Postbasic and graduate education for nurses: report on a WHO meeting, Helsinki, 4–8 June 1984

111111111111\l I Im +rn 111rn·nYH + 7orld Health Organization-~ .egional Office for Europe f • ~ Copenhagen ~ EURO Reports and Studies 99 :Postbasic and graduate education for nurses Report on a WHO meeting Helsinki 4-8 June 1984 ICP/HSR 303/m02 ISBN 92 890 1265 X © World Health Organization 1985 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Conven- tion. For rights of reproduction or translation, in part or in toto, of publications issued by the WHO Regional Office for Europe application should be made to the Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen 0 , Denmark . The Regional Office welcomes such applications . The designations employed and the presentation of the material in this publi- cation do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries . The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organiz- ation in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The views expressed in this publication are those of the participants in the meeting and do not necessarily represent the decisions or the stated policy of the World Health Organization. PRINTED IN DENMARK ISSN 0250-8710 CONTENTS Page Introduction Background 2 The state of postbasic education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Iceland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 The primary health care model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Changing health needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 The way forward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Curriculum development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Organization and management of the nursing department . . . . . . . . . 6 The director The teachers Faculty issues Student issues Resources, facilities and services 7 7 8 9 10 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Recommendations II Evaluation of postbasic education ....... ....... .... . .... .. ... , . . 11 Data and information systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Development of critiera and standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Transitional arrangement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Continuing education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Network development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Special programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Annex I. Definition of terms 14 Annex 2. Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Summaries in French , German and Russian . . . . . . . . . . . . . . . . . . . . . 23 INTRODUCTION The Symposium on Postbasic and Graduate Education for Nurses in Europe was convened by the WHO Regional Office for Europe in collab- oration with the Government of Finland and the authorities of the City of Helsinki, and was held from 4 to 8 June I 984. The purposes of the Symposium were to : review the state of the art of post basic programmes of education in nursing and examine their relative development towards primary health care; examine the principles of organization and management of post- basic schools of nursing in the light of the regional strategy for attaining health for all; examine the trends in education in Europe over the next 20 years (including student-related issues) and the implications of these changes for the development of postbasic programmes in nurs- ing; and stimulate national authorities to respond to the educational needs of their nursing personnel so that they in their turn can respond effectively to the requirements of health for all by the year 2000. The Symposium was attended by 37 participants from 21 countries. Most of the participants were nurses (including four students), but the disciplines of medicine , sociology and general education were also repre- sented. The European Nursing Group, the European Nursing Students Group, the International Committee of Catholic Nurses, the International Confederation of Midwives, the Internationa l Council of Nurses and the Northern Nurses Federation sent representatives. Four officers of the World Health Organization also attended, three from the Regional Office for Europe a nd one from headquarters. The Symposium was opened by Dr Leo A. Kaprio , WHO Regional Director for Europe. In his opening address, Dr Kaprio stressed that strategies for nurse education were one of WHO's priorities in the 1980s. The Minister of Social Affairs and Health, Eeva Kuuskoski-Vikatmaa, and the Chancellor of the University of Helsinki, Nils Oker-Blom, also addressed the Symposium at the opening ceremony. BACKGROUND A number of themes must be considered if a coherent strategy for the education of nurses is to be achieved throughout Europe. Nurses need to develop the ability to relate to the recipients of health care and to provide the kind of support, information, teaching and physical care that the community requires. Nurses also need to have confidence in their own skills and knowledge and to be more aware of their position as equal partners in a multidisciplinary team of health workers. This may require a change in attitudes and attributes and in particular the development of communication and teaching skills. The state of postbasic education A recent WHO surveya on the current state of post basic nursing education in Europe suffered from the limitations of the data collected and the great variations among the countries studied. It carried several clear messages nevertheless. On the positive side, university programmes for the edu- cation of nurse leaders have been developing gradually. The focus, how- ever, is mainly on educational and managerial skills, with some emphasis on research , and only rarely on advanced skills and knowledge of nursing. Many traditional programmes are still geared to a hospital model of the health services. Thus the curricula tend to be illness-oriented and have not yet fully adopted primary health care concepts and principles. Teachers in postbasic education are urgently needed with the appro- priate knowledge and skills to develop courses at the university or higher education level. The average postbasic nursing student has had IO years' general education, 3 years' nursing education and 4 years' professional experience. Although there are great variations among countries, post- basic students tend to lack basic nursing knowledge and skills. This means that much time has to be spent in postbasic courses compensating for deficiencies in the initial nurse training. a Maillart, V. & Maglacas, A.M. Report on a survey of post basic training programmes for nurse teachers(educators) and administrators(managers). WHO document HMD/ NUR/83. 1. 2 The mode of learning tends to be traditional , with little em phasis on learning objectives in either the theoretical or the practical parts of the cou rse. There is little evidence of evaluation in terms of the goals and purposes of the course, the educational processes or the outcomes of the course. Iceland Plans to move nursing education out of the traditional hospital-based schools and into the university sector in Iceland have gone through several stages of development. It was vital that the nursing and medical pro- fessions, through their associations, shared a common belief that the proposed move would result in better nursing services. Equally important was the support and collaboration of both the health and the education ministries who prepared the groundwork and the legislation necessary for the establishment of a department of nursing within the university. Col- laboration with WHO provided consultancy services and some financial assistance whi ch helped curriculum development, teaching input and evaluation of the course. A strik ing feature was the time scale required (in this case, 15 yea rs of planning and development) and the need for a variety of strategic and influential bodies to collaborate in working towards a common goal. The primary health care model There is a gradual reorientation of health systems in the countries of the European Region towards a model based on primary health care. This has necessitated changes in medical education, especially that of general prac- titioners who must now study new areas such as epidemiology, public health, public administration and behavioural sciences. The evolution of education in the health sciences is in part related to changes in educational methods. Student-based learning objectives, modern teaching methods and technology, plus a valid and reliable evaluation of student per- formance both in theory and in practice are essential. As the health needs of society change, so must the education of its health personnel. Nurses, as an essentia l element of the health team, must be able to make their full contribution to the work. As this means collaboration and effective com- munication bet ween professional groups, shared learning and multidisci- plinary