The problem of reforming the training of nurses in Ukraine and Poland

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The problem of reforming the training of nurses in Ukraine and Poland

O. V. Goray

V. A. Kovalchuk

The article presents the results of a comparative analysis of national and Polish experience in reforming the training of nurses. The analysis of the modern professional model of nursing in Poland and Ukraine is carried out, the common and distinctive features are distinguished. The challenges of modern society necessitate the renewal of the nursing professional model. Compliance with the requirements for maintaining and improving the health of each patient requires changes in the organization, structure, and nursing tasks. The functions of the nurse are changing - he or she is not only the performer of tasks assigned to the doctor, but also a partner in the medical process: collects anamnesis, identifies problems of the patient, can independently monitor, treat certain groups of patients (for example, in hospices, homes or nursing units, medical institutions for chronic patients and others). These changes should be reflected in training.

Based on analytical and comparative methods, the main characteristics of the training of such specialists in the medical field were determined. The specifics of the model of professional training of nurses in Poland and Ukraine were clarified, the characteristics of the organization of the educational process were conducted; the legal base, curricula, educational and teaching support of teaching the disciplines are analyzed, common and distinct aspects in the allocation of teaching hours for the study of different disciplines, carrying out educational and industrial practices are determined. In general, foreign experience has shown that in the professional training of the nurse practical training in medical institutions takes much more hours than in

Ukraine and it passes by the method of "sandwich", that is, during two or three days students are in theoretical and practical classes in the educational institution, after that, they work on improving their skills in a medical establishment under the guidance of a mentor appointed by the administration of this establishment.

The importance of creating a syllabus for teaching subjects in the training of nurses is outlined. Examples of the experience of positively solving certain problems of reforming nursing education are given. Based on the analysis of the positive experience of Poland, the possibility and necessity of introducing a system of measures aimed at improving the national professional training of nurses is substantiated.

Key words: nurse, professional training, educational and training program, syllabus, professional nurse standard.

national nursing professional

ПРОБЛЕМА РЕФОРМУВАННЯ ПІДГОТОВКИ МЕДИЧНИХ СЕСТЕР В УКРАЇНІ ТА ПОЛЬЩІ

О. В. Горай, В. А. Ковальчук

У статті представлено результати порівняльного аналізу вітчизняного та польського досвіду реформування підготовки медичних сестер. Проведено аналіз сучасної професійної моделі сестринської справи в Польщі та Україні, виділено спільні та відмінні риси. Виклики сучасного суспільства зумовлюють необхідність оновлення професійної моделі сестринської справи. Дотримання вимог збереження і поліпшення стану здоров'я кожного пацієнта, потребує змін в організації, структурі та завданнях сестринської справи. Змінюються функції медичної сестри - вона не тільки виконавець поставлених лікарем завдань, а й партнер у лікувальному процесі: збирає анамнез, визначає проблеми пацієнта, може самостійно вести спостереження, лікування певних груп хворих (наприклад, у хоспісах, будинках або відділеннях медсестринського догляду, лікувальних установах для хронічних хворих та інших). Ці зміни мають відображатися у професійній підготовці.

На основі аналітичного та порівняльного методів з'ясовано основні характерні особливості підготовки таких фахівців медичної галузі. З'ясовано специфіку моделі професійної підготовки медичних сестер в Польщі та Україні, проведено характеристику організації навчально-виховного процесу; проаналізовано нормативно-правову базу, навчальні плани, навчальні програми та навчально-методичне забезпечення викладання дисциплін, визначено спільні і відмінні аспекти у розподілі навчальних годин на вивчення різних дисциплін, проведення навчальних та виробничих практик. Зарубіжний досвід засвідчив, що у професійній підготовці медичної сестри на практичну підготовку в лікувальних закладах відводиться значно більше годин ніж в Україні і вона проходить за методом "сандвіча", тобто протягом двох-трьох днів студенти на теоретичних та практичних заняттях знаходяться в навчальній установі, після чого день працюють над вдосконаленням вивчених навичок у лікувальному закладі під керівництвом наставника, призначеного адміністрацією цього закладу.

