to the entire population.

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

In modern conditions, the requirements for professional training of nurses are increasing. The need for average medical personnel, which can work on modern therapeutic and diagnostic medical equipment: electrocardiograph, x-ray installations, physiotherapy devices, apparatus for resuscitation and monitoring the patient. In addition, the medical sister should own the basics of psychology, know the nursing process and be able to apply knowledge directly in practice. The medical sister should know the basis of the legal framework and be able to correctly fill out medical records.

An important role in organizing the work of the nursing service belongs to the leaders of nursing services at various levels: senior medical sister, main medical sister, medicine managers. For more efficient work of the nursing service, there must be a close vocational relationship and cooperation of nurses with doctors, the administrative part, the Ministry of Health and Social Development, other specialists and divisions.

Currently, there are many flaws and deficiencies in organizing the work of the nursing service. It is important to further improve its organization and management in the Russian Federation. Development and introduction of general principles and approaches to the organization of work of nursing staff are needed. Currently there is no common, unified management system. This adversely affects the work of nurses, and therefore directly on the health of patients. For a more efficient organization of the nursing service, it is necessary to organize a multi-level management system. The main thing here is the emergence of specialists in the Nursing Court 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 main medical sister should own the fundamental principles and have higher education in the specialty "Medicine Manager". It is better to provide high quality organization of the work of the nursing service. Development and implementation in the practical work of the standards of professional activities of the medical sister in the outpatient work of the polyclinic field and hospitals. In order for the nurse to qualitatively perform its work and satisfy the needs of the patient (on the oil), it should not only clearly and professionally perform prescribed manipulations. The basis of the professionally performed work of the medical sister should be the observance of the culture of deontology, ethical norms, respectful attitude towards each patient.

Ministry of Health of the Russian Federation
College

Nursing Development in Health Reform Conditions

The board of the Ministry of Health of the Russian Federation notes that the industry is carried out and is constantly being improved by the work on the implementation of tasks defined by the concept of health care and medical science in the Russian Federation, in terms of the development of a nursing case in the context of health care.

In the period from 1994 to 2001, the preparation and use of Nursing specialists were discussed at the 6th colleges of the Ministry of Health of Russia, at the 1st All-Russian Congress of Middle Medical Workers and the 1st All-Russian Employment Congress, Council Policy Council meetings with the Minister of Health of the Russian Federation and Council Ministry of Health of Russia in Nursing. The doctrine of medium medical and pharmaceutical education in the Russian Federation, the sectoral program of development of the nursing business in the Russian Federation. The work carried out to improve the quality of training specialists of nursing at all stages of vocational education and most effectively use them in practical health care.

The board notes the increasing role of nursing staff as the largest category of health workers in ensuring accessible and qualified medical and social and social assistance to the population of the Russian Federation, enhancing preventivecy.

The Ministry of Health of Russia provides organizational and methodological guidance of 450 secondary medical and pharmaceutical educational institutions, in which over 230 thousand tents are studying.

In order to regulate educational activities and ensure the quality of the preparation of medical personnel by the Ministry of Health of Russia, together with the All-Russian Educational and Scientific and Methodological Center for Continuing Medical and Pharmaceutical Education, the state educational standards of secondary vocational education of a new generation for all 10 specialties enshrined in the industry are developed and approved by the Ministry of Education of Russia. Health. " The introduction of standards in all medium-sized medical and pharmaceutical educational institutions of the Russian Federation has been provided since September 1, 2002.

In order to implement the requirements of the State Standard, creative teams of educational institutions have been developed and approved by the Ministry of Health of Russia, curriculas providing the educational process of the 1st year of study on the new state. Approved recommendations on educational and methodological and technical support of the educational process. Currently, the development of new training programs for subsequent courses in all specialties of training is actively continuing. Work is organized on creating copyright groups for the preparation and publication of textbooks, educational and methodical literature, benefits.

Over the past decade, the Ministry of Health of Russia, together with the territorial health care bodies, a lot of work was carried out on the preparation and use in practical health care nurses with higher medical education. Health management bodies of all constituent entities of the Russian Federation consider it extremely important and necessary this practice.

To date, in higher educational institutions of the Ministry of Health of Russia, 30 faculties are operating, where about 7 thousand tents are studying, of which more than 4.5 thousand in correspondence formation of medical sisters with higher education on the initiative of the Ministry of Health of Russia approved by the Decree of the Government of the Russian Federation From 11/22/97 and is actively introduced in universities of Russia, which allows the use of this form of training internized medical sisters, midwifery and paramedics.

Improving the personnel support system of the industry, employment of graduates of educational institutions depending on the level of education and consolidation of them at workplaces is currently one of the main tasks in reforming the industry.

All educational institutions of the Ministry of Health of Russia have retained a graduate employment system. In medium-sized medical and pharmaceutical educational institutions, departments for promoting graduates were created. In most regions, health care workers have developed and approved sectoral programs for promoting medical and pharmaceutical workers with trade unions of health care workers.

The most important direction of the Nursing Development Program is the improvement of all forms of postgraduate education.

Stores of postgraduate training in areas according to the approved nomenclature of specialties of medium-sized medical workers have been developed and approved.

The highest nursing education continues to be developed and improved, which will allow to create the potential for scientific research and the modernization of nursing care, will provide a branch with highly qualified management and pedagogical personnel.

Recently, the active activities of the regions on the fulfillment of tasks aimed at reforming the nursing cause were noted.

Regional programs for the development of sister affairs have been developed and approved and approved and approved, problematic commissions or sister-based councils have been created, meetings of colleges. For the management of nursing activities in 73 health authorities of the subjects of the Russian Federation, the posts of major specialists in the nursing business were introduced.