ed ucation are needed at the university level. Changing health needs The health needs of European countries a re changing and the traditional approaches to the education, training and deployment of health manpower 3 cannot meet the new demand for health services. Plans must be made now to invest wisely and cost-effectively to produce nurses who are able to respond to these health needs. For the health services of the future, nurses will require, in addition to the generally accepted nursing skills, the atti- tudes, knowledge and competencies to enable them to: stimulate healthy lifestyles and promote self-care educate the community/family/individual about health analyse and resolve community/family/individual health problems work within health teams composed of different professional groups collaborate with and coordinate different groups, so that common health goals can be achieved. The way forward The development of a rational structure for nursing education must focus on the following five topics: curriculum development the organization and management of the nursing department facult y issues student issues resources, facilities and services CURRICULUM DEVELOPMENT Several important areas must be considered before appropriate curriculum development plans can be made. The starting point for curriculum devel- opment is to identify the health needs of the country. Demographic and epidemiological trends and environmental data will help predict the type of health facility and health personnel that will be required over the next 5, JO or 20 years . Public expectations of health services and health personnel must be considered and distinctions drawn between demands, wants and needs so that the most effective use of resources is ensured and the benefit of investment in health services is maximized. Current legislation , economic forces , and health policies and priorities must be considered, as must the nature and pace of development of health 4 care facilities, so that the curriculum will prepare nurses to work in the manner and setting required by any particular country. The values and beliefs of the community to be served must be examined. So must the mores of both the educational institutes and the clinical facilities where nursing courses may take place. Consideration must be given to the general level of commitment and support, within the nursing and medical professions, for the idea of changes in nurse education so that strategies likely to achieve the desired goals can be developed. The precise purpose of every nursing course should be explicit. The knowledge, skil ls and attitudes to be achieved by the end of the course shou ld be enunciated clearly. The relationship of each course to the development of nurses' ability to meet a specific range of health needs should be demonstrated. Particular consideration must be given to the way in which theory will be integrated with and applied to practice, so that learning objectives can be achieved. Every course should have an appropriate practical component in which students should have clear objectives. Each period of practice must be supervised and assessed according to explicit criteria related to the overall goa ls of the course. All courses should be firmly based on sound educational principles and shou ld be able to demonstrate a particular model of nursing and of health needs. Curricula cannot be developed in isolation by ministries or health departments. They must involve nurse teachers and teachers from other disc iplines , consumers (i.e. both the users of nursing services and students participating in courses), government agencies responsible for public spending, providers of nursing services as the employers of nurses and the professional associations of nursing and related disciplines . Nurse teachers must have advanced knowledge of the sciences on which nursing is based and must, in addition, have knowledge of edu- cationa l theory and skills in both teaching methods and nursing practice. The core subjects within the curriculum must emphasize nursing theory and practice. The desire to benefit from shared learning and multidisci- plinary teaching should not overshadow the need for post basic education to focus specifically on nursing goals and the future practice of nurses. The content and methods of every course and the effectiveness of its outcomes should be evaluated according to specific criteria. The criteria for curriculum evaluation outlined in a recent WHO papera were thought to be appropriate . a Farrell, M. & Stussi, E. The evaluation of nursing management educational programmes. WHO document EURO/NUR/83.2. 5 The education of nurse teachers, managers and researchers can be most effectively accomplished within the university or higher education sector, as this is where interdisciplinary studies and education and research re- sources are to be found. ORGANIZATION AND MANAGEMENT OF THE NURSING DEPARTMENT The appropriate location for the education of nurse teachers, managers and researchers is the university or higher education sector. There are several reasons for this . Health services based on a model of primary health care demand new knowledge, skills and attitudes from nurses. They require the ability to identify and analyse problems, to plan strategies, and to undertake research. Primary health care assumes that the public will become more know- ledgeable about health issues such as lifestyles, environmental influences, risk factors and so on. The consumer will make new and increasing demands on health professionals for information based on epidemiology, morbidity statistics and the analysis of trends . The health education needs of the public will change, and therefore nurses' education must prepare them to continue to meet new demands. Teamwork, collaboration and effective communication among health personnel is an essential element in a model of primary health care . The interaction among professional disciplines in a university or institute of higher education will provide the experiences that will later affect the nurses' ability to work with others. The development of scientific methods, research and interprofessional teaching and learning can be most readily facilitated in the university and higher education sector. The development of the art and science of nursing as an essential part of the education of nurses will contribute to more effective health care. Universities and higher education institutes enable three essential areas of knowledge to coexist: namely education, practice, and research. All these bodies of knowledge are essential if nurse teachers are to develop the educational programmes needed to produce nurses who can operate ef- fectively within a primary health care model of health services. Oppor- tunities to practise nursing in actual situations through planned clinical experience are expected. University or higher education is an essential part of a coherent pattern of education for nurses. This education starts with broadly-based 6 foundation courses in nursing. A structure of postbasic , degree and higher degree courses can be built on this foundation. Every course in nurse education should lead to a specific level of knowledge and competence and it should be possible to demonstra te that it produces practitioners who can contribute to and meet the identified health needs of a particular community. University or higher education for nurses is not an end in itself. It is a means of achieving important goals within the strategy of health for all by the year 2000. The director The director of a nursing department, within the university or higher education sector, should hold initial and postbasic nursing qualifications and should have a higher degree and experience in both teaching and the administration of education. The director should have the same range of responsibilities as other directors within the parent institution and should be financially account- able for the programmes under his or her control. The director should be responsible for entry criteria, for controlling the numbers entering each course and for hiring and firing the staff of the department. There are several areas in which the director should be able to function, but no attempt was made to draw up a definitive list as a basis for role specifi- cation. For illustrative purposes, the following attributes could be con- sidered important: the ability to develop a dialogue with education and health policy- makers , the nursing profession and other disciplines; the ability to develop systems for staff development , peer review, quality control, staff research and course evaluation; the ability to collaborate with managers of health care establish- ments so that the legal responsibilities, rights and obligations of teaching and clinical staff, with regard to students in supervised practice, are clearly expressed; and the ability to participate in curriculum development, research and the evaluation of programmes. The teachers The teachers should be nurses who are graduates and who can demonstrate specia li zed knowledge and skills in the theory and practice of nursing as well as in education. 