Окреслено значення створення силабусу до викладання навчальних предметів у професійній підготовці медичних сестер. Наведено приклади досвіду позитивного вирішення окремих завдань реформування медичної сестринської освіти. Обґрунтовано на основі аналізу позитивного досвіду Польщі можливість та необхідність впровадження системи заходів, спрямованих на удосконалення вітчизняної професійної підготовки медичних сестер.

Ключові слова: медична сестра, професійна підготовка, навчально-методична програма підготовки, силабус, професійний стандарт медичної сестри.

Introduction of the issue

The development of medical education in Ukraine in the context of its integration into the European educational space is caused by significant changes in the socio-economic life, reform of the entire national education system. There are acute problems of insufficient number of specialists in the labor market, quality of professional training according to world standards, employment of the best specialists abroad. This is especially noticeable in the nursing community. Nursing education is one of the most important branches of medical education that needs to be updated and modernized [1].

Nursing is the largest section of healthcare professionals that brings together about 230,000 nurses. In Ukraine, the reform of nursing education is underway and, in accordance with it, elements of new functions and concepts concerning their role in the healthcare field of Ukraine are being laid in the process of training such specialists. Studying international experience on nursing reform and the implementation of progressive ideas will contribute to a significant improvement in the quality of vocational training, the rational use of nursing staff, the availability and cost-effectiveness of health care delivery, and the effective use of health care resources.

Current state of the issue

Problems of medical education of middle and higher level are reflected in the works of I. Bulakh, A. Vasilyuk

Y. Voronenko, O. Horay, S. Gordiychuk,

B. Khristopa, I. Makhnovskaya,

L. Romanishina, Y. Tsekhmistra, Z. Sharlovich, V. Shatilo, M. Shegedin. The researches of O. Andriychuk, T. Demianchuk, K. Liushuk, O. Uvarkina, K. Shuliak, O. Yudin, who considered the issue of education of future medical specialists, and gave some recommendations on the organization of the process. These scientists also covered foreign experience as an important and necessary element of systematic study of the problem. The works of Polish researchers are vital for the comparative analysis of the problem under study. Thus, the publications of B. Brosovskaya, B. Voynarovskaya, A. Oblachinskaya, V. Ostrenga, M. March, V. Kapala, S. Dzvonkovskaya and others deserve attention. The analysis of these works shows that their authors are concerned with the problem of improving the training of nurses, adapting the specifics of the education system of a particular country to the unified requirements, international standards of professional training of specialists in the medical field, etc. Considering the similarity of educational systems, the relevance of the processes of reforming the medical sector in Poland and the successful implementation of major innovations, we share the opinion of scientists about the expediency of using the Polish experience in solving the main problems of the national system of medical professionals training.

Aim of research is to highlight the results of the analysis of the professional training of nurses in Poland in recent years and to identify opportunities for the use of effective innovations in the practice of the domestic medical industry.

Results and discussion. The existing system of nursing care in Ukraine does not have the necessary human resources to solve the medical and social problems. It will become much more efficient and cost-effective if it is based on the example of foreign countries by specially trained highly qualified nurses, capable of competent and professional decision making, which to some extent constitute the authority of a doctor. It is a question of formation of a qualitatively new type of nursing staff with expanded authority.

The modern professional model of nursing is a combination of science and

practice aimed at improving the health of each patient, caring for another, reflecting numerous changes in the organization, concept, structure and tasks of nursing. The nurses in their roles are not simple executors of the doctor's will, as before, but partners: they collect anamnesis, identify problems of the patient and constantly monitor his or her behavior, inform the doctor about all changes in his or her condition, participate in patients' examination. They can independently monitor, treat certain groups of patients (for example, hospices, nursing stations, hospitals for chronic patients, etc.), and call a doctor for consultation or in emergency situation [2; 3].

The purpose of training of specialists with secondary medical education is conditioned by social needs and form social order of the community, which requires a significant improvement of the quality of training of medical professionals of the middle level. The general requirements for the level of training in the field of pedagogy, theory of teaching, and teaching methods are knowledge of the structure, purpose, objectives of secondary medical education as well as requirements for the content and level of training of graduates of secondary medical education, established by state standards. We have analyzed the experience of training nurses in Poland and Ukraine in accordance to these aspects.

