The main directions of development of nursing. The main directions of the reform of nursing. There are certain prospects for postgraduate advanced training of nurses with higher education


The main problems noted in the Concept: 1. ... The ratio between the number of doctors and nurses in our country is much lower than in most developed countries of the world, which causes an imbalance in the system of medical care, limits the development of post-treatment, patronage, and rehabilitation services.


Educating patients and families Assessing the needs of the individual and their family Identifying problems that can be addressed through nursing interventions Involving the patient and their immediate environment in prevention and rehabilitation Assessing the knowledge and skills of family members Preparing and providing adequate information Assisting the patient and the immediate environment in mastering the necessary skills Implementation of nursing care with the inclusion of nursing interventions for prevention for rehabilitation for psychological support of an individual or family Functions of nursing staff (WHO Bureau of Nursing)


The main problems noted in the Concept: 2. Low wages for nursing staff. 3. Equalizing approaches to wages. 4. Low social protection of medical workers with secondary medical education. 5. Low prestige of the profession.


The main problems noted in the Concept: 6. Non-compliance of the Federal State Educational Standard of secondary vocational and higher nursing education with modern healthcare needs. 7. Low quality of teaching. 8. Lack of a system of continuing medical education




Low motivation of healthcare workers Low motivation of healthcare workers Insufficient level of remuneration The average salary in healthcare was 8870 rubles, The average salary of nurses was 4546 rubles 38% of healthcare workers have wages below the subsistence level The difference in funding at the level of constituent entities of the Russian Federation reaches 12 times, and at the level of municipalities - 50 The difference in financing at the level of subjects of the Russian Federation reaches 12 times, and at the level of municipalities


The most important problems in the field of health management are low wages and equalizing approaches to remuneration of nursing personnel, low social security and prestige of the profession, discrepancy between the Federal State Educational Standards of secondary medical education and modern health needs, the lack of a system of continuing medical education, low awareness of nurses about modern means and methods of patient care, methods of diagnosis, prevention and rehabilitation 12


The main priorities of the Program for the Development of Nursing in Russia until 2020 development of the state and public system development of the state and public system for managing nursing activities, managing nursing activities, creating legal, organizational and economic creation of legal, organizational and economic conditions for the development of nursing in Russia, conditions for development nursing in Russia, improving the quality and accessibility of nursing care, improving the quality and accessibility of nursing care, motivation of the population to preserve and strengthen the motivation of the population to preserve and promote health, the formation of a cult of a healthy lifestyle. health, the formation of a cult of a healthy lifestyle. Slide author I.MISKARYAN 13


The purpose of the development of nursing is to improve the quality of nursing care through the rational use of the potential of nursing staff, which ensures an increase in the quality and life expectancy of the population, contributing to patient satisfaction with the quality of medical services, their availability and cost-effectiveness. fourteen


Tasks for the development of nursing Care Formation of conditions for improvement Formation of conditions for increasing the efficiency and strengthening the role of nursing personnel in providing medical care to the population by improving the regulatory legal and material and technical base of nursing activities, using modern and economically acceptable organizational forms and resource-saving technologies in the work of nursing personnel, ensuring the quality of medical care, its preventive orientation, increasing the satisfaction of the population with the medical services provided; fifteen


Tasks for the development of nursing; improvement of the management system; improvement of the management system of nursing activities by increasing the efficiency of the use of human and financial resources in health care, information support; improvement of the remuneration system; improvement of the remuneration system for nursing professionals, taking into account the specifics of their work, the level of education, as well as the results of work; 16


Tasks for the development of nursing: improvement of the system of professional improvement of the system of vocational training in accordance with the needs of the individual, with the needs of the labor market in each region, by forming a highly qualified nursing specialist capable of independent decision-making within his competence; ensuring the management of the scientific field; ensuring the management of the field of scientific activity in the field of nursing, coordinating and increasing the volume of activities to create a new generation of methodological literature for nursing professionals; 17


First stage: Preparation of normative legal acts regulating the activities of specialists with different levels of nursing education in the field of health care and determining the differentiated workload on nursing personnel, taking into account the contingent of patients, the use of new nursing care technologies and the type of nursing care 18


First stage: completion of the development of professional standards and procedures for the provision of pre-hospital medical care by specialists with secondary medical education, informatization of the activities of nursing staff, the introduction of an information system for personalized medical care accounting. 19


First stage: implementation of measures for the transition to a new system of organizing medical care, the formation of an integrative system of continuous training based on a unified personnel policy, the development and implementation of a program of technologies for the prevention, diagnosis and treatment of socially significant diseases by specialists with secondary medical education. twenty


First stage: Continued implementation of the national project "Health" in the following areas: the development of primary health and social care and the improvement of preventive measures, increasing the availability and quality of specialized, high-tech medical care, the formation of motivation for a healthy lifestyle among the population of the Russian Federation, reducing morbidity and mortality from socially significant diseases . 21


Second stage: raising the status of a specialist with a secondary medical education, creating a system of social protection for nursing personnel, implementing a phased transition to a self-regulating system for organizing the provision of medical care, conducting widespread computerization of workplaces, 22


Second stage: introduction of new technologies developed taking into account the priorities of the innovative development of healthcare in the region, standardization and informatization of the activities of personnel with secondary medical education, ensuring the continuity of the actions of medical services at each level at all stages of treatment to achieve the best result, 23