7 When teachers from other professional backgrounds make a contri- bution to the course, it should be within a clear framework of learning objectives that specify nursing goals. Nurse teachers should retain their clinical skills and continue to participate in the professional practice of nursing. They should also participate in research, publish results and engage in activities that will bring research findings to the attention of practising nurses and members of related health disciplines. The nursing department should demonstrate the effectiveness of its programmes and actively evaluate every aspect of the teaching it provides. The department should be clearly identified as an autonomous body, operating within the parent institution, with the full range of rights and responsibilities that apply to other departments in that institution. The teachers, individually and collectively, should accept the responsibility of communicating with the public. They should, for instance, be able to demonstrate the effectiveness of their programmes by producing nurses with the knowledge, skills and attitudes required by the community. The criteria outlined in a recent WHO paper0 for the evaluation of the organiz- ation and management of nursing departments were felt to be appropriate. FACULTY ISSUES For the purpose of discussion, the term "faculty" was used to describe a department of nursing and its academic staff, offering postbasic education courses and nursing degrees, that is identifiable as a discrete entity within the parent institution. It should have the same range and level of responsibility, control and accountability as other departments within the institution . Teaching staff should be qualified nurses with experience, knowledge and expertise in nursing. They should also be graduates and qualified teachers, to ensure that they have educational knowledge and expertise. There should be enough of them to meet the purposes and objectives of the programmes. Their terms and conditions of service, their workload, rights, duties and responsibilities should be the same as those of members of other faculties within the parent institution. They should be involved in the full range of the institution's work by participation in its academic councils, committees and other relevant structures. Appropriate means of keeping up to date, carrying out further study or research, and ensuring professional growth should be available to all teaching staff. a WHO document EURO/NUR/83.2. 8 Their responsibilities towards students, the nursing profession, mem- bers of other professions or disciplines and the public are important and should be explicit. The research activities of staff should include evaluation of the course and of student performance during and after the course, as well as follow- up studies to assess the effectiveness of the course in meeting its curriculum objectives. They should also study the needs of the health services for nurses with particular skills, knowledge and attitudes. The outcome of this research should be published and made widely available for general in- formation and for use in the teaching of other nurses and health personnel. Teaching staff should participate in curriculum development, in the evaluation, selection, monitoring and guidance of students, and in the development of departmental policies and procedures. They should also participate in and be responsible for the supervised practice of students. STUDENT ISSUES The qualifications necessary for admission to postbasic courses should be established by the department of nursing. Candidates for nursing should meet the qualifications for university admission in the same way as any other university candidate and their educational level should be equi- valent . Candidates must have successfully completed an initial course in nursing and be recognized as registered nurses in their own country. It may be necessary for candidates to have completed specified periods or particu- lar types of professional practice before admission to the course. The criteria set must take into account the entry to practice, laws or regulations , and employer/consumer expectations. In some countries, students may be allowed to demonstrate their academic ability by means other than normal matriculation . Examples of ways in which some nurses might demonstrate academic ability include: research, publications, evidence of personal study and achievement, or success in a special entrance examination acceptable to the parent insti- tution, the department of nursing, and/or boards of registration in nursing. Students should study a specific body of nursing knowledge and related sciences, and should have appropriate supervised practical experience, in which to apply the knowledge learned. Students should be aware of the responsibilities of teaching and clinical staff towards them and of their own duties as course participants. They should be able to participate in course planning, curriculum development and course evaluation . 9 Students' rights, duties and responsibilities, including their social and legal status, should be clearly expressed. In particular, the protection of both the public and students during supervised practice should be explicit. RESOURCES, FACILITIES AND SERVICES The full range of resources, facilities and services of the parent institution should be available to and used by the nursing department , so that up-to- date teaching methods and learning styles are available to all postbasic courses for nurses . The physical facilities , such as offices, classrooms , laboratories and conference rooms, should be adequate for the programmes that are of- fered . Space and equipment for research are also essential. Comprehensive and up-to-date library facilities , teaching materials other than books, and a wide range of the equipment of educational technology are required. Administrative equipment and services, and secretarial and clerical staff should be sufficient to support the educational programmes offered by the department. Clinical resources that are adequate and appropriate for the supervised practice of the students should be identified, and appropriate agreements drawn up between the department of nursing and the health care estab- lishment so that the objectives of the curriculum can be achieved. There should be a periodic review of resources, facilities, services and maintenance. This review should involve the administration, the faculty and the students. CONCLUSIONS The appropriate location for the education of nurse teachers, managers and researchers is the higher education or university sector. Further, such programmes are based on a rational, systematic plan for development, implementation and evaluation . In turn, this planning is part of the ra- tional structure of nurse education, which starts with an adequate base of knowledge and practice that leads to an initial qualification in nursing. Postbasic courses should build on this foundation to produce nurses with advanced or specialized knowledge and skills . In addition, special post- basic courses are required to prepare nurses for work that has wider dimensions than clinical practice, such as the development of curricula in nurse education, the administration of nursing services, and research . Continuing education is essentia l for all nurses, but each country in Europe is at a different stage of development in nurse education . Strategies to ac hieve a logical structure of basic, postbasic, degree and advanced courses for nurses must be developed within each country's own context. Further, it will be necessary to have options in initial and continuing education if full use is to be made of nursing talent. Top priority should be given throughout Europe to the education and preparation of nurse teachers, managers and researchers as without these key personnel the other necessary parts of the education system cannot be developed. RECOMMENDATIONS Evaluation of postbasic education If countries are to evaluate effectively the outcome of post basic and higher education in terms of its relevance to the health needs of the community, then a study of the performance of nurses in practice, in teaching, in manage ment and in research is essential. It is of paramount importance that mechanisms be established for monitoring and fo llowing up former students. This should be clearly identified as a responsibility of the school of nursing. Data and information systems Data on the number and distribution of nurses are not readily available. In formation about education resources and the number and type of post- basic courses avai lab le in each country is patchy. Even where there are mechanisms for collecting such data, they are less efficient than they might be in providing information and feedback to decision-makers. Informa tion systems fo r the collection of data on nurse manpower and education shou ld be established both locally and regionally. Development of criteria and standards The cri teria for the eva luation of educat ional institutions outlined in a recent WHO paper0 were accepted by the participants. In collaboration a WHO document EURO/NUR/83.2. 