Accession of Poland to the European Union has had a positive impact on the Polish education system. European standards have increased the requirements for education in the professions of nursing and midwife, improved the quality and permeability of education, as well as strengthened the rank and social status of these professions. In the early 2000s, a regulatory framework for the national education system's compliance with European standards was developed and adopted in Poland. It also applied to medical education. A model of nursing training was defined accordingly, which included the following levels: first - three or four years of first degree education - Bachelor of Nursing (I STOPNIA); the second is more often a two-year education, which grants the right to receive a master's degree, meaning a higher education level (II STOPNIA); and the third - a doctorate for nurses, PhD level [4].

An important step in reforming the structure of higher education has been the work on standardization of The European Credit Transfer and Accumulation System (ECTS), aimed at increasing learning mobility across time and space. The consistent implementation of this system makes it easier to resolve the issue of introducing a special "Diploma Supplement”. This appendix informs about the subjects studied in the HEI. It is especially important for studying abroad. If we draw a parallel with Ukraine, there is much in common in this aspect of the training of future nurses. The new Law of Ukraine "On Higher Education" in 2017 also regulates the multilevel structure of higher education. In order to provide advanced training of specialists at the undergraduate and postgraduate stages of training according to the standards of the World Federation of Medical Education in Ukraine, the following system of training of junior specialists with higher medical education was introduced: graduate nurse (junior specialist) - training is provided on the basis of grades 9 and 11 (4 and 3 years); nurse-bachelor - preparation is carried out at the level of junior specialist with a term of study of 1-2 years or based on 11 classes (4 years); and nurse-master, the training takes 2 years on the basis of a bachelor's qualification [5]. However, for the training of nurses it is not yet practiced to obtain a PhD for the Nursing specialty, this process is still under development.

According to the content of education in Ukraine, the cycle of humanitarian and socio-economic training is represented by a list of subjects defined by the Ministry of Education and Science of Ukraine, and it is a general purpose, whereas in Poland the disciplines are related to humanitarian and socio-economic training, and they are adapted the specialty for which preparation is carried out. The analysis of the curricula of two higher medical institutions of Ukraine (MHEI "Zhytomyr Medical Institute” of Zhytomyr Regional Council) and Poland (Uniwersytet Rzeszowski, Instytut Pielegniarstwa i Nayk o Zdorowiu) has led to the following conclusions: more clinical time is spent in preparing a bachelor's degree in Poland on the basis of medical and preventive institutions (42 credits) and reduction in individual work (30 credits), whereas in Ukraine this ratio is 13.5 credits and 76. Accordingly, the total number of hours is not equal: 186 ECTS credits in Poland and 240 credits in Ukraine

In Poland, unlike Ukraine, only 16 % of study time is spent on theoretical studies, and 45 % on practical time, which is 20 % more than in Ukraine. In Ukraine a large number of hours is devoted to individual work - 33 % of the total number of hours, which is significantly different from Poland, here this figure is 16 % lower. Clinical practice in Ukraine accounts for only 6 %, whereas in Poland - 195 [6: 4243]. This difference in hours is due to the fact that in Poland clinical practice is carried out by the method of "sandwich", that is, for two or three days students are on theoretical and practical classes in an educational institution, after that, during 1 day they work to improve obtained skills in a medical institution under the leadership of a mentor appointed by the administration of this institution.

At the state level, reforming the training of nurses is possible through the adoption of an appropriate regulatory framework (development of industry standards, definition and approval of functional responsibilities of nurses, etc), appropriate financing of specialty, support of medical institutions that cooperate with educational establishments in the professional training system, etc. An analysis of educational standards for nurses and midwives has shown that the learning process can be organized in the form of courses (subjects) that correspond to specific medical disciplines, integrated courses that combine the nursing and clinical parts of the same discipline (e.g., surgical nurse and surgery) and

interdisciplinary modules on specific topics (e.g. geriatric care). It is proposed to further extend the modular approach to curriculum development, to introduce multidisciplinary modules dedicated to specific topics. Such a practice of updating educational standards is observed both in Ukraine and in Poland [7: 106-107].