Second stage: giving priority to preventive work for all categories of personnel with secondary medical education in the primary health care system, development of patronage and rehabilitation medical care, including the creation of a network of institutions for rehabilitation, rehabilitation, medical care, unified equipping of health facilities with equipment in accordance with the standards and procedures for providing medical care. 24


1. Increasing satisfaction of the population with the quality of medical care, including nursing. 2. Preparation of legal acts regulating the differentiated workload for nursing staff, remuneration of nursing professionals depending on the level of education, quality and volume of work performed, as well as labor protection and prevention of occupational diseases of nursing professionals. 1. Increasing satisfaction of the population with the quality of medical care, including nursing. 2. Preparation of legal acts regulating the differentiated workload for nursing staff, remuneration of nursing professionals depending on the level of education, quality and volume of work performed, as well as labor protection and prevention of occupational diseases of nursing professionals. EXPECTED RESULTS AND PERFORMANCE EVALUATION


3. Increasing the prestige of the nursing profession. Consolidation of young specialists with secondary medical and pharmaceutical education in the healthcare system. 4. Formation of a management model for nursing services, which will improve the organization of the activities of nursing staff. 5. Improvement of the current nomenclature of specialties for workers with secondary medical and pharmaceutical education. 3. Increasing the prestige of the nursing profession. Consolidation of young specialists with secondary medical and pharmaceutical education in the healthcare system. 4. Formation of a management model for nursing services, which will improve the organization of the activities of nursing staff. 5. Improvement of the current nomenclature of specialties for workers with secondary medical and pharmaceutical education. EXPECTED RESULTS AND PERFORMANCE EVALUATION


6. Increasing the level of professional responsibility of nursing professionals and expanding the range of nursing services through the rational distribution of participants in the provision of medical care. 7. Creation of standards for the professional activity of nursing personnel with different levels of education, standards for nursing services, a standard for equipping workplaces. 6. Increasing the level of professional responsibility of nursing professionals and expanding the range of nursing services through the rational distribution of participants in the provision of medical care. 7. Creation of standards for the professional activity of nursing personnel with different levels of education, standards for nursing services, a standard for equipping workplaces. EXPECTED RESULTS AND PERFORMANCE EVALUATION


8. Formation of the information infrastructure of the industry using systems and technologies, telecommunication networks. 9. Creation of conditions for the development of scientific research in the field of nursing, preventive and clinical medicine. 10. Development of international cooperation in the field of nursing. 8. Formation of the information infrastructure of the industry using systems and technologies, telecommunication networks. 9. Creation of conditions for the development of scientific research in the field of nursing, preventive and clinical medicine. 10. Development of international cooperation in the field of nursing. EXPECTED RESULTS AND PERFORMANCE EVALUATION



After studying this topic, you will learn:

  • causes, directions and events of the era of nursing reform in Russia;
  • periodicals for nursing staff in Russia;
  • the main activities of nursing staff in medical organizations;
  • background, essence and main directions of nursing reform in Russia;
  • decisions of the international scientific-practical conference on the reform of nursing in Russia (Golitsyno, 1993);
  • the content of the resolutions of the I and II All-Russian Congresses of paramedical workers;
  • the level of training of nurses in Russia;
  • the role and tasks of the Russian Association of Nurses (RAMS);
  • the importance of conducting scientific research in nursing;
  • further prospects for the development of nursing in Russia.

Key concepts: nursing staff training system, FVSO,

activities of nursing staff, schools for patients with chronic diseases, hospice, palliative care, RAMS, MSM.

MAIN DIRECTIONS AND EVENTS OF REFORMING NURSING IN RUSSIA

The reasons that gave rise to the need for reform include the low level of quality of medical care for the population, the low prestige of the profession, the low social status of nurses, the lack of prospects for professional growth, the mismatch of the level of nursing education with the requirements of the time, the shortage of nursing teaching staff, the lack of scientific research in the field of nursing and ignorance of foreign experience.

The reform of nursing in Russian health care has unfolded in several directions:

  • nursing education;
  • practical activities;
  • conducting scientific research in nursing;
  • self-management and consolidation of the nursing profession;
  • development of international cooperation.

Let's highlight the main events in the reform of nursing in Russia (Table 7.1).

Table 7.1

The main events of the era of reforming nursing in Russia

Founding events

Opening in Moscow of the country's first advanced training school for workers with secondary medical and pharmaceutical education

Nursing Conference in Tula

National Nursing Seminar in Rostov-on-Don

Appearance in the nomenclature of educational specialties in the field of health care of the specialty "nursing" instead of "nursing"

Nursing conference in Zvenigorod

I European Nursing Conference (Vienna)

All-Union Conference of Specialists with Secondary Medical Education (Tula)

Opening of the first hospice in Russia (St. Petersburg)

Order of the State Committee of the USSR on Public Education dated June 28, 1991 No. 313 “On the opening of the specialty “nursing” (in higher education)

Opening of the first colleges and first faculties of the VSO (MMA named after I.I. Sechenov, Samara State Medical University, Kursk State Medical University ...). The first steps to create a multi-level system for training nursing personnel (basic - advanced - higher)

Formation of an initiative group for the creation of the Interregional Association of Nurses of Russia

Opening of St. Demetrius School of Sisters of Mercy (Moscow)