11 with WHO, countries should assess whether these criteria could be ac- cepted throughout Europe. Transitional arrangement The countries of Europe are at different stages in the development of postbasic education for nurses. Immediate action is needed to develop a cadre of nurse teachers, managers and researchers who will be able to carry forward developments in nurse education and practice. To give effect to this recommendation it will be necessary to: (a) convene national groups of nursing leaders from the health system and key personnel from nursing associations and educational institutes who can act as catalysts and who can plan, initiate, motivate and support research and developments in postbasic education; (b) take immediate action to increase the number of qualified nurse teachers who are able to participate in postbasic education; (c) establish a system of continuing education for nurses now engaged in teaching and management to enable them to keep their knowledge and skills in nursing and education up to date; and (d) provide special courses for academically able qualified nurses to enable them to meet the entrance criteria for postbasic education courses in the higher education or university sector. Continuing education To provide courses that will prepare nurses who can apply the knowledge and skills required for health care, countries should develop and support • programmes of continuing education for all nurses. In particular, in the first instance, there should be special courses for present nurse teachers, managers and researchers to help them develop the new areas of know- ledge and skill that will be required of them. Research Only a few countries in the Region have adequate nursing research fa- cilities and capabilities to allow nurses to conduct and participate in research activities. The network of WHO collaborating centres in nursing should be strengthened, so as to enable countries who lack nurse re- searchers and research facilities to develop research skills and initiate research projects. 12 In all the European countries, mechanisms should be established to fund both the training of nurse researchers and nursing research projects. In collaboration with WHO, countries should develop an index of completed nursing research so that abstracts of such studies may be made available throughout Europe. Network development In a period of rapid social change , curricula need regular revision and re- evaluation . Information networks within and between countries are vital to facilitate the exchange of information about curriculum development, research results, educational innovations and the success or failure of particular approaches to the solution of common problems. In collaboration with WHO, countries should continue to develop such networks so that research findings and developments in postbasic edu- cation can be made available in the language of each country to assist in the process of change. Special programmes To promote effective nursing education, new areas of study need to be included in postbasic education . While it is understood that decisions concerning curriculum content and approaches rest with the faculty and the students, serious consideration of the following subjects is recom- mended: epidemiology, health statistics, economics of health care, and health and social policy development. For the present, such subjects may have to be offered to the present generation of teachers and managers as special courses. 13 Annex 1 DEFINITION OF TERMS Nursing education is a complex subject and every country has its own definitions and systems. The following explanation of what is meant in this report by some of the most common terms should help avoid any mis- understandings. An initial professional or nursing qualification is awarded to a person who successfully completes a course of studies and supervised practice with defined educational objectives, designed to produce a nurse with the necessary knowledge, skills and attitudes required to give nursing care to specific client groups within the health service of a country. Such qualified nurses are entitled to apply to have their name included on the lists or register kept by the competent national authority and be known as reg- istered nurses. A postbasic education consists of a course of studies and supervised practice with defined educational objectives, designed to provide qualified nurses with advanced or specialized clinical knowledge and skills that will enable them to provide nursing services and participate in nursing re- search, teaching and management. These post basic courses should ideally take place in a university or institute of higher education, continue from year to year, be recognized by an appropriate authority, have specific admission requirements, and have a full-time staff of nurse teachers and support personnel. Successful completion of such courses should result in the award of a degree in nursing. A degree from a university or institute of higher education may also however be awarded as an initial professional qualification . In either case, a degree is a prerequisite qualification for • advanced university study. Advanced university study can be carried out at a university or institute of higher education, and may consist of a period of specific advanced study or the completion of a registered research thesis . Successful completion of either results in the award of a higher degree, which may be at the master's or doctoral level. Higher degrees may be awarded only to qualified nurses. Post basic courses in a university or institute of higher education are, or should be, the responsibility of the nursing faculty, which consists of a department of nursing and its academic staff. The parent institution to which the faculty belongs, as an integral and autonomous part, may be one or more senior colleges or universities (a consortium). Finally, an important element in nursing education is continuing edu- cation. This consists of systematic learning experiences designed to build 14 on previous knowl,edge and skills. It requires both the provision of an organized, planned programme and an independent effort on the part of the learner. It should provide nurses and midwives with the opportunity to learn new knowledge and skills, to review and increase the knowledge they have already gained, to investigate new approaches and to strengthen their clinical competence . 15 Annex 2 PARTICIPANTS Algeria Mr C. Nazef, Institut technologique de Sante publique d'El Marsa, Algiers Austria Dr B. Deutschmann, Public Health Officer, Federal Ministry of Health and Environmental Protection, Vienna Belgium Mrs A.M. Simoens-DeSmet, Ministere de la Sante publique et de la Famille, Inspection des Ecoles pour Personnel paramedical, Cite administrative de l'Etat, Brussels Finland Ms R. Raatikainen, University Instructor, Department of Primary Care, University of Helsinki France Mrs N. Loraux, Technical Adviser for Nursing, Direction generale de la Sante, Paris Germany, Federal Republic of 16 Mr G. Dielmann, Manager, Gesundheits-Abteilung der Gewerkschaft Offentliche Dienste, Transport und Verkehr, Hauptvorstand, Stuttgart Mrs 0. Weinrich, Principal, Deutschen Berufsverbandes fur Kran- kenpflege, Frankfurt-am-Main Greece Miss M. Pouloyianni, Director of Studies, State School of Public Health Nursing, Athens Hungary Mrs E. Varhelyi, Officer, Ministry of Health of the Hungarian People's Republic, Budapest Ireland Miss K. Keane, Chief Education Officer, An Bord Altranais (Irish Nursing Board), Dublin Morocco Mrs H. Hassani, Head of Service, Formation des Cadres techniques, and Principal, Ecole de Cadres, Ministere de la Sante publique, Rabat Netherlands Miss C.A.M. Verbeek, Director, School of Higher Education for Health Professionals, Leusden Norway Miss B. Ellefsen, Lecturer, Norwegian School of Advanced Education in Nursing, Oslo Poland Dr H. Lenartowicz, Chief, Department of Organization of Nursing Services, Faculty of Nursing, Medical Academy, Lublin Portugal Dr R. dos Santos Carmo, Nursing Officer, Department of Nursing Education, National Institute of Health, Lisbon 17 Romania Dr G. Balta, Inspector-General, Ministere de la Sante de la Republique socialiste de Roumanie, Bucharest Spain Ms N. Aguilera, Nurse Adviser to the Directorate-General of Health Planning, Ministry of Health and Consumer Affairs, Madrid Sweden Mrs U.