An important component of professional training is the development of educational and methodological support for the discipline. In the experience of Polish teachers, we will highlight the features of this process. The creation of a syllabus of academic discipline has become very popular recently. Syllabus (syllabus or syllabi) is an educational and methodological program of the discipline, including its description, goals and objectives, summary, topics and duration of each training period, individual work, consultation time, teachers'

requirements, evaluation criteria and a list of main and additional literature [8]. For each subject being taught the teacher must create a separate syllabus. The volume of the syllabus varies from one to several pages. In practice, the domestic system of higher professional education the analogous to the syllabus is the development of educational and methodological support of the discipline. The difference between these documents is that the syllabus is created for active communication of the teacher with the student, in contrast to the Ukrainian version of creating volumetric program implementation for reporting the tutor on the level of teaching discipline. The popularity of the syllabus usage in foreign institutions of higher professional education is in the ease of use, conciseness, transparency of the educational process, its interactivity. The main functions besides communicative include motivational, informative-advisory, supportive, and educational. Before the beginning of each semester, syllabuses from each discipline are posted on the department's website, which are freely available to each student. This successfully optimizes the mutual activity of the teacher and students, increases the level of effectiveness of the course development due to the accessibility and transparency of the learning process. The main sections are: cover page, which covers the

curriculum data - title, discipline code, specialty, study time, hours and forms of training and control. On separate pages, if necessary, there are additional information on the description of the discipline (purpose, tasks, expected results, system of requirements, rules of conducting lectures, practical classes and individual work), of the curriculum-thematic distribution of hours by types of classes, methodical instructions for students, basic and additional literature, etc. In recent years, the syllabus has gained wide popularity in Europe and the world. It is called a "course book” or "study guide”.

In In Ukraine, this kind of educational and methodological description of the discipline is just beginning to be implemented. The recommendations of the NATIONAL (National Agency for Quality Assurance in Higher Education) identified the need for teachers to use such a document that will promote efficiency and productivity in achieving the results of training, improve the quality of their training [9]. The introduction of a syllabus in each discipline will allow the teacher to maximize the individual development of the material for each student, to take into account possible personal characteristics, individual way of learning.

In reforming the professional training of specialists in the research area, it is important to coordinate the activities of different branches of government, the public, and educational institutions. Similar problems exist in the practice of Polish medical education. For example, on March 27, 2017, a discussion on the problems of modern nursing and midwifery in Poland was held at the Educational Center of Warsaw Medical University, it became a kind of 'diagnosis' of the situation [10]. The discussion was organized by the Minister of Health in conjunction with the High Council of Nurses and Midwives, the National Professional Union of Nurses and Midwives, and the Medical University of Warsaw. Among the main issues discussed were the insufficient definition of the role and responsibilities of nurses and midwives in the healthcare system, their working conditions (including those related to the possibility of using new technologies, such as electronic accounting), the quality of pre- and postgraduate education and the introduction of new forms of education (e-learning, telemedicine). It has been determined that improving the quality of nursing and midwifery education is possible through the development and implementation of a model of cooperation between universities and medical institutions for practical education (practical training and internships); practical training in organizations that meet quality criteria in terms of organization, equipment resources, and staff qualifications; harmonization of the results of study of the first and second degree graduates in order to avoid repetition of the acquired knowledge and skills in the course of postgraduate study; training graduates of nursing and midwifery institutions with a profile of competence relevant to the current needs of the health care system and the requirements of EU regulations [10: 10-11].

Increasing subsidies for public higher education institutions in order to increase the entrants to the faculties of nursing and midwifery is one of the priority areas in solving the main problems. Earlier in 2015, the Minister of Health Care of Poland announced a competition entitled "Implementation of programs for the development of medical universities participating in the training of nurses", which took place in three stages [10: 77-82]. The subject of the competition was the realization of development programs of medical universities, which participate in the process of training nurses and midwives. More than 120 million were allocated for the competition. Within the competition, co-financing agreements were signed with 10 universities that provide nurses and midwives training for a total of over 31 million zloty, under which more than 3,500 nurses and midwives were trained. This form of government support encourages higher education institutions to train medical professionals. Accordingly, public funding in Ukraine is limited. Usually, funds are allocated for professional training, but the cooperation of different agencies - Ministries of Finance, Education and Science, Health Care, public organizations, charitable foundations - is needed in solving the problem.