Opening of the faculty for advanced training of specialists with secondary medical education at RMAPE

Termination of the publication of the journal "Medical Sister"

Conference on nursing within the framework of the international project "New Sisters for the New Russia" in Golitsyn

Founding of the journal "Medical assistance"

Adoption of the "Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens"

Creation of the country's first experimental department of nursing care (mini-hospital) on the basis of the St. Petersburg Medical Center named after L. Sokolov (at TsMSCH-122)

Registration of the Interregional Association of Nurses of Russia (MAMS)

Founding events

Defense of the dissertation for the degree of Doctor of Medical Sciences G.M. Perfilieva "Nursing in Russia (social and hygienic analysis and forecast)"

Creation of a WHO collaborating Center for Nursing and Midwifery on the basis of the Faculty of Higher Nursing Education of the Moscow Medical Academy. THEM. Sechenov (Director - Prof. G.M. Perfilieva)

Publication of the first issue of the magazine "Nursing"

Beginning of part-time classes for trained nurses at the FVSO (St. Petersburg, Samara, Orenburg)

All-Russian conference on nursing "Problems and prospects for the development of nursing" (June 27-28, St. Petersburg). The conference adopted in the first reading the Code of Ethics for Russian Nurses developed by IALA

Publication of a package of educational materials on nursing within the framework of a WHO project "LEMON" (Leaning Materials On Nursing)
  • 1996-

Implementation of the State educational standards for 10 medical specialties

All-Russian Conference on Nursing (May 26-28, St. Petersburg). Adoption of the Code of Ethics for Russian nurses. Establishment of a permanent Ethics Committee at IALA (Chairman A.Ya. Ivanyushkin)

Participation in the XXI MSM Congress (Vancouver, Canada) of two Russian nurses as guests. Danish nurse Kirsten Stalknecht elected as MSM President

Order of the Ministry of Health of Russia dated July 24, 1997 No. 217 "On the improvement of postgraduate training of medical and pharmaceutical personnel in internship"

Opening of the inpatient department of the First Moscow Hospice (September 18). Field service has been functioning since 1994

Decree of the Government of the Russian Federation of November 5, 1997 No. 1387 "On measures to stabilize and develop health care and medical science in the Russian Federation"

Opening of the Nursing Research Center on the basis of the advanced training school for workers with secondary medical and pharmaceutical education at TsMSCh-122 (St. Petersburg, November)

Order of the Ministry of Health of Russia dated December 31, 1997 No. 390 "0 measures to improve nursing in the Russian Federation"

Acceptance by the world community of the program "Health for All in the 21st Century"

All-Russian Conference on Nursing (June, St. Petersburg)

I All-Russian Congress of nurses (November 3-5, St. Petersburg). The draft State Program for the Development of Nursing in the Russian Federation was approved in the main

Resumption of the publication of the journal "Medical Sister"

Founding events

Creation by the American International Health Union of the Leadership Institute to prepare nurses from the CIS countries and Central and Eastern Europe to the role of international leaders

Participation of Russian sisters as guests in the international conference dedicated to the 100th anniversary of the International Council of Sisters

Approval of the Doctrine of Secondary Medical and Pharmaceutical Education in the Russian Federation

Creation of the Nursing Council under the Ministry of Health of Russia. The appearance in the Ministry of Health of the Russian Federation of the position of chief specialist in nursing

Order of the Ministry of Health of the Russian Federation dated 09.01.2001 No. 4 "On the Industry Program for the Development of Nursing in Russia"

Creation of the Interregional public organization of operating nurses. The main activity of the organization is aimed at holding interregional and international conferences on general and individual problems of the activities of operating room nurses.

A public organization of nurses of the Republic of Tatarstan has been registered, which currently unites about 11,000 members

Admission of Russian nurses to the International Council of Nurses

III All-Russian Congress of nurses (October 15-16, Yekaterinburg). It approved the draft Program for the Development of Nursing in the Russian Federation for 2010-2020.

The last mass enrollment of students in the specialty "Nursing" in Russian universities

Establishment of the Non-Commercial Partnership "Association of Specialists with Higher Nursing Education" (NP "ASVSO"),

The Ministry of Education and Science of the Russian Federation approved and put into effect the Federal State Educational Standard for Higher Professional Education (FG0S VP0) in the direction of training 060500 Nursing (qualification (degree) "Bachelor")

Opening in 1979 of the country's first advanced training school for workers with secondary medical and pharmaceutical education, held in 1986-1988. seminars and conferences, the certification of nurses that began in 1987 can be considered the starting points for subsequent changes in nursing and in the minds of doctors and nurses.

In 1988, the First European Conference on Nursing was convened in Vienna, the final documents of which noted the need for changes in the preparation, practice and management of nursing services.

In the framework of the practical recommendations adopted in Vienna for 1988-2000. WHO/Europe has set and implemented the following priorities: development of educational materials on AIDS for nurses; creating, translating, locally adapting and distributing a nursing package (LEMON); development of leadership in nursing; training of teachers and managers; promoting the creation of national plans for the development of nursing, etc.

In 1989, the All-Union Conference of Specialists with Secondary Medical Education discussed the place of nursing personnel in the domestic health care system and adopted recommendations for implementing the decisions of the Vienna Conference. This marked the beginning of a process that continues despite the socio-political cataclysms.