-B. Carmes, Head, Section for Medical and Paramedical Pro- fessions and the Faculties of Medicine, Dentistry and Pharmacy, National Board of Universities and Colleges, Stockholm Ms M. Raftell , Head, Division for Medical and General Health Pro- fessions and the Faculties of Medicine, Dentistry and Pharmacy, National Board of Universities and Colleges, Stockholm Switzerland Miss L. Bergier, Principal, Ecole superieure d'Enseignement infirmier de la Croix-Rouge suisse, Lausanne Representatives of other organizations European Nursing Group Mr J . Mullen, President, Dublin, Ireland European Nursing Students Group Mr T. O'Malley, President, Manchester, United Kingdom International Committee of Catholic Nurses Miss K. Keane, International President, The Holy See 18 International Confederation of Midwives Mrs M. Torn, Vice-President, Espoo, Finland International Council of Nurses Ms H. Willman, Director, Helsinki College of Nursing, Finland Northern Nurses Federation Miss K. Lerheim, Oslo, Norway Observers Professor R. Adams-Stockier, Faculty of Nursing, University of Tel Aviv, Israel Ms P. Feleki, Hellenic Red Cross Higher School of Nursing and Public Health, Athens, Greece Ms K. Kuosmanen, Nursing Officer, National Board of Health, Hel- sinki, Finland Dr S. Lauri, Associate Professor of Nursing, University of Kuopio, Finland Ms H. Leino, Nurse Teacher, Turku School of Health Personnel, Finland Ms A. Makinen, Chief, Bureau of Higher Education, Ministry of Education, Helsinki, Finland Mrs Y. Zomer, Head, Departement therapeutique et Soins, UER de Bobigny, France Temporary advisers Miss G. Dechanoz, Senior Nursing Officer, Head, WHO Collaborating Centre, Hospices civils de Lyon, France Mr N. Dickson, Editor, Nursing times, London, United Kingdom 19 20 Professor J.-F. d'Ivernois, Director, Departement de Pedagogie des Sciences de la Sante, UER de Bobigny, France Ms A. Jarvinen,a Planner, University of Tampere, Finland Ms P.H. Jarvinen/ Director, Kemi School for Health Personnel, Finland Ms K. Krause/ University Instructor, Department of Primary Care, University of Helsinki, Finland Miss I. Magnusdottir, Chief Nursing Officer, Ministry of Health and Social Security, Reykjavik, Iceland Ms L. Nederstrom,ll Director of Department, National Board of Vo- cational Education, Helsinki, Finland Dr A. Oakley, Sociologist, National Perinatal Epidemiology Unit, Radcliffe Infirmary, Oxford, United Kingdom Mrs M. Pelkonen, Public Health Nurse, Masters Student in Nursing Administration, University of Kuopio, Finland Miss M. Plakiotou, Hellenic Red Cross Higher School of Nursing and Public Health, Athens, Greece Dr N. Platin, Instructor, Hacettepe University School of Nursing, Ankara, Turkey Mr H .O. Sigurdsson, Student, Nursing Programme, University of Ice- land, Reykjavik, Iceland Miss M. Sorvettula, Nurse Researcher, The Nursing Research Institute, Helsinki, Finland (Chairman) Mrs M. Tallberg,ll University Instructor, Department of Primary Care, University of Helsinki, Finland Miss W.W. Thomson, Nursing Officer (Education), Scottish Home and Health Department, Edinburgh, United Kingdom (Rapporteur) Ms U. Tuomaala/ Nurse Teacher, Turku School for Health Personnel , Finland a Participation expenses not paid by WHO. World Health Organization Regional Office for Europe Dr M. Farrell, Regional Officer for Nursing Dr J.-P. Menu, Regional Officer for Health Manpower Planning and Management Miss E. Stussi, Nursing Officer Headquarters Dr A. Mangay-Maglacas, Senior Scientist for Nursing, Division of Health Manpower Development 21 RESUME Les objectifs du symposium etaient les suivants : faire le point de la situation actuelle en ce qui concerne les pro- grammes d'enseignement infirmier superieur et leur orientation relative vers les soins de sante primaires; examiner les principes d'organisation et de gestion des etablisse- ments d'enseignement infirmier superieur a la lumiere de la strategie de la Sante pour tous dans la Region europeenne de !'OMS; examiner les tendances de l'enseignement en Europe au cours des vingt prochaines annees (y compris les questions etudiantes) ainsi que les consequences de cette evolution pour !'elaboration des programmes d'enseignement infirmier superieur; encourager les administrations nationales a repondre aux besoins de formation de leur personnel infirmier, de fai;:on a pouvoir repondre efficacement aux besoins de la Sante pour tous d'ici l'an 2000. Ont participe au symposium vingt representants de dix-huit pays et dix-sept conseillers temporaires de six pays. Quatre autres pays ont envoye des observateurs. La plupart des participants etaient des infirmieres, mais les disciplines de la medecine, de la sociologie et de l'enseignement general etaient ega lement representees. II y avail aussi un representant des consom- mateurs et quatre representants des etudiants. Etaient aussi representes le Conseil international des infirmieres (CII), la Confederation interna- tionale des sages-femmes (ICM), I' Association des infirmieres des pays du nord (NNF), le Groupement du nursing europeen (GNE), le Comite international catholique des infirmieres et assistantes medico-sociales (CICIAMS) et le Groupe europeen des etudiants en nursing (ENSG). Point de depart et resume des discussions La Declaration d' Alma-A ta de I 978, qui a ete acceptee par les gouverne- ments des pays d'Europe, a d'importantes repercussions sur la formation et !'utilisation du personnel infirmier. 23 L'orientation necessaire pour atteindre la Sante pour tous d'ici l'an 2000 devra tenir compte du contexte caracterise par le vieillissement des popula- tions, l'instabilite sociale, le ch6mage, la retraite anticipee et la mobilite de la population . II est imperatif, compte tenu des facteurs economiques et sociaux, que la formation et !'utilisation du personnel infirmier permettent de satisfaire efficacement les besoins sanitaires des collectivites particulieres. II est urgent d'organiser de fa9on rationnelle les soins infirmiers dans le cadre de l'enseignement superieur et specialise pour que les infirmieres qui occupent, ou sont sur le point d 'occuper des postes cles dans les services de sante, puisse nt acquerir les connaissances et les competences qu'exigent de tels postes. II faut, pour commencer; avoir des connaissances theoriques et pratiques suffisantes pour acquerir une premiere qualification. A partir de la, un enseignement devrait donner aux infirmieres des connaissances et des competences avancees ou specialisees. Parallelement, un enseigne- ment special devrait preparer les infirmieres a un travail plus varie que la seule pratique clinique. II pourrait s'agir de !'elaboration de programmes d'enseignement infirmier, de gestion de services infirmiers ou de developpe- ment de la recherche. II faudrait mettre )'accent sur le developpement de !'aptitude a la communication et a la negociation que suppose le travail d'equipe pluridisciplinaire dans le domaine de la sante. Les criteres et les normes applicables a l'e nseignement superieur devraient etre explicites, et !'elaboration et le contr6le des cours devraient etre confies a des infirmieres qualifiees. La structure des programmes, la designation des enseignants et les promotions, les procedures d'admission des eleves et les installations, ressources et services necessaires devraient etre comparables a ceux des autres cours de l'etablissement de tutelle. Conclusions • En matiere de soins infirmiers, ce sont l'enseignement supeneur et la formation specialisee qui sont les mieux a meme d'assurer la formation de personnel d'enseignement, de gestion et de recherche. La formation permanente est essentielle pour toutes les infirmieres, meme si l'enseignement infirmier est a un stade de developpement different dans chaque pays d'Europe. Les strategies propres a la mise en place d'une structure logique pour l'enseignement infirmier de base, superieur, avance et universitaire devront etre elaborees dans le contexte propre a chaque pays. Le degre de priorite le plus eleve devrait etre donne dans toute !'Europe a la formation de personnel d'enseignement, de gestion et de recherche, faute de quoi on ne peut esperer developper Jes autres secteurs necessaires du systeme d'enseignement. 