Not all activities that currently belong to the nursing profession should be performed by nurse. In accordance with current trends in replacement of healthcare services, some care functions could be performed by secondary healthcare employees that would be an important support for nurses and patients alike. There is no ancillary profession in the Polish and Ukrainian healthcare systems, whose role will be to participate directly in patient care and at the same time to support the work of nurses. Therefore, a perspective direction is the development of a normative and educational-methodological substantiation of the implementation of an additional profession "Assistant Nurse" in the healthcare system [11: 26].

Promoting this responsible and respected profession must be of great importance in society. It is necessary to create appropriate centers,

associations, public unions, which in collaboration with medical schools will simultaneously solve the current problems of the industry in accordance with their functions. Thus, the Center for Nursing Development in Ukraine, established in 2019, has high hopes [12; 13; 14]. The main purpose of the newly created center is the modernization of nursing education, development of a system of professionalism improvement of medical personnel of this level, development of standards of professional medical education, updating of the model of work in the conditions of reforming the national medical system as a whole, development of real complex decisions and development of a strategy aimed at determining concrete steps on improving the status of domestic nursing and midwifery nowadays and in the future.

One example of advertising is the annual All-Ukrainian Nursing Competition of professional skills "Esculap-Professional" [15].

Participants are nurses who have to demonstrate the professional knowledge, skills, and competence needed to provide nursing assistance. It also includes testing, which requires to answer a hundred of questions in one hundred minutes concerning the

pediatrics, surgery, therapy, emergency care and infectious diseases; presentation of practical skills in all industries; and also surgical, hygienic treatment and demonstration of all stages of hand antiseptic.

Conclusions and research perspectives. The analysis of the professional training state of nurses in Poland and Ukraine showed the similarity of processes, their conditionality by social, cultural and economic factors. All measures aimed at improving the training system should be planned and implemented systematically, at the same time, at national, regional, and at the level of the specific educational institution.

At the state level, in our opinion, the creation of a multidisciplinary and monoprofile medical infrastructure, namely medical imitation centers intended for the practical training of nurses, may be promising in reforming the process of nurses training. Such centers are widespread in the practice of the Polish health care system. Increasing the financial support of educational institutions by the state, the public and individuals is also vital. The existing standards of nursing education (first and second degree studies) and postgraduate specialization programs need to be updated in order to clearly define professional competences, possible extension and addition, in order to avoid unreasonable repetition of the content of education and its updating.

Expanding the knowledge and professional skills of the health care provider can also be achieved by incorporating the learning outcomes into the core curriculum for the profession, updating the teaching and methodological support, implementing a student-centered approach, etc. Prospects for further study of this problem are in-depth analysis of new approaches to improve the quality of training of future nurses.

References (translated & transliterated)

Stratehiia rozvytku medychnoi osvity v Ukraini [The development strategy of medical education in Ukraine]. (n.d.). moz.gov.ua. Retrieved from

moz.gov.ua/article /.../strategy arozvitk u-medichnoi-osviti [in Ukrainian].

Klymeniuk, V.P., &

Synelnikova, L.F. (2007). Suchasna medsestrynska osvita v umovakh intehratsii Ukrainy v yevropeiskyi

osvitnii prostir [Modern nursing education in the context of Ukraine's integration into the European

educational space] Holovna medychna sestra - Head nurse, 12, 11-19 [in Ukrainian].

Hordiichuk, S.V. (2016).

Stvorennia standartiv novoho pokolinnia u zabezpechenni yakosti medychnoi osvity [Creating new

generation standards in ensuring the quality of medical education] Neperervna profesiina osvita: teoriia i praktyka - Continuing professional education: theory and practice, 1-2 (4647), 121-126 [in Ukrainian].

Zakon Respubliky Polshcha "Pro

vyshchu osvitu" vid 27 lypnia 2005 roku, Ministerstwo Nauki i Szkolnictwa Wyzszego [Low of the Republic of Poland "On Higher Education" from

February 27, 2005, Ministry of Science and Higher Education]. nauka.gov.pl. http: //www.nauka.gov.pl/szkolnictwo- wyzsze / sprawy-

miedzynarodowe/proces-bolonski/ [in Polish].