One of the most significant periods in the reform of nursing in Russia (see Table 7.1) can be considered 1993. Association of Nurses of Russia and " World Vision International sponsored by the US Agency for International Development (USAID).

At the conference, an attempt was made to understand the meaning of nursing as a profession, its values, and to define such categories as the patient, health, environment and nursing itself. The concept of the philosophy of nursing was included in the mandatory minimum content of professional programs in the specialties of nursing and pharmaceutical personnel in 1997.

The philosophy of nursing in Russia defines patient as a person (individual) who needs and receives nursing care. At the end of 1993, the patient's right to receive nursing care was legally enshrined in the Constitution of the Russian Federation, Art. 41-42 which guarantee the citizen health protection and medical care.

Proceeding from it, the Fundamentals of the Legislation of the Russian Federation on the Protection of the Health of Citizens were adopted, which define the principles of protecting the health of citizens, the tasks of the legislation, the rights of citizens in the provision of medical and social assistance, the obligations and rights of medical and pharmaceutical workers, the procedure for the production of medical examination, responsibility for causing harm the health of citizens in the provision of medical care.

In 1997, the Code of Ethics for Russian nurses was adopted, which defines the most important tasks of a nurse's professional activity, the sister's relationship with patients, colleagues, and society. For the first time there was a document relating directly to the activities of nursing staff. For the first time in a document that singled out the activities of a sister from the total activities of other specialists in the state healthcare system, the category “patient's rights” appears, thereby defining a qualitatively new subject-subject level of relationships in the “nurse-patient” system. Emphasizing the "humanistic human-centeredness" of the profession, the Code defines the ethical norms of a nurse's behavior as professionally important qualities.

In the “Concept for the Development of Healthcare and Medical Science in the Russian Federation”, adopted in the same 1997, there are, unfortunately, no direct instructions for nursing services, which still indicates an underestimation of the capabilities of nursing staff in reforming the industry, although the state of health care is characterized as approaching line "followed by the collapse of the entire health care system" .

However, the Order of the Ministry of Health of the Russian Federation of December 31, 1997 No. 390 “On measures to improve nursing in the Russian Federation” one of the leading roles in health care reform, ensuring the quality, accessibility and efficiency of the health care system, strengthening the preventive focus, solving the problems of medical and social assistance assigns specialists with secondary medical education. Therefore, in order to further develop nursing in Russia, to streamline the duties, responsibilities and functions of specialists with secondary medical education, it was decided to develop a State program for the development of nursing in Russia. Also, the order approved the "Regulations on the chief specialist in nursing of the health authorities of the constituent entities of the Russian Federation".

In 1998, the First All-Russian Congress of Nursing Workers took place, which approved the draft State Program for the Development of Nursing in the Russian Federation. The main objectives of the program:

  • creation of optimal conditions for the development of nursing;
  • development of new organizational forms and technologies of nursing
  • ensuring the quality of nursing care to the population;
  • raising the professional and social status of the nursing profession;
  • ensuring social security of personnel;
  • improving the management system of nursing services;
  • assistance in the development of professional associations and their involvement in the implementation of state policy in the field of nursing development in Russia.

In October 2004, the Second All-Russian Congress of Nursing Care Workers “Quality of Nursing Care - Healthcare Strategy of the 21st Century” was held, the main task of which was to form constructive proposals for the development of nursing, to determine the place and role of nursing personnel in reforming Russian health care. The Resolution of the Congress noted the need to create a Conceptual Model of Nursing in Russia, which should clearly define the place of a nurse in the healthcare system.

You can learn more about the activities of nursing staff on the pages of magazines published in our country: "Nurse", "Nursing", "Bulletin of the Association of Nurses of Russia", "Chief Nurse", "Medical Assistance", "Sister of Mercy", "Paramedic and Midwife".

By order of the Ministry of Health of the Russian Federation dated 09.01.01 No. 4, the industry program for the development of nursing in the Russian Federation was approved.

Nursing is the most important component of the healthcare system, therefore it cannot develop autonomously, its improvement is possible only together with the reform of the healthcare system as a whole, which, as you know, is aimed at creating qualitatively new forms of medical care focused on the final socially significant result in public health protection.

The history of the development of nursing, starting with N.I. Pirogov, S.P. Botkin testifies to the integration of the activities and educational space of the higher medical school and medical schools. The multi-level system of training of nursing professionals that is being formed now creates a real continuity of knowledge and skills according to the level of training. It is used in the practice of postgraduate education of nurses with higher education, who fill the content of the profession with new meaning.

The scope of nursing activities includes the provision of a wide range of services within the framework of primary health care and participation in high-tech scientific research. In a number of states, a similar range of roles for nurses was formed unplanned and unsystematic. This process was driven by the needs of the population, and in some countries by the desire to contain the growth of health care costs. Consequently, it has become more difficult for planners to describe the nature and extent of medical practice and, accordingly, to bring the skills and knowledge of nursing staff to the level of the needs of the population without duplicating services.