24 Recommandations Evaluation de /'enseignement superieur Si l'on veut que les pays evaluent efficacement la mesure dans laquelle l'enseignement superieur et universitaire permet de satisfaire les besoins de la collectivite, ii est indispensable de suivre les resultats obtenus par les infirmieres dans la pratique, l'enseignement, la gestion et la recherche. II est de la plus haute importance a cette fin de mettre en place un mecanisme approprie et de garder le contact avec Jes anciens eleves. II faudrait indiquer clairement que ces activites incombent aux etablissements d'enseignement infirmier. Systemes de donnees et d'informations Les donnees sur le personnel infirmier, leur nombre et leur repartition ne sont pas facilement disponibles . Les informations sur les ressources educatives, ainsi que sur le nombre, la nature et le type de cours superieur sont disparates selon les pays. Meme lorsque des mecanismes pour la collecte de ces donnees existent, ils sont moins efficaces qu'ils pourraient l'etre pour la communication de renseignements aux responsables des decisions a des fins de planification. Des systemes d'information pour la collecte des donnees sur Jes effectifs et l'enseignement infirmiers devraient etre crees aux niveaux local et regional. Elaboration de criteres et de normes pour /'enseignement infirmier superieur Les criteres d'evaluation des etablissements d'enseignement, exposes brievement dans un documenta presente a la conference annuelle de I' Association europeenne des programmes dans les etudes pour lesser- vices de sante, qui s'est tenue a Goteborg en 1983, ont ete acceptes par les participants au symposium. Les pays devraient, en collaboration avec !'OMS, dire si ces criteres pourraient etre acceptes dans toute !'Europe. Dispositions transitoires Les pays d'Europe se trouvent a des stades differents en ce qui concerne le developpement de l'enseignement infirmier superieur. Des mesures immediates sont necessaires pour creer un cadre d'infirmieres chargees de a Farrell, M. et Stussi, E. The evaluation of nursing management educational programmes. Copenhague, Bureau regional de !'OMS pour !'Europe, 1983 (document non public EURO/ NURS/ 83.2). 25 l'enseignement, de la gestion et de la recherche et qui seront a meme de mettre en oeuvre les progres de l'enseignement et de la pratique des soins infirmiers. Pour que cette recommandation entre en vigueur, ii faudra : reunir, au niveau national, un groupe de responsables infirmiers venant du systeme de sante et de responsables d'associations d'infirmieres et d'etablissements d'enseignement qui pourront jouer le role de catalyseurs, et pourront planifier, lancer, motiver et soutenir la recherche et le developpement dans l'enseignement superieur; prendre des mesures immediates pour accroitre le nombre des infirmieres enseignantes qualifiees capables de participer a l'ensei- gnement superieur; mettre en place un systeme de formation permanente a l'intention des infirmieres chargees d'enseignement et de gestion, pour qu'elles puissent actualiser leurs connaissances et leurs qualifications, sur les plans professionnel et pedagogique; organiser des cours speciaux a l'intention des infirmieres qualifiees, titulaires d'un diplome universitaire, pour leur permettre de satis- faire aux criteres d'admission aux cours de formation superieure dans les etablissements d'enseignement infirmier a l' universite . Formation permanente Afin d'assurer des cours preparant les infirmieres a appliquer effective- ment les connaissances et Jes competences requises pour les soins de sante, ii est recommande que les pays elaborent et appuient des programmes de formation permanente pour toutes les infirmieres, a commencer par des cours speciaux pour le personnel infirmier actuel d'enseignement , de gestion et de recherche, pour !'aider a definir les nouveaux domaines de connaissance et de competence qu'il devra maitriser. Recherche Seuls quelques pays de la Region ont des installations et des moyens de recherche pour les soins infirmiers qui permettraient aux infirmieres de conduire des activites de recherche et de participer a de telles activites. Dans les pays qui manquent d'infirmieres et de moyens pour la recherche, ii faudrait renforcer le reseau de centres collaborateurs de !'OMS et prendre des initiatives pour developper les aptitudes des infirmieres a la recherche. Dans tous les pays d'Europe, ii faudrait creer des mecanismes pour assurer le financement a la fois de la formation des infirmieres 26 chargees de recherche et des projets de recherche en matiere de soins infirmiers. En collaboration avec !'OMS, Jes pays devraient mettre au point un index des travaux de recherche qui ont ete effectues dans le domaine des soins infirmiers, pour que !es resumes de ces travaux puissent etre mis a la disposition des interesses dans toute !'Europe. Developpement de reseaux Aune epoque ou !'evolution rapide des societes demande la revision et la reevaluation regulii:res des programmes , ii est necessaire d'avoir des reseaux d'information dans !es pays et entre Jes pays pour faciliter l'echange de renseignements sur !'elaboration des programmes d 'ensei- gnement, !es resultats des recherches, Jes innovations dans l'enseignement , et le succi:s ou l'echec d'approches particulii:res visant a resoudre des probli:mes communs. En collaboration avec !'OMS, Jes pays devraient continuer d'elaborer de tels reseaux, de fa9on que Jes resultats de la recherche et Jes faits nouveaux survenant dans l'enseignement superieur soient accessibles dans la langue de chaque pays, afin de faciliter le processus de changement. Programmes speciaux Pour promouvoir un enseignement infirmier efficace, ii faut inclure de nouvelles matii:res dans Jes programmes d'enseignement superieur. S'il est vrai que Jes decisions concernant le contenu des programmes et Jes methodes sont l'affaire de !'administration universitaire et des etudiants, ii est neanmoins recommande de prendre en consideration Jes matieres suivantes : epidemiologie, statistiques sanitaires et aspects economiques des soins de sante, elaboration de la politique sanitaire et sociale. Pour le moment, on pourrait peut-etre proposer de tels sujets a la generation actuelle d'enseignants et de gestionnaires sous forme de cours speciaux. 27 ZUSAMMENF ASSUNG Zweck des Symposiums war: - die Oberpriifung des derzeitigen Standes der Weiterbildungspro­ gramme in der Krankenpflege und die diesbeziigliche Entwicklung im Hinblick auf die primare Gesundheitsversorgung - die Untersuchung der Organisationsform und Fiihrungsstruktur weiterfiihrender Krankenpflegelehranstalten aus der Sicht der europaischen WGO-Regionalstrategie fur "Gesundheit 2000" die Untersuchung der Entwicklungstendenzen im europaischen Ausbildungswesen in den kommenden 20 Jahren (einschlieBlich Fragen, die mit den Auszubildenden zusammenhangen) und der Implikationen solcher Veranderungen in bezug auf die Aus­ arbeitung von Weiterbildungsprogrammen in der Krankenpflege die einzelstaatlichen Behorden anzuregen, dem Ausbildungsbedarf des Krankenpflegepersonals ihres Landes nachzukommen, um den sich aus der Strategic "Gesundheit 2000" ergebenden Anforde­ rungen gerecht zu werden. Auf dem Symposium waren anwesend: 20 Vertreter aus 18 Landern, 17 Berater auf Zeit aus 6 Landern und Beobachter aus 4 weiteren Landern . . Die meisten Teilnehmer waren Krankenschwestern, daneben nahmen aber auch Vertreter der Medizin, Soziologie und des Erziehungswesens teil. Ein Teilnehmer vertrat die Verbraucher und vier weitere befanden sich in der Krankenpflegeausbildung. Ebenfalls vertreten waren die Organisationen: ICN (Weltbund der Krankenschwestern und Krankenpfleger), ICM (International Confederation of Midwives), NNF (Nordischer Verband der Krankenschwestern und -pfleger), ENG (Europaische Krankenpflege­ gruppe), CICIAMS (lnternationaler Verband katholischer Kranken­ schwestern) und ENSG (European Nursing Students' Group). Bisherige Entwicklung und Zusammenfassung der Diskussionen Die Erklarung der WGO auf der Konferenz von Alma-A ta ( 1978), die von den Regierungen der europaischen Lander gebilligt warden ist, wirkt sich 28 in bedeutendem Umfang auch auf die Ausbildung und den Einsatz der Krankenschwestern aus. Um das Ziel "Gesundheit filr alle bis zum Jahr 2000" zu verwirklichen, ist eine Neuorientierung erforderlich, die trotz Bevolkerungstiberalterung, gesellschaftlicher Instabilitat, Arbeitslosigkeit, frilhzeitigen Ruhestands und Bevolkerungsbewegungen einsetzen mufi. Aus okonomischen und sozialen Grunden mufi die Ausbildung und Verwendung des Krankenpflegepersonals so gestaltet sein, dafi die Gesund- heitsbedtirfnisse der jeweiligen Bevolkerungskreise effizient und effektiv befriedigt werden. Es mufi dringend eine rationelle Struktur filr die akademische Weiterbildung der Krankenschwestern entwickelt werden, damit die jetzigen oder zukilnftigen Krankenschwestern in leitenden Posi- tionen Zugang zu dem Fachwissen und der Ausbildung haben, die solche Stellungen erfordern. Als Ausgangsposition gilt die Wissensgrundlage und praktische Ausbildung der Krankenschwestern. Darauf aufbauend soil ten in nichtakademischen Lehrgangen Krankenschwestern mit fortgeschrit- tenem bzw. spezialisiertem Wissen und praktischem Konnen ausgebildet werden. Aufierdem milssen besondere nichtakademische Weiterbildungs- kurse veranstaltet werden, um die Krankenschwestern auf Tatigkeiten vorzubereiten, die tiber die klinische Praxis hinausgehen . Beispiele hierftir sind: Zusammenstellung des Lehrplans in der Krankenpflegeausbildung, Verwaltungstatigkeiten im Krankenpflegedienst und die Ausarbeitung von Forschungsprojekten. Es sollte auch ein gewisses Gewicht auf die Aneignung von Kommunikations- und Verhandlungsfertigkeiten gelegt werden , da sie filr die multidisziplinare Teamarbeit im Gesundheitsbereich benotigt werden. Die Kriterien und Standards filr nichtakademische Weiterbildungs- kurse soil ten eindeutig festliegen, die