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*Corresponding Author: Bugaevskaya Nataliya Anatolyevna. The Petro Mohyla Black Sea State University, Nikolaev, Ukraine.
Citation: Bugaevskaya N Anatolyevna, Bugaevsky K Anatolyevich. (2022). Paliative Care: Features Training of Nurses on Hospise Care in Ukraine and Poland, J. Women Health Care and Issues, 5(4) DOI: 10.31579/2642-9756/121
Copyright: © 2022 Bugaevskaya Nataliya Anatolyevna. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 09 May 2022 | Accepted: 19 May 2022 | Published: 01 June 2022
Keywords: ukraine; poland; hospice; hospice care; patients; nurses.
This article presents the results of studies on the features of practical training of nurses-bachelors care and provide appropriate palliative and hospice care hospice patients to facilities in Ukraine and Poland. The peculiarity of the formation and development of this type of care seriously and terminally ill patients in both countries.
* Higher Medical Educational Institution (HMEI)
* a pan-European system for recording the educational work of students in the development of an educational program or course (ECTS system)
Problems of Ukraine's integration into the European space are relevant, irreversible and extremely necessary for our country [1, p. 45-48; 8, p. 78-79]. Ukraine has been cooperating with many countries for many years on the reform and modernization of nursing education, using their positive experience in both the training of nurses and the introduction of a new model of nursing in practical medicine [5, p. 126-129; 9, p. 4-7]. Much attention is paid to these issues in the process of training new nurses, bachelors and masters of nursing [1, p. 45-48; 5, p. 126-129; 8, p. 78-83].
For many years in Ukraine, this issue has been taken care of by such specialists as Chernyshenko TI (Director of the State Institution "Central Methodical Cabinet for Training of Junior Specialists" of the Ministry of Health of Ukraine, Yastremska SO, Director of the Institute of Nursing, NI Rega, Ternopil Gorbachev State Medical University of the Ministry of Health of Ukraine ”, VY Shatylo (Rector), PV Yavorsky - Zhytomyr Institute of Nursing, MB Shegedyn - Director of Andriy Krupinsky Lviv State Medical College, IY Gubenko (director), IV Radzievska, LP Brazaliy - Cherkasy Medical College.
Today requires the introduction of the problem of creating and developing palliative care in the educational process and in the sphere of social change in Ukraine. In Ukraine, as in most countries of Europe and the world, the percentage of elderly people, patients (both adults and children) with severe, incurable diseases that require round-the-clock care and special palliative care [1, p. 45-48; 9, p. 4-7]. The number of hospices in the country is insufficient, knowledge and practical skills, necessary medicines, medical equipment and means of medical and sanitary care are chronically lacking, there is a lack of qualified medical and nursing staff [8, p. 78-83]. All this requires radical changes, both the thinking of the authorities and the leadership of the medical industry, and society itself to the problem of palliative and hospice medicine. New hospices are needed (buildings, tools, staffing and equipment), curricula need to be changed, both in medical schools and colleges and in medical universities [8, p. 78-83].
It is necessary to separate such subjects as "Geriatrics and Gerontology", "Palliative and Hospice Medicine". This requires the introduction of additional teaching hours in universities of I-IV levels of accreditation, the introduction of these disciplines for doctors and nurses in the system of postgraduate education [8, p. 78-83]. In order to implement all this, it is necessary to more actively study European and world experience, both in the educational process and in practice. Among other neighbors of Ukraine, Poland's experience in training nurses and their further work in palliative and hospice care facilities is invaluable for our country.
The purpose of this article is to review and compare the training of nurses in Ukraine and Poland, at different levels of their training (both diploma and postgraduate), while studying such a discipline as "Nursing in Palliative Care".
In writing this article, we used a method of research such as a review and literary-critical analysis of available, Ukrainian and Polish, scientific and scientific-methodological literature devoted to different levels of training and competence of nurses, in the field of "Nursing in Palliative Care".
In both Ukraine and Poland, issues of care, communication and care for terminally ill patients, students of medical schools and colleges begin in senior undergraduate courses. This is due to the fact that the study of palliative and hospice care requires prior study of a number of clinical and supportive disciplines, which allows a fuller understanding and mastery of issues related to the problems and needs of dying patients. Without knowledge of the basics of nursing, patient care, manipulation techniques, ethics and deontology, medical psychology and the basics of interpersonal communication, nursing in oncology and a number of other disciplines, it would be difficult to imagine future nurses mastering an important part of training - palliative and hospice care. The peculiarity of studying issues related to palliative and hospice care in the system of undergraduate nursing education, in contrast to their study by Polish students of nursing is that Ukrainian students do not study this discipline separately, as in Poland, except for master's studies [10, p. .23-27].
In our country, the study of this discipline is carried out in accordance with a number of curricula prepared in 2011 by specialists of Cherkasy Basic Medical College, specialties: 5.12010102 "Nursing" - for students of medical universities I-II accreditation and 6.120101 "Nursing" for bachelors who study in medical universities of the III level of accreditation and nursing institutes [3, p. 2-5]. This is the training program "Nursing in Gerontology, Geriatrics and Palliative Medicine" for the training of nurses in medical schools of I-III level of accreditation [3, p. 2-7]. This curriculum was prepared and introduced into the educational process in 2011 by the author's team of teachers of Lviv State Medical College. Andrei Krupinsky (Director - Doctor of Medicine, Professor, Honored Doctor of Ukraine MB Shegedyn) with the participation of a leading lecturer of Cherkasy Basic Medical College IV Radzievskaya. This program provides a total of 81 teaching hours, of which issues of palliative and hospice care are listed in a separate section "Fundamentals of palliative medicine" [3, p. 2-7].