In some countries, there are 15 or more additional categories of nursing personnel, which differ in the degree of their professional training. A sister who has completed advanced training is characterized by:

specialization;

Expanded knowledge and improved skills;

Higher education and reinforcement of practice with research;

a significant degree of independence in practical work and independence in decision-making"

The reasons that gave rise to the need to reform nursing in Russia include the low level of quality of medical care for the population, the low prestige of the profession, the low social status of nurses, the lack of prospects for professional growth, the mismatch of the level of nursing education with the requirements of the time, the shortage of nursing teaching staff, the lack of scientific research in the field of nursing and ignorance of foreign experience. If in most European countries the reform of nursing began in the mid-70s, then in our country the need to reorganize the system of providing medical care to the population was truly realized only in the early 90s.

In Russia, the question arose of developing a concept for the further development of healthcare and medical science in the Russian Federation. Such a concept was developed and approved by the Decree of the Government of the Russian Federation of November 15, 1997. In December 1997, the order of the Ministry of Health of the Russian Federation No. 390 "On measures to improve nursing in the Russian Federation" appeared, and in January 2001 - order No. 4 of the Ministry of Health RF "On the sectoral program for the development of nursing in the Russian Federation". In the same period (December 2000), the Ministry of Health of the Russian Federation holds a collegium "On the training of social work specialists, clinical psychologists, nurses with higher education (managers) in universities of the Ministry of Health of Russia and their employment", and also issues order No. 440 from 20.12.2000 "On the establishment of the Council of the Ministry of Health of Russia on nursing." Much of what is reflected in these regulatory documents was prepared in St. Petersburg. “It was in our city in 1992 that the first faculty of higher nursing education in Russia was opened on the basis of the Medical Academy. I.I. Mechnikov, and in 1999 the Department of Nursing was created on the basis of SPbMAPO.

The reform of nursing and education in Russia, the development of medical science, the introduction of intensive medical, pedagogical and information technologies impose new requirements on nursing personnel. Currently, the modern concept of nursing specialty is being formed. Nursing is an independent branch of medicine.

In the conditions of reforming nursing and the labor market, high demands are placed on a modern nurse, regarding both a good education, possession of manipulative techniques, and the presence of critical thinking, communication and pedagogical skills. Thus, the growth of the effectiveness of medical care with a sufficiently high level of education of the nursing staff allows for the differentiation of nursing activities, improve the standards of pre-medical care, determine and standardize the patient's needs for medical services, monitor and record medical care and, therefore, rationally and economically use health resources.

Currently, nursing in our country is facing many problems. First of all, it is:

The traditionally established idea of ​​a nurse, only as an assistant to a doctor;

· low salaries of nurses;

Performing unskilled labor (a nurse devotes only 15-20% of her working time directly to patient care);

Lack of standards of practice;

· “blurring” and ambiguity of official duties;

Great physical and psychological stress on the nurse (as a rule, there are up to 30 patients per nurse in the therapeutic department);

· constant outflow of qualified nursing personnel from practical health care;

routine and lack of creativity in the work of a nurse;

· shortcomings in the professional training of nurses;

Insufficient scientific approach to the problems of nursing;

Lack of a regulatory and legal framework for independent nursing practice, the impossibility of private practice;

It is impossible not to mention the conservatism of doctors and, moreover, even some of the nurses towards reforms in nursing.

The reform of nursing education, “although slowly and often painfully, is moving forward, and using not a revolutionary, but rather a reasonable, pragmatic approach: without destroying the valuable that has been accumulated over the years and using all the advanced foreign experience, but in no case copying it blindly."

The reforms are based on a strategy aimed at the comprehensive development of primary health care, including nursing. The key element of the reform was the turn of medical organizations to the personality of a nurse as a subject of activity, the development of which will inevitably entail the development of the organization itself. The practice required a nursing specialist of a new formation.

Therefore, the reform of nursing in Russian health care has unfolded in several directions:

nursing education;

· Nursing practice;

scientific research in nursing;

self-management and consolidation of the nursing profession;

· the international cooperation.

Thus, the following conclusions can be drawn:

The reforms currently taking place in healthcare are fundamentally designed to transform the system of nursing and education in Russia. The powers of the modern nurse-manager should be much broader than those of her predecessors, who performed purely technical functions of a physician's assistant.

The reform of nursing in Russian health care has developed in several directions: nursing education; nursing practice; scientific research in nursing; self-management and consolidation of the nursing profession; the international cooperation.

The reasons that gave rise to the need for reform include the low quality of medical care for the population, the low prestige of the profession, the low social status of nurses, the lack of prospects for professional growth, the mismatch of the level of nursing education with the requirements of the time, the shortage of nursing teaching staff, the lack of scientific research in the field of nursing and ignorance of foreign experience.

The reform of nursing in Russian health care has unfolded in several directions:

Conducting scientific research in nursing;

Reforming nursing education;
-reformation of practical activities;
-development of international cooperation;
-self-management and consolidation of the nursing profession. Let us single out the main events in the reform of nursing in Russia (table).

Opening in 1979 of the country's first advanced training school for workers with secondary medical and pharmaceutical education; holding in 1986-1988. seminars and conferences; The certification of paramedical workers, which began in 1987, can be considered the starting points for subsequent changes in nursing, and, first of all, in the minds of both doctors and nurses.

In 1988, the First European Conference on Nursing was convened in Vienna, the final documents of which noted the need for changes in the preparation, practice and management of nursing services.

In the framework of the practical recommendations adopted in Vienna for 1988-2000. WHO/Europe has set and implemented the following priorities: development of educational materials on AIDS for nurses; creating, translating, locally adapting and distributing a Nursing Education Package (LEMON); development of leadership in nursing; training of teachers and managers; promoting the creation of national plans for the development of nursing, etc.