Verantwortung filr die Ausarbeitung und Durchftihrung solcher Kurse mufi in den Handen einer qualifizierten Krankenschwester liegen. Curriculum-Aufbau, Lehrkrafteauswahl, Kar- rieremoglichkeiten, Ausbildungszulassungsverfahren, Einrichtungen, Res- sourcenund Dienstleistungen bei der Weiterbildung sollten den Bedin- gungen anderer Kurse an der eigenen Lehranstalt entsprechen . Schlu8folgerungen Die Ausbildung der Lehrschwestern sowie der Schwestern mit Manager- und Forschungsfunktionen sollte auf akademischem Niveau erfolgen. Die Weiterbildung ist filr alle Krankenschwestern wichtig, auch wenn der Entwicklungsstand der Krankenpflegeausbildung in Europa von Land zu Land verschieden ist. Strategien zur logischen Struk- turierung der Grundausbildung, nichtakademischen und akademischen Ausbildung bis zu Kursen zur Erlangung eines akademischen Grads filr 29 Krankenschwestern miissen unter Beriicksichtigung des landesspezifischen Rahmens entwickelt werden. In ganz Europa sollte der Ausbildung und Vorbereitung der Lehr- kriifte, Manager und Forscher im Krankenpflegewesen hochste Prioritiit zuerkannt werden, weil ohne diese Spitzenkriifte die anderen unentbehr- lichen Komponenten des Ausbildungssystems nicht entwickelt werden konnen. Empfehlungen Wenn die einzelnen Lander beabsichtigen, die Resultate der akademischen und nichtakademischen Ausbildung nach dem Kriterium zu beurteilen, ob sie die Gesundheitsbelange der Bevolkerung erfiillt, soil ten unbedingt die Leistungen der Krankenschwestern in den Bereichen Praxis, Unterricht, Management und Forschung iiberwacht werden . Es ist von groBter Bedeu- tung, daB Oberwachungsmechanismen und eine Erfolgskontrolle der Ausgebildeten wiihrend ihrer spiiteren Tiitigkeit eingefiihrt werden . Diese Aufgabe sollte eindeutig von der Krankenpflegelehranstalt wahrgenommen werden. Daten-und lnformationssysteme Ober das Krankenpflegepersonal, Personalstiirken und -verteilung sind nicht ohne weiteres Angaben zu erhalten. Die Informationen iiber Ausbil- dungsmi:iglichkeiten sowie Zahl und Art der in jedem Land angebotenen Weiterbildungskurse sind liickenhaft. Auch wenn Mechanismen zur Er- fassung der Angaben bestehen, erfiillen sie doch nicht die Anforderungen, die die Entscheidungstriiger an eine lnformierung und Riickmeldung zu Planungszwecken stellen ki:innen. Auf i:irtlicher und regionaler Ebene sollten Informationssysteme zur Erfassung von Oaten iiber das Krankenpflegepersonal und die Ausbildung eingerichtet werden. Aufstellung von Kriterien und Standards fur die nichtakademische Weiterbildung im Krankenpflegewesen Die Symposiumsteilnehmer billigten die Kriterien fiir die Evaluierung von Ausbildungseinrichtungen; die Kriterien sind in einem Beitraga enthalten, der auf der Jahreskonferenz der Europiiischen Vereinigung fiir Pro- gramme iiber Gesundheitssystemstudien (EAPHSS) 1983 in Gi:iteborg a Farrell, M. & Stussi, E. The evaluation of nursing management educational pro- grammes. Kopenhagen, WGO-Regionalburo fur Europa, 1983 (unveroffentlichtes Doku- ment EURO/ NURS/83.2). 30 vorgelegt wurde. Die Mitgliedslander sollten in Zusammenarbeit mit der WGO entscheiden, ob diese Kriterien fiir ganz Europa iibernommen werden konnen. Vbergangsordnung Die nichtakademische Krankenpflegeweiterbildung weist in den ver- schiedenen europaischen Landero nicht den gleichen Entwicklungsstand auf. Es sollten sofort Sauf. Es sollten sofort Schritte zur Aufstellung von Kadern unternommen werden, die Krankenschwestern mit Lehr-, Manager- und Forschungsfunktionen umfassen und imstande sind, die neuen Kom- ponenten der Krankenpflegepraxis und -ausbildung weiterzufiihren . Um dieser Empfehlung Gewicht zu verleihen , sind folgende Schritte erforderlich: Zusammenstellung einer Gruppe auf Landesbasis, die Entschei- dungstrager im Gesundheitswesen sowie maf3gebende Personen von Krankenpflegeverbanden und Lehranstalten umfaf3t . Von ihr wird erwartet, daf3 sie bei der Planung, Ingangsetzung, Motivierung und Unterstiitzung der Forschung und Entwicklung im Bereich der Weiterbildung eine Katalysatorwirkung ausiibt Sofortige Ergreifung von Maf3nahmen zur Erhohung der Anzahl qualifizierter Lehrschwestern, die zur Weiterbildung beitragen konnen Einfiihrung von Weiterbildungsmaf3nahmen fiir Krankenschwe- stern, die bereits unterrichten und am Management beteiligt sind, damit sie ihr Fachwissen und -konnen in der Krankenpflege und Ausbildung dem jeweiligen Entwicklungsstand anpassen konnen Durchfiihrung von Sonderkursen fiir qualifizierte und akademisch taugliche Krankenschwestern, damit sie die Zulassungskriterien fiir akademische Weiterbildungskurse erfiillen . Fort bi/dung Es wird empfohlen, daf3 die Lander Fortbildungsprogramme ausarbeiten und durchfiihren , damit die Krankenschwestern iiber das in der Gesund- heitsversorgung benotigte Fachkonnen und -wissen verfiigen. Diese Kurse soil ten fiir alle Krankenschwestern durchgefiihrt werden; man sollte auch Sonderkurse fiir derzeitig tatige Krankenschwestern mit Lehr-, Manager- und Forschungsfunktionen einrichten, damit sie sich die neuen theore- tischen und praktischen Gebiete aneignen konnen, die sie kiinftig be- herrschen sollen. 31 Forschung Es gibt nur wenige Lander in der Europaischen Region, die iiber Kran- kenpflegeforschungseinrichtungen und -kapazitaten verfiigen und es den Krankenschwestero ermoglichen wiirden, eine Forschung zu betreiben oder sich daran zu beteiligen. In den Landero, wo es an Kranken- pflegeforschero und Forschungseinrichtungen fehlt, sollten die WGO- Kollaborationszentren ausgebaut und MaBnahmen ergriffen werden, um das Forschungspotential der Krankenschwestero aufzubauen. In alien europaischen Landero sollten Mechanismen zur Finanzierung der Ausbildung von Krankenpflegeforschero und Krankenpflegefor- schungsprojekten ausgearbeitet werden. In Zusammenarbeit mit der WGO sollten die einzelnen Lander ein Verzeichnis von Beitragen zur Krankenpflegeforschung anlegen, damit entsprechende Kurzfassungen solcher Untersuchungen in ganz Europa zur Verfiigung stehen. Aujbau eines Verbundnetzes In einem Zeitalter sich schnell anderoder Gesellschaftsverhaltnisse in den Landero miissen die Lehrplane in regelmafiigen Abstanden iiberpriift und neu bewertet werden; deshalb benotigt man auf nationaler und interoa- tionaler Basis Informationsnetze, die einen Informationsaustausch mog- lich machen iiber: Curriculum-Forschung, Forschungsergebnisse, Innova- tionen der Ausbildung sowie die Ergebnisse (Erfolge oder Fehlschlage) bestimmter Versuche zur Losung gemeinsamer Probleme. Um Wandlungsprozesse zu unterstiitzen, sollten die einzelnen Lander in Zusammenarbeit mit der WGO die Einrichtung derartiger Verbundnetze weiterverfolgen, damit die Forschungsresultate und neue Komponenten der Weiterbildung in der jeweiligen Landessprache verfiigbar sind. Sonderprogramme Im Zuge einer effektiven Krankenpflegeausbildung miissen neue Wis- sensbereiche in die Weiterbildung aufgenommen werden. Zwar sind Entscheidungen iiber Curriculum-Inhalt und Vorgehensweisen Sache der Lehranstalt und Auszubildenden, doch wird empfohlen, die Einfiihrung der nachstehenden Gebiete erostlich zu erwagen: Epidemiologie, Gesund- heitsstatistik und okonomische Aspekte der Gesundheitsversorgung sowie gesundheits- und sozialpolitische Entwicklung. Im Augenblick konnen diese Themen der gegenwartigen Lehrkrafte- und Managergeneration wahrscheinlich nur als Sonderkurse angeboten werden. 32 PE31lME nepe,n CHMn03HYMOM CTORJlH c.ne,nylO!JlHe 3a,na,rn: npoaHaJIH3HpoBaTb ,nefiCTByJOMHe npoI"paMMLI nOCT,nHnJIOMHOI"O oOyqeHH.R Me,ncecrep B CBeTe HX COOTBeTCTBH.R Ue.rt.RM pa3BHTH.R nepBH'D-IOH Me,llHKO-Ca.HHTapHOH noMOMH! paCCMOTPeTb npHHUHfThl B o0.naCTH OpI"aHH3allHH ynpaBneHHR JIIKOJJaMH nOCTJlHilJlOMHOI"O oOyqeHH.R Me.ncecrep C yqeTOM 3a,naq eBponeHCKOH perHOHanbH°'1 CTpaTeI"HH 803 no .nOCTH- lleHHJO 3,00poBb.R ,nn.R BCeX ! 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CBOHX npe.ncraBHTeneH Taiate HanpaBHJIH Mell.nyHapo,llHl,!H COBeT Me,llH- 1.0iHCKHX cecrep ( MCMC) ; MelK,llyHapo,IlHa.R <I>e,llepauH.R al<YlllepoK (M<i>A), <i>e.nepaUH.R Me.nHUHHCKHX cecrep ceBepHblX CTpaH (<i>MCCC), 33 EBponeflcKaR rpynna Me.oHUHHcKIDC cecrep (ET'MC), Me~apo,llHblH KOMHTeT KaTO.rnNeCKHX Me,llHl..lHHCKHX cecrep (MKKMC) H EBponeH- CKaR rpynna cry.oetrrOK-Me.ncecrep (EI'CM). HcXO.llHaR HH<J>opMaUHR H KpaTKoe H3no~el-lJ,!e HTOrOB .llHCKYCCHH AJIMa-ATiiHCKaR .oeKnapallHR; npHHRTaR CTpaHaMH EBpoflbl B 1978 ro.oy, ncx:TaBH.na cepbe3Hble 3a,oa<oi B oOnaCTH oOy,.i:eHHR H pacnpe,.aeneHHR Me.mnlHHCKHX cecrep. TiepeopHeHTaUHR .oeRTeJlbHOCTH B 9TOM HanpaBnel-lJ,!H, npH3BaHHaR oOecne'-OiTb ~eHHe 3.IlOP0BbR .llJlR Bcex K 2000 ro.ny, npoHCXO,llHT B YCJIOBHRX crapeHHR Hace.neHHR, COUHaJibHOH HeycrOH'niBC>Cni, Oe3paCXn1-n.u,l, n011HTHKH COKpalJleHHR B03paCTa Bl,IXO.[la Ha neHCHIO H nOBblll!eHHR Mo0HJibHOCTH Hace.neHHR. 