To revise current standards for nursing staff in 11 territories, work is carried out on the study of the differentiated load on the nursing staff of therapeutic and prophylactic institutions, taking into account the reform of nursing activities.

Medical prevention centers work, a network of medical and social offices, nursing houses for the treatment and rehabilitation of the elderly, disabled, incl. At home.

Experimental work is expanding on the introduction of the nursing process in the LPU.

Developed programs for the interaction of educational and medical and preventive institutions.

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

The Ministry of Health of Russia has been developed and presented for discussion the draft model of the nursing support of the health system of the Russian Federation.

In order to form a system for managing the activities of specialists of the Nursing Specialists, the position of chief specialist in the nursing business was introduced (order of the Ministry of Health of Russia of 26.02.2002 N 65).

In the development of the nursing case, there are also a number of unresolved problems: insufficient regulatory support and imperfection of the Nursing personnel management system, the ineffective use of nursing personnel in practical health care, the fulfillment of the unusual functions of the younger medical personnel, unevenness in providing the population by Nursing Specialists, an imbalance in relation Doctor / medical sister. Require solutions related to low social and professional status of nursing staff. There are practically no scientific research in the field of nursing business, as well as scientific developments on the standardization of the work of a medical sister. An acute problem is the employment of graduates of the faculties of higher nursing education.

Unfortunately, now in practical health care is not formed Wednesday for the activities of a new formation medical sister. Heads of medical and preventive institutions do not fully use the potential of nursing staff, taking into account his professional competence. First of all, this concerns the introduction of a modern system of nursing care to the work of a medical sister on disease prevention, health, rehabilitation, help and home care, to provide palliative care.

It should be noted that today the pace of development and implementation in practical health care of modern nursing technologies is insufficient, which requires the development of a special model of specialists of nursing, taking into account the reform of the industry, restructuring inpatient care, the organization of the branches of nursing care, and expanding outpatient policlinic assistance and the redistribution of existing medical services .

Currently require an urgent solution to the following problems:

- development of the planning and forecasting system for the training of specialists of nursing, their employment in accordance with the need of health institutions;

- improvement of the regulatory framework and the system of management of nursing staff;

- preparation of professional standards / protocols of nursing activities;

- the introduction of state educational standards of higher and secondary vocational education and the publication of educational and methodical literature, textbooks, visual benefits;

- Scientific support for the development of nursing.

In order to further improve and develop a nursing case in the Russian Federation in the context of reforming health care

College

solves:

1. To consider the strategic goal of the development of the nursing case in the context of reforming health in the Russian Federation - improving the efficiency of activity and strengthening the role of nursing staff in the provision of 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 introduction of state educational standards of higher and secondary vocational education of a new generation.

2.2. By January 1, 2003, to analyze the activities of the services of facilitation in the employment of specialists of nursing cases in educational institutions and prepare guidelines in order to improve the efficiency of their work.

2.3. By August 1, 2002, to prepare a draft order for the introduction of specialty institutions of health care specialty "Department of Nursing Activities".

3. By November 1, 2003, the Department of Educational Medical Institutions and Personnel Policy (Volodin N.N.), the All-Russian Educational and Methodological Center for Continuing Medical and Pharmaceutical Education of the Ministry of Health of the Russian Federation (Usersukov P.A.) Develop and approve the training Programs for educational implementation of state standards of a new generation.

4. Department of Educational Medical Institutions and Personnel Policy (Volodin N.N.), Department of Organization and Development of Medical Aid Population (Halfin R.A.):

4.1. By February 1, 2003, to submit to the approval of the nursing system for the health system of the Russian Federation.

4.2. By December 1, 2002, to develop a provision on the All-Russian Competition for the Best Medical Sister.

5. Department of the organization and development of medical care to the population (Halfin R.A.), the management of medical problems of motherhood and childhood (Korshunsky A.A.), Department of Economic Development Health, Finance and Material Management (Putin M.E.), Department educational medical institutions and personnel policies (Volodin N.N.):

5.1. By December 1, 2002, to submit proposals for the establishment of standards / protocols of professional nursing activities in medical and preventive institutions.

5.2. By December 1, 2002, to finalize and submit to approval Methodical recommendations for the study of the differentiated load on the nursing staff in medical and prophylactic institutions.

6. Department of Economic Development Health, Financial Management and Material Resources (Putin M.E.), Department of Organization and Development of Medical Aid Population (Halfin R.A.), Department of Educational Medical Institutions and Personnel Policy (Volodin N.N.):

6.1. By November 1, 2002, consider clarifying the names of the posts introduced into health institutions, in relation to the specialty "Department of Nursing Activities" and develop tariff-qualification characteristics on them, followed by a submission to the Ministry of Affairs of Russia.

6.2. By October 1, 2003, consider the issue and submit proposals for the revision of existing standards for nursing staff.

7. By January 1, 2003, the Office of Research Medical Institutions (Tkachenko S.B.), Department of Educational Medical Institutions and Personnel Policy (Volodin N.N.), Rectors of Higher Medical Academic Institutions, Directors of Research Medical Institutions to develop promising Research plan for the development of nursing business.

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

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

8.3. Until January 1, 2003, take measures to staffing the health authorities of the constituent entities of the Russian Federation by the main specialists in the nursing case.

8.4. By January 1, 2003, to develop a promising plan for the training of nursing specialists with the highest and increased level of education in order to complete the positions of the main and older medical sisters of therapeutic and preventive institutions.

8.5. By January 1, 2004, develop a plan of measures to introduce modern nursing technologies in medical and preventive institutions and monitor the progress of its implementation.

Chairman of the Collegium
first Deputy
minister Health
Russian Federation
A.I.Velkov

Secretary of the Collegium
I.V.Pleshkov