Table. The main events of the era of reforming nursing in Russia.

In 1989, the All-Union Conference of Specialists with Secondary Medical Education discussed the place of nursing personnel in the domestic health care system and adopted recommendations for implementing the decisions of the Vienna Conference. This marked the beginning of a process that continues to go on, despite the socio-political upheavals.

1993 can be considered one of the most significant periods in the reform of nursing in Russia (see Table 2-1). carried out by the Interregional Association of Nurses of Russia and World Vision International with the financial support of the United States Agency for International Development (USAID).

At the conference, an attempt was made to understand the meaning of nursing as a profession, its values ​​and to define such categories as the patient, health, environment and nursing itself. The concept of “philosophy of nursing” was included in the mandatory minimum content of professional programs in the specialties of nursing and pharmaceutical personnel in 1997.

In the philosophy of nursing in Russia, a patient is defined as a person (individual) who needs and receives nursing care. At the end of 1993, the patient's right to receive nursing care was legally enshrined in the Constitution of the Russian Federation, articles 41-42 of which guarantee the citizen health protection and medical care.
Proceeding from it, the Fundamentals of the Legislation of the Russian Federation on the Protection of the Health of Citizens were adopted, which define the principles of protecting the health of citizens, the tasks of the legislation, the rights of citizens in the provision of medical and social assistance, the obligations and rights of medical and pharmaceutical workers, the procedure for medical examination, responsibility for causing harm the health of citizens in the provision of medical care.

In 1997, the "Ethical Code of the Nurse in Russia" was adopted, which defines the most important tasks of the nurse's professional activity, the sister's relationship with patients, colleagues, and society. For the first time there was a document relating directly to the activities of nursing staff. For the first time in a document that singled out the activities of a nurse from the total activities of other healthcare professionals, the category “patient's rights” appeared, thereby defining a qualitatively new, subject-subject, level of relationships in the “nurse-patient” system. Emphasizing the "humanistic human-centeredness" of the profession, the Code defines the ethical standards of behavior of a nurse as professionally important qualities.

Unfortunately, the “Concept for the Development of Healthcare and Medical Science in the Russian Federation” adopted in the same 1997 does not contain direct instructions for nursing services, which still indicates an underestimation of the capabilities of nursing staff in reforming the industry, although the state of health care is characterized as approaching the line "followed by the collapse of the entire health care system."

However, already the Order of the Ministry of Health of the Russian Federation dated December 31, 1997 “On Measures to Improve Nursing in the Russian Federation” assigns specialists with secondary medical education. Therefore, in order to further develop nursing in Russia, to streamline the duties, responsibilities and functions of specialists with secondary medical education, it was decided to develop a State program for the development of nursing in Russia. Also, the order approved the "Regulations on the chief specialist in nursing of the health authorities of the constituent entities of the Russian Federation."

In 1998, the First All-Russian Congress of Nursing Workers took place, which approved the draft State Program for the Development of Nursing in the Russian Federation.

The main objectives of the program:
-creation of optimal conditions for the development of nursing;
-development of new organizational forms and technologies of nursing care;
- ensuring the quality of nursing care to the population;
- raising the professional and social status of the nursing profession;
-ensuring the social security of personnel;
- improvement of the nursing services management system;
- assistance in the development of professional associations and their involvement in the implementation of state policy in the field of nursing development in Russia.

In October 2004, the II All-Russian Congress of Nursing Care Workers “Quality of Nursing Care - Healthcare Strategy of the 21st Century” was held, the main task of which was to form constructive proposals for the development of nursing, to determine the place and role of nursing personnel in reforming Russian health care. The decision of the congress noted the need to create a "Conceptual Model" of nursing in Russia, which should clearly define the place of a nurse in the healthcare system.

You can learn more about the activities of nursing staff on the pages of magazines published in our country: “Nurse”, “Nursing”, “Bulletin of the Association of Nurses of Russia”, “Chief Nurse”, “Medical Assistance”, “Sister of Mercy”, "Paramedic and Midwife".

Read also:
  1. ADMINISTRATION OF THE PRESIDENT OF THE RUSSIAN FEDERATION, ITS ROLE IN SUPPORTING THE ACTIVITIES OF THE PRESIDENT OF THE RUSSIAN FEDERATION. STATE COUNCIL OF THE RUSSIAN FEDERATION
  2. Actual problems of history in Russian historiography.
  3. Acts of the Constitutional Court of the Russian Federation. Legal positions of the Constitutional Court and their influence on the development of the legal system of the Russian Federation.
  4. Acts of the Government of the Russian Federation. Normative legal acts of federal executive authorities.
  5. Acts of the constituent entities of the Russian Federation and local governments and their relationship with federal legislation
  6. Analysis of the main shortcomings of the modern Russian financial system
  7. Ticket number 29. Influence of ethno-national factors on federal relations and prospects for the development of federalism in the Russian Federation.

Today, the attention of both society and the state is riveted to health care reform. The leaders of the country are aware that the sharp deterioration in the health of the population and the demographic crisis that manifested itself in the 1990s are becoming a serious factor in reducing the level of national security. Society vitally needs high-quality and, at the same time, more affordable medical services that reflect the current level of development of medical science and technology. In addressing this issue, the use of the potential of the nursing component of health care can provide significant assistance. Nursing, which has occupied a secondary position for many decades, is experiencing the full range of modern socio-economic problems, requires progressive changes.