3KOHOMH'-leCKHe H COUHaJn,Hble <l>aKTOPbl Onpe,[le.11RJOT HeoOxo- .llHMCX..""Tb oOecne'-OiTb 3<1>¢eKTHBHCX..""Tb H .OeHCTBeHHOCTb Mep B oO.naCTH oOy,.i:eHHR H pacnpe,JleneHHR Me,ncecrep .ll)1R Y.OOMeTBO- pel-lJ,!R nOTpeCiHOCTeH KOHKpeTHhlX rpynn Hace.neHHR B Me,lll-0..lHHCKOM o0cnyl!CHBaHHH. KpaHHe BaIHO pa3paOoTaTb pallHOHaJlbHYlO CTPYK- TYPY ncx..-r,m,1nnoMHoro oOyqeHHR Me.ocecrep B y,.i:peQeHHRX Bb!Cllle- ro H CneUHaJIH3HpQBaHHoro o0pa3OBaHHR C TeM, '-1To0bl Me,ncecr- Pbl, KOTOPbJe 3aHHMaIOI' H.l'IH Oy .oyT 3aHHMaTb K.lllO'-leBble nOCTbl B 3.opaBOOXpaHel-lJ,!H; MOrJJH paCtl!HpRTb CBOH 3HaHWI H Orn.IT, HeoO- XO,IU,iMble ,aJlR Ta KOH paOoTbl. .lI.nR 9TOro npeQe Bcero HeoOXO,llH- MO CO3,lla.Tb COOTBeTCTByt()IJlHe YCJIOBHR .llJ1R nOJlyqeHHR nepBOHa- '-laJll:,HhlX TeOpeTJ.1'-leCKHX H npaKTH'-leCKHX 3HaHHH. PaOora noc-r-- .llHMOMHblX KypcOB .OOJmHa oa3HpQBaTbCR Ha TaKHX npe,nnOCbLTT.KaX H oOecne'-IHBaTb no.orOTOBKY Me,ncecrep, HMeIOlllHX IIIHpQKHe oOlllHe H cneUHaJn,Hb(e 3HaHWI H HaBblKH. KpoMe Toro I HeoOXO.llHMO co3- .oaBaTb nOCT.llHMOMHble KYPCbl, oOecne'-lHBa.KlltHe no.orOTOBl<Y Me.o- cec-rep no Oo.nee IIIHJ)OKOMy KPYry .llHCUHnJJHH, qeM Toro TpeCiyeT KJlHHH'-leCKaR npaKTHKa. TipHMepaMH 3.0ecb MOryT CJlyl!CHTb nporpaM.Mhl HaY'-lHh!X HCCJle.I]OBaHHH~ ynpaBneHHR cecrpHHCKHM nep- COHanoM H pa3BHTHR CHCTeM oOyqeHHR Me.ocecrep. OcoOoe BHH- MaHHe cne.nyeT Y.OeJlHTb pa3BHTHIO CBR3eH H KOHTaKTOB MeQY Me.ocec-rpaMH I KOTOPbJe HeoCiXO,IIHMbl .OnR paOoTbl B OPHra.oe CITeUHaJJHCTOB 3~00XpaHeHHR. HeoOXO.oHMO pa3pa0oTaTb '-leTKHe KPHTepHH H CTaH.OaPTbl pa- OoTM KypcOB nOCT.oHnnOMHoro oOyqeHHR' OTBeTCTBeHHOCTb 3a npoBe,nel-lJ,!e KOTOPblX .OOJIMHbl HeCTH KBa.nH¢HmipOBaHHble Me.oceCT- pbl. CrpYKTypa yqeOHOH nporpaM.Mhl, npoue.nypbl Ha3Ha'-leHHR H 34 npo.nsmteHH.R no cn;rxCSe npeno.nasaTeneH, npaBHJia npHeMa CTy,IIeHTOB, MaTepHa.TlbHo-TexHH'tleCKaR Oci3a, pecypa.1 H CJiylKObl n<x..---r.IIHMOMHoro oOy-qeHH.R ,IIOJll!Hhl OTBe'tlaTb KPHTePHJ'IM, npHH.RTblM .ll1lFI .npyrn.x KypcoB; KOTOPblMH PYKOBO.IIHT ro.nOBHoe y-qpe~eHHe. 8b1BO.llbl no.nrOTOBKa Me,IIHUHHCKHX cec-rep, c neUHaJIH3HPYl<lllHXC.R B oO.JJacnt npeno.naBaHHnr ynpaaneHHR H Ha~x 1-1ccne.noBaHHH, ,IIOJU(Ha OL""'YJ!leCTB.11.RTbC.R y-qpeg,IIeHH.RMH Bblcmero o0pa3OBaHH.R HJIH ycoBepmeHCTBOBaHH.R Ka.np<)B. Bee Me.ncecrp1,1 ,IIOJIIHbl nocro.RHHO COBePllleHCTBOBaTb CBOH 3HaHHR B cenf HenpepblBHoro oOy-qeHH.Rl XOT.R H cne.nyeT ;nn,ITbl- BaTb, '4TO B CTpaHax Espom, cymeCTByJOT pa3JIJ,Nlffl B CTeneHH pa3BHTH.R TaKHX CHCTeM. 8 KaJl,llOO CTpaHe .IIOJll!Hbl ObrI'b pa3pa- OcrraHbl npHHUHmi CO3,IIaHH.R JlOn-NHOH CTPYKTYPbl KYpc0B OCHOB- HorO, nOCT.IIHMOMHoro: npo.IIBHHYToro H cneUHaJlbHoro oOy-qeHH.R Me.ncecrep, y-qHTblBalCIUHX HauHOHaJlbHble ycnoBH.R. nepBOO'tlepe,ItHoe BHHMaliHe BO Bcex CTpaHax EBpomi Heo0XO- ,IIHMO Y.Ilen.RTb nO.IIrOTOBKe H oOy-qeHHIO Me.ncecrep, 3aHHMal<lllHXC.R BOnpocaMH npenO,IIaBa.HH.R, ynpaBJleHHR H Ha~x HCCJle,IIOBaJ-Il,IH, nOCKOJibKY (Se3 TaKHX KJUOtlem.1x Ka,IIpOB HeB03NO&HO pa3BHBaTb .npyrne Heo0XO.IIHMble KOMI10HeHTbl CHCTeMbl o0pa3OBaHH.R. PeKOMeH.IIaUHH OueHKa nOCT,IIHMOMHOro oOyqeHH.R 9¢qleKTHBH<X."'Tb OUeHKH pe3yJ1bTaTOB OOCT,llHilJIOMHoro H BY3OBCKOro oOy-qeHH.R C y-qeTOM ero 3Ha'4eHH.R ,IIJ1.R OXpaHbl 3,IIOpoBb.R HaceneHH.R M0,1teT Obrl'b oOecne'tleHa Ha OCHOBe MOHHTO- PHHra .IIe.RTeJlbHOCTH Me.ncecrep, 3aHRI'blX npaKTH\leCKOH paOOToo, npeno.naBaHHeM, ynpaB.11eHHeM H HaytDiblMH HCC1le,IIOBaliH.RMH. Ype3BbNaHHO ~O C03,IIaTb MeXaliH3Mbl .IlJl.R KOHTpoJl.R 3a paOOI'OO Ob1BIIIHX CTy,IIeHTOB H TTOBblmeHH.R HX KBaJIH(tliKallHH• 3Ta 3a,IIa'4a ,IIOJU(Ha Ob!Tb BMeHeHa B o0R3aHHOCTb MKOJl Me,IIceCTep. CHCTeMbl HH¥?J)MallHOHHO-c:npaBO'I.D-ll,IX ,llal-lHLIX He &..--er .oa nen<o no.ny-qHTb ,IIaHHhle o '-llicne H nop.R,llKe pacnpe.neneHH.R Me.ncecrep. 0Tph!BO'4HOO .RBJl.ReTC'..R HH<l>OPMaUH.R o pecypcax oOy-qeHH.R; '-IHC'Jle, xapaKTepe H BH.IIe nOCT.IIHMOMHhlX 35 KypcOB B KaJIJlOH C'l'paHe. ,Ilaite TaM, r,ne ecrb MexaHH3Mbl ,Il.llR cOopa Tal<HX .IlaHHLIX, HX 9¢¢eKTHBHOCTb B nnaHe oOecne<1eHHR PYKOBO,llHTeJleH HCXO,IlHOH H oOpaTHOH HH<l>OJ)MauHeH B Ue.nRX nna- HHpoBa.HWi ()(..'TaBJJReT ll.eJiaTb JJY'{lllero. Ha MeC'l'HOM H perHOHaJlbHON ypoBHRX cne,nyeT CO3,IlaTb CHCTeMl.l .llJlR cOopa .IlaHHblX o Ha.rlH'lHH cecrJ)HHCJ<oro nepcoHana H ero no.nroTOBKe. Pa3pa0oTKa KpHTepHeB H C'l'aH,nap:roB nOC'I'.DHMOMHOro oOY'ieHHR Me,ncecrep YqacTHHl<H 01MnO3HYMa nonOlKHTeJibHO oueHWJH KPHTepHH oueHI<H ,newrein,HOCTH Y'ij.)elt.IleHHH oOpa3OBaHHJ1, H3nOlleHHbie B .IlOKYMeHTea, npe,ncrasneHHoN Ha paccMOTpeHHe egero.IlHOH KOH¢epeHJ..tHH EBponeAcl<oA acCOUHauHH no nporpaMMaM H3yqeHHR cnyIO 3,IlpaBOOXpaHeHHR (reTeOopr, 1983). CTpaHaM H 803 cne,nyeT onpe,nemrrb B03NOllHOC'I'b HcnO.11b3OBaHHJ'I 9THX KpHTepHeB B EsponeAcKOM pernoHe B ue.noM. npoMeiyTO'D-!ble Mept,1) yqHTl,IBalOIIIHe COB!)eMeHHoe COC'l'ORHHe ,nen B crpaHaX EBpoI'lbl nOCT.IlHMOMHoe oOyqeHHe Me.IIHUHHCKHX cecrep HaxO,llHTCR Ha pa3.rtH'D-lbOC C'l'a,IJHRX pa3BHTHR. HeoOXO.IlHMO npHHRTb 0e30TnaraTenbHLle Mepbl K TOMy, '1To0bl CO3,IlaTb pe3epB npeno,naBaTeJieH, PYKOBO,IlJDIIHX H HayqHLIX paOoTHHKOB B oO.naCTH ceCTpHHCKOro ,ne.na, KOTOPble MOrJIH Obi CO,IleHC'l'BOBaTb ,IlaJlbHeH- meMy pa3BHntIO oOyqeHHR H KJlffl-lHqeCJ<OH no,nrOToBI<H Ne,ncecrep. ,ll.roi npeTBOpeHHR 3TOH peKOMeH,.llaUHH B llH3Hb Heo0XO,IlHMO: - C03,IlaTb HauHOHaJlbHyJO rpynny Me,ncecrep~ 3aHHMalOIIIHX OTBeTC'l'BeHHble nOCTLI B 3,IlpaBOOXpaHeHHH, H PYKOBO,IlHTeJieH aCcaiHaUHH MKOn Me,ncecrep; KOTOpaR Morna Obi KOOp,IlHHH- poBaTb, Il11aliHp0BaTb, CTHMy.JIHpoBaTb H pa3BHBaTb Hay'D-!Lle HCCJle,IlOBaHHJ'I B oO.naCTH llOCT,IlHnnOMHOro oOyqeHHR; a 41apenn, M. H CrycCH, E. OUeHKa nporpaMM oOY'ieHHR ceCTpHHCKOrO nepcoHana MeTO,IlaM ynpasneHHR KoneHrareH, EBponeflcKoe pernoHanbHoe 610po 803, 1983 {HeonyO.r'iHKOBaHHLIA .OOKYMeHT 36 r npHHRTb cpo'lfiible Mepbl no yae.m-NeHHIO tniCJJa KBaJIH<IJ!,nn.ipo- BaHHblX Me,.ucecrep-npeno,naBaTeneH, ytra.CTByI()lllHX B )leRTeJll:r'" .lleFITe.rtbHOCI'H CHCTeMbl nO(.""T)lHMOMHOro oOyqeHHR! C03)laTb CHCTeMy HenpepblBHoro oOyqeHHR .[].JlR Me,.ucecrep, 3aHHMa(<JllHXCR BOnpocaMH oOyqeHHR H ynpaBneHHR, B Ue.nRX COBePbleHCTBOBa.HWf HX 3HaHHH H omrra B oOnaCTH cecrpHH- CKOro )lena H oOyqeHHR: opraHH3OBaTb cneUHa.IlbHhle KYPCbI .[].JlR cnocoOHbiX 1<Ba.11H¢H- UHPQBaliliblX Me,.ucecrep, C TeM 'ITo0bl pacb!HpHTb oOl>eM 3HaHHH, HeoOXO)lHMl,IH .[].JlR nocrynneHHR B BblCblee yqeOHoe 3aBe,.uru-rne. HenpepbiBHoe oOyqeHHe 3a,naqa no CO3)laHHIO KypcOB nO)lrOTOBI<H Me,.uce...---rep K Bbl- nOJIHeHHIO Heo0XO)lHMblX <l>YHKllHH B CHCTeMe 3.Jlpa.BOOxpaHeHWI Tpe- OyeT pa3paOOI'I<H B CTpaHaX nporpaMM HenpepblBHOro oOyqeHHR Bcex Me,.ucecrep, H B nepByIO oqepe,llb npenO.aaBaTeneH ~ PYKOBO- )lHTeJleH' Ha~blX paoorttHKOB cecrpHHCI<Oro )lena' KOTOpble nµ,t3BaHhl nOMoqb HM B pa3BHTHH HOBblX o0naCTeH 3Hal-!HH C yqeTOM npe,u'bRBJIReMblX K Me.ItceCTpaM Tpe0oBaHHH. lIHblb HeMHorne CTpaHbl PernoHa HMelOT B CBOeM pacnoprutte- HHH MaTepHanbHo--Te.lCHH'leCKyIO oa3y;- n03BOJlRKl!lYIO Me,.uceCTpaM yqaCTBOBaTb B HayqHblX HCcne,.uoBaHHRX HJlH PYKOBO.llHTb HMH. Cne)lyeT Y!<pellHTb ceTb COTpY.IIHJ,ft@IOillHX UeHTpoB 803 B TeX CTpaHax, r.Ite He XBaTaeT Ha~blX paCiorHHI<OB H HeT COOTBeTCT- ByIOl!lHX BO3M0,11;HOCTeH .[].JlR npoBe,.ueHWI Ha~ H3blCKaHHH. HeoOXO.llHMO npHHRTb Mepbl no pa3BHTHIO y Me,IIHUHHCKHX cecrep HaBblKOB I< npoBe,.ueHHIO Ha~OH paOOTld. Bo Bcex CTpaHax EBporlbl HeoOXO.IlHMO CO3)laTb MeXaHH3Mhl .[].JlR (fl,ittaHCHpoBaHHR no)lr-OTOBI<H HayqHJ,IX paOorHHI<OB B oOnacrH ceCTpHHCKOro .nena, a TaI<JKe npoeKTOB Ha~blX H3blCKaHHH B 3TOH oOJlaCTH. Crpattbl BMecre c 803 .lIOJl!tHbl cocraBHTb nepeqeHb HayqHbJX pa3paooro1< B oOJlaCTH ceCTpHHCKOro .lleJla; MaTepHaJlbl O KOTOPblX MOrnH Obi pacnpoCTpa.Hifl'bCR cpe.ItH &.""E!X CTpaH EBpom1. 37 Pa3BHTHe cerefl B nepHO.ll Ot.icrpwc o0111ecreeHHWC H3Mettel-lH}f, Tpe0y!(IIIHX nepHQJlH'lecKoro aHa.mrna H nepeouettKH ;r'leOHblX nporpaMM; ocoOo ocrpo BC'I'aeT Bonpoc O CO3,llaHHH HallHOHaJibHblX H MextHauHOHaJU,- , HblX OICTeM HH4><)pMauHH O pa3BHTHH ;r'leCStn.lx nporpaMM, pe3ym,- TaTax HaY'IHblX H3blCKal-lH}f, HOBblX MeTO,llaX B npenO,llaBaHHH, nonOJIHTeJlbHWC H HeranmHlilX pe3ym,TaTax OT,lleJlbHlilX nO,llXO,llOB K pemeHHJO o0111HX npoO.neM • C'rpaHaM BMecre c 803 c.ne.nyeT CTpe.MHTbCR K pa3BHTHIO TaKHX OICTeM C reM, 'IToObl nepeBe,lleHHhle Ha HauHOHaJlbH!de ff3hlKH MaTepHam.I O pe3y.J1bTaTax HaY'fliblX Hcc.ne.noBal-lH}f H pa3paOo-roK no TlOCT,llHMOMHOMy oO;r'leHHIO MOr.nH Obi HcnOJlb30- BaTbCR B Kaxt,llOH CTpaHe ,ll.nR BHeceHHFI COOTBeTCTBylOlllHX H3MeHeJiHA. C'leUHaJn,Hble nporpru,tMbl B nporpaMMLI nOCT,llHMOMHOro oO;r'leHHR c.ne.nyeT BKJ110trnTb HOBble npe,JlMeTbl B UeJlRX nOBlillUeHHFI SCWleKTHBHOCTH oO;r'leHHR cecTPHHCKOro nepcotta.na. XOTR pemeHHFI, KacaK1UHeCR co.nepxta- HHR ;r'leOHbIX nporpa.MM H MeTO,llOB; HaxO,llRTCR B KOMneTeHUHH npenO.llaBaTe.neH H CTY.lleHTOB, HaCTORTe.nbHO peKOMeH,llyeTCR BKJllOt{aTb B nporpaMMbi TaKHe ,llHCUHnJIHHJ,l; KaK 311H,1leMHO.norHR, craTHCTHKa 3,llpaBOOXpaHeHHFI, 9KOHOMHKa 3,llpaBOOXpaHeHHR, J)a3BHTHe 3,llpaBOOXpaHeHHR H COUHaJibHaR nonHTHKa. Ha HaCTOR- l!leM 9Tane 9TH npe,llMeTbl MOlDiO OWJO Obi BKJ110trnTb B nporpaMMbl cneUHaJlbHl,IX KYJ)COB no no.nrOTOBKe ylle paOOTalOIIXHX npeno,naBa- Te.neH H PYKOBO,llHTe.neH. 38