Iermolova, Yu.V. Pidhotovka

medychnykh sester zdiisniuvatymetsia za onovlenymy standartamy osvity [The training of nurses will be carried out according to the updated educational standards]. Retrieved from

https://www.umj.com.ua/article/1189 5/pidgotovka-medichnix-sester- zdijsnyuvatimetsya-za-onovlenimi- standartami-osviti [in Ukrainian].

Hordiichuk, S.V. (2019).

Udoskonalennia praktychnoi

87

pidhotovky medychnykh kadriv yak element systemy zabezpechennia yakosti osvitnoi diialnosti [Improving the practical training of medical personnel as an element of the quality assurance system of educational activities]. Innovatsiina pedahohika - Innovative pedagogy, 15, (2), 41-46 [in Ukrainian].

Mazhenova, H.A.,

Muratbekova, S.K., & Piahai, N.P.

(2007). Modulnaia prohramma obuchenyia v podhotovke

medytsynskykh rabotnykov sredneho zvena [Modular training program for the training of mid-level medical workers]. Meditsina i ekologiya - Medicine and ecology, 4, 106-110 [in Ukrainian].

Silabus chi robocha programa chi

ye obov yazkovim nayavnist silabusu z distsiplini pid chas akreditatsiyi zvo [Syllabus or work program: is it

mandatory to have a syllabus in the discipline during accreditation ihe?]. chmnu.edu.ua. Retrieved from

https: / / chmnu.edu.ua/ silabus-chi- robocha-programa-chi-ye-obov- yazkovim-nayavnist-silabusu-z- distsiplini-pid-chas-akreditatsiyi-zvo/

[in Ukrainian].

Kryterii "Navchannia ta

vykladannia" pry akredytatsii osvitnikh prohram [Criterion "Teaching and learning" in the accreditation of educational programs]. naqa.gov.ua. Retrieved from

naqa.gov.ua/2020/04/KpHTepm- HaBHaHHa-Ta-BHKAagaHHa-np/ [in

Ukrainian].

Srategia Na rzecz rozwoju piel^gniarstwa i poloznictwa w Polsce. (2017). [Srategia For the development of nursing and midwifery in Poland]. Projekt wspolfinansowany przez Uniq Europejskq w ramach Europejskiego Funduszu Spolecznego - Project cofinanced by the European Union under the European Social. Fund Warszawa:

Fundusze EuropejskieWiedza Edukacja Rozwoj, 108 [in Polish].

Karniej, P., Lys D., &

Grzebieluch, J. (2012). Wplyw kompetencji pracownikow medycznych na funkcjonowanie praktyki lekarza rodzinnego [Impact of the competence of medical workers on the functioning of the family doctor's practice]. Family Medicine & Primary Care Review, Journal, 14 (1), 24-28 [in Polish].

Tsentr rozvytku medsestrynstva v Ukraini. moz.gov.ua. Retrieved from https: //moz.gov.ua/article/news/uper she-v-ukraini-z%e2%80%99javilas- institucija-scho-dbatime-pro-rozvitok- medsestrinstva [in Ukrainian].

Svyrydiuk, V.Z., &

Svyrydiuk, V.V. (2019).

Naukometrychni kryterii otsinky rezultativ naukovykh doslidzhen studentiv Zhytomyrskoho medychnoho instytutu yak vazhlyvyi chynnyk pidvyshchennia yakosti profesiinoi medychnoi osvity [Scientometric criteria for evaluating the results of scientific research of students of the Zhytomyr Medical Institute as an important factor in improving the quality of professional medical education].Mahistr medsestrynstva - Master of Nursing, 2 (22), 86-99 [in Ukrainian]. Svvyrydiuk, V. (2017).

Prospective approaches to forming of communicative competence of students of master's degree in nursing [The research challenges in nursing practice]. Rzesow:Wydawnictwo Universsytetu

Rzeszuwskiego, 9-20 [in Polish].

IKh Vseukrainskyi konkurs

profesiinoi maisternosti medychnykh sester "Eskulap-Profesional".

lbmk. lutsk. ua. Retrieved from

http://www.lbmk.lutsk.ua/news/our/i kh-vseukrainskyi-konkurs-profesiinoi- maisternosti-medychnykh-sester- eskulap-profesional/ [in Ukrainian].

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