Reforming the health care system is a priority in many WHO Member States, driven by low levels of care, the financial crisis, dissatisfied consumer demand, antipathy towards centrally controlled structures and a range of ideological motives. Countries are faced with the difficult task of creating new systems that can more effectively deal with pressing problems at a time when there is a shortage of human resources and financial resources, and when the transition from a planned centralized economy to a mixed or market economy has already reached a stage where the old system is not applicable, and the new one does not work yet.

The complex of political, socio-economic, demographic and environmental factors that have arisen in recent years in the country has had an extremely negative impact on the state of public health. The increase in demand for medical services occurs against the backdrop of an ever-increasing shortage of material and financial resources. Financing health care from the budgets of all levels and at the expense of compulsory medical insurance (CHI) funds cannot provide the population with publicly available free medical care. With the transition to compulsory medical insurance, a need arose for a new resource-saving organization system in healthcare.

The state policy in the field of Russian health care is focused on obtaining the maximum effect from available resources and, in particular, nursing personnel, whose services are considered the most valuable source of health care to meet the population's needs for affordable, affordable and cost-effective medical care. An important role in the healthcare reform, ensuring the availability and quality of services provided to the population, strengthening the preventive focus, solving the problems of medical and social assistance is assigned to specialists with a secondary medical education, an advanced level of education and a higher medical education in the specialty "Nursing" and constituting the largest category healthcare workers.



The World Health Organization (WHO) sees nursing personnel as a real potential to meet the growing needs of the population for affordable medical care.

WHO confirms that the strengthening and development of nursing should be supported through:

ü developing a strategy for planning labor resources and training nursing staff;

ü creating a regulatory legal framework for the development of nursing;

ü providing conditions for the effective activity of nursing staff, the possibility of full realization of their professional potential in cooperation with other categories of medical workers.



The most important determinants that determine the need for the development of nursing 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 pathology; the emergence and spread of new diseases, in particular AIDS; increase in the cost of medical services. This requires a wider use of nursing staff, strengthening the activities of nursing staff in the preventive direction of health care.

The healthcare system as a whole suffers from the imbalance of medical personnel, the ineffective use of nursing personnel in practical healthcare, which has a significant impact on the quality of medical care. There is an outflow of nursing staff, the burden on the remaining nursing staff is increasing, their dissatisfaction and social tension are growing. The real personnel disposition "nursing staff - doctors" is accompanied by interrelated negative trends:

An increase in the share of medical services in medical activities that do not require medical qualifications, but are to be carried out by well-trained nursing staff;

Downplaying the role of nursing staff in the treatment process, whose functions are reduced to performing technical work, often not requiring professional training.

The last factor is facilitated by the disappearance of the category of junior medical personnel, whose functions are forced to be taken over by nursing personnel to the detriment of their professional activities.

The current state of affairs in the domestic healthcare system is unique in its own way: the ratio of medical and nursing personnel is 1:2.28, while according to international standards, the effective functioning and development of the healthcare system, including in terms of economic indicators, is possible with a ratio of below 1:5. In practice, the negative impact of the current situation is expressed in the fact that an extremely high burden falls on the nursing staff, which does not allow each patient to be provided with high-quality and decent care, leading to numerous errors in their work. The state spends a significant part of the resources on providing expensive treatment at the most modern level, but the results of treatment are not consolidated by proper recovery and rehabilitation of patients, and often are completely nullified due to the inability to provide the patient with professional care.

Over the past decades, nursing has not been given due attention in the country. This led to a significant lag (about 20 years) in this area of ​​healthcare from the development of modern science and medical technologies, was the reason for the departure of qualified nursing personnel from the profession, a widespread decrease in the provision of medical and preventive institutions with nursing personnel, an increase in the imbalance in the ratio between doctors and medical sisters, and, as a result, the deterioration of the quality of medical care.

The problem of shortage of nursing staff is global in nature and is in the focus of attention of the World Health Organization, the International Council of Nurses, and health authorities in most countries of the world. The development of nursing is seen as a key direction in the progress of the entire health care system of the future.

In recent years, the Ministry of Health of Russia, together with the territorial health authorities, has carried out significant work that contributes to the revival, increasing the social significance and prestige of the nursing profession. This is confirmed by the implementation of the State Program for the Development of Nursing in the Russian Federation, the implementation of decisions of the collegiums of the Ministry of Health of the Russian Federation dated 04.20.94 "On the state and prospects for the development of nursing in the Russian Federation", dated 04.06.97 "On the development of medical and pharmaceutical education in the Russian Federation", a number international seminars "New Sisters for the New Russia". Decree of the Government of the Russian Federation dated 05.11.97 No. 1387 "On measures to stabilize and develop healthcare and medical science in the Russian Federation" provides for the implementation of a reform aimed at improving the quality, accessibility and cost-effectiveness of medical care to the population in the conditions of the formation of market relations.

In the context of economic transformations in Russia, the strategy for the development of nursing should meet the changing needs of healthcare, be socially acceptable, while guaranteeing the high quality of medical care for the population (Order of the Ministry of Health of the Russian Federation No. 4 of 09.01. ).

The role, functions and organizational forms of activity of nursing staff are changing in accordance with the new challenges facing health care:

Development of primary health care aimed at disease prevention and health promotion, hygiene education and education of the population;

Restructuring of medical institutions aimed at reducing the length of stay in the hospital;

Expanding the scope of home care;

Increase in rehabilitation measures;

Formation of hospitals/departments with different intensity of treatment and care;

The introduction of hospices and the provision of palliative care to the dying.

These factors require the improvement of the educational system for training and advanced training of nursing professionals, taking into account the needs of the healthcare system and the composition of the nursing staff. Implementation of the necessary changes in the personnel policy in the field of health requires evidence-based approaches to planning, training and use of nursing personnel, effective management of nursing personnel, ensuring a rational balance and partnership between doctors and nurses.

Obstacles to the implementation of the necessary changes in personnel policy and nursing education to date remain the weak material and technical base of educational institutions, the lack of specially trained teaching staff, etc.

A key concept that emphasizes the improvement of the field of nursing is to define the role of the nurse, which would correspond to the needs of people's health more than the needs of the health system. This means a fundamental restructuring of the concept of the traditional role of the nurse as a doctor's attendant. She must be a well-educated professional whose unique and significant contribution to health care is welcomed by all colleagues and who is considered an equal partner in the medical team. Its main practical activity is directly working with a patient or a population group, namely, work aimed at improving people's health. Thus, reforming health care, bringing its organizational structure in line with modern requirements is impossible without improving and changing existing approaches to organizing the work of a nurse.

To carry out reforms in nursing in the Russian Federation, it is necessary to solve the following problems:

Improving the system of professional training and use of nursing staff;

Improvement of the regulatory legal, material - technical and organizational - methodological base;

Improving the management of nursing activities;

Information support of the organization of nursing.

The training of nursing professionals and the introduction of the nursing process in medical institutions are among the priorities of the health authorities. For the rational and effective use of the existing human resources nursing potential, in the current situation, the formation of a state policy in the field of nursing and an increase in the responsibility of authorities at all levels for its implementation is becoming important.

In this regard, in the context of the Concept for the Development of Healthcare and Medical Science in the Russian Federation, the State Program for the Development of Nursing has been developed in order to specify and implement directions and provisions related to all aspects of nursing. The program was developed in accordance with the order of the Ministry of Health of the Russian Federation dated December 31, 1997 No. 390 "On measures to improve nursing in the Russian Federation." Each region should have its own plan for the implementation of this Program.

The main objectives of the State Program are:

· providing assistance at the federal level and in the subjects of the Federation to bodies and institutions of healthcare, education, science in creating optimal conditions for the development of nursing;

Improving the efficiency of using the resource of paramedical workers;

development of new organizational forms and technologies of nursing care;

Improving the system of training and use of nursing staff;

Ensuring the quality of nursing care to the population;

Improving the management system of nursing services and legal regulation;

Improving the professional and social status of a nurse.

In accordance with the established priorities, the following directions for the development and improvement of the activities of nursing staff:

· primary health care with an emphasis on preventive work;

· treatment and diagnostic assistance, including the provision of intensive inpatient treatment and care;

· Rehabilitation assistance and medical and social assistance to the chronically ill, the elderly and the disabled;

medical and social assistance to the incurable sick and dying.

Tasks of reforming nursing determined by the established directions for the development of the profession, namely:

· increasing the role in health education of the population in such important areas as, for example, the formation of a healthy lifestyle, the prevention of diseases, poisoning and accidents, etc.

providing education to the population in emergency care and methods of caring for the sick and disabled persons

· expanding the participation of nursing staff in new organizational forms of out-of-hospital care: day hospitals, centers for outpatient surgery and medical and social care, etc.

In connection with the restructuring of the hospital bed fund in terms of the intensity of the treatment and diagnostic process, the profiling of activities and the rational use of nursing staff are becoming important. There is a growing need for personnel who can work with modern medical equipment, monitor the condition of patients, know the nursing process, the basics of psychology, and provide comprehensive comprehensive care and rehabilitation of the patient.

Reducing the duration of the hospital stage provides for the intensification of the nursing process in the hospital and the spread of the practice of maintaining nursing care plans and documenting the activities of nursing staff. Particular attention is paid to the formation of the administrative and managerial direction of nursing, since the determining role in the organization of all areas of activity of nursing personnel belongs to the heads of nursing services at various levels.

In order to obtain the maximum personnel return at each stage from nursing management to the provision of nursing care, it is necessary to revise the structure of the staffing table, taking into account changes in the duties of nursing staff.

Unevenness in providing the population with nursing staff, the existing imbalance in the ratio between doctors and nursing staff put on the agenda the task of reorganizing the system of planning and distribution of human resources. This reorganization will make it possible to change the doctor/nursing staff ratio in the direction of increasing the latter, with the transfer of part of the functions currently performed by doctors to the nursing staff. In order to ensure the appropriate level of professional readiness and qualification of specialists, which guarantees the quality of medical services provided to the population, the task is to create an effective system of certification and attestation.

To create economic incentives to increase labor efficiency and rational use of resources necessary for the production of services, the task is to reform the system of remuneration of nursing staff in order to achieve the maximum possible correspondence between the amount of remuneration and the volume and quality of work performed.

We recommend reading