It provides for the study of 31 academic hours, of which 21 hours are allocated for practical classes, 10 hours for independent work of students. Theoretical (lecture) hours are not provided by this program [3, p. 2-8]. In the training of master nurses, in 2015 the Palliative Medicine Work Program was developed and introduced into the educational process. Area of knowledge 22 "Health" [6, p. 2-12]. Developer: S.O. Yastremska, Director of the Institute of Nursing, Ternopil State Medical University. AND I. Gorbachev Ministry of Health of Ukraine ”. This program provides a total of 180 hours, of which lectures - 12 hours, practical classes - 48 hours, independent work - 120 hours [6, p. 2-12]. As for the issues of postgraduate training of nurses, the training of nurses is carried out in accordance with the "Program of theoretical improvement for primary health care nurses", prepared in 2011 by leading experts of Cherkasy Basic College [2, p. 2-12]. ]. In 2011, the State Institution “Central Methodical Cabinet for Training of Junior Specialists” of the Ministry of Health of Ukraine (Director TI Chernyshenko) introduced a program of the cycle of specialization “Nursing in Palliative and Hospice Care” for postgraduate students, developed by Cherkasy. Medical College (director I.Ya. Gubenko) [2, p. 2-12; 4, p. 89-93]. According to this program, a total of 288 hours are provided, of which 252 hours are allocated for lectures, 36 hours for independent work [2, p. 2-12]. This program provides 40 hours of theoretical material (lectures). In addition to psychological and legal issues related to the provision of palliative and hospice care, the emphasis was on "Palliative care for chronic pain syndrome" - 12 hours, and "Palliative care for intracranial cancer patients" - 16 hours [2, p. 2-12]. To improve and improve the teaching of palliative care to student nurses, in 2011 was introduced "Thematic plan and program of advanced training courses for teachers of nursing Higher Medical Educational Institution (HMEI) I-III level of accreditation (full-time and part-time) [7, p. . 1-9]. It provides 12 theoretical hours for the study of such important topics as "Features of the nursing process in geriatric clinics" and "Nursing in palliative and hospice care" [7, p. 1-9].
As for the training of nurses on palliative and hospice care in the pre-diploma and postgraduate stages of education, there are some peculiarities. But before that I would like to briefly explain the specifics and levels of training of Polish nurses. In Poland, there is the following system of nursing education: [10, p. 23-27].
After receiving a bachelor's or master's degree in nursing, each graduate, in order to obtain the right to practice their profession as a nurse, undergoes a 12-month postgraduate internship in a medical care institution [10, p. 23-27]. Only after that the district union of nurses and midwives can send him to a higher-level internship [10, p. 23-27]. During the study for the title of bachelor (level I degree) and master (level II degree), according to the order of the Minister of Science and Higher Education on standards of education (Rozporządzenie Ministra Nauki i Szkolnictwa Wyższego z dnia 9 maja 2012 r. (Dz. U. 631 / Regulation of the Minister of Science and Higher Education of 9 May 2012. (The order 631) w sprawie standardów kształcenia), Polish students, in addition to other disciplines, also study such a subject (discipline) as "Palliative Medicine". For its study at the I-II levels, the curriculum is devoted to 95 hours, of which 15 theories, 40 hours are devoted to practical classes in colleges and medical institutions [10, p. 23-27]. Postgraduate education has the following distribution: specialized training, qualification courses, specialization courses and additional training courses) [10, p. 23-27]. After completing two years of specialized training, the nurse receives a qualification in the specified field and the title of specialist in it. Another form of training is qualification courses, which give the opportunity to obtain special qualifications to perform certain medical manipulations [10, p. 23-27]. Specialized courses provide qualifications for narrowly defined, specific medical, including and nursing manipulations (peritoneal and renal dialysis, stoma, insulin pump, etc.) [10, p. 23-27]. At the same time, additional training courses deepen and update the knowledge of the nursing profession, as well as specialization and narrow specialization of the work of a nurse [10, p. 23-27]. Postgraduate studies in Poland can be conducted both in-patient and part-time [10, p. 23-27]. Thus, in particular, in Poland, according to the new (2015) curricula, in postgraduate education, there are 20 areas of specialization for nurses. Three of them concern the issues of care for the elderly and seriously ill patients [10, p. 23-27]. These are nursing care in geriatrics (Pięliegniarstwо opieki geriartycznrej / Geriatric Nursing care), long-term care in seriously ill patients (Pielęgniarstwo opieki długoterminowej / Long-term care Nursing) and nursing palliative care (Pielęgniarstwo opieki paliatywnej / Nursing palliative care) [10, с. 23-27]. This specialization lasts 2 years and contains the following hours of study:
• Nursing in geriatrics - 990 hours, of which - 580 theoretical and 245 practical hours and 165 hours for self-training [13, p. 1-7].
• Nursing of long-term care for seriously ill patients in inpatient and home conditions - 967 hours, of which - 617 theoretical, 350 practical and 193 hours for self-training [12, p. 2-9].
• Nursing in palliative care - 960 hours, of which - 485 theoretical, 315 practical and 160 hours for self-training [11, p. 4-12].
To this list we can safely add a fourth area - nursing in oncology (pięliegniarstwо opieki onkologicznej / Nursing care for oncology) [14, p. 12-18]. The specialization of nurses in this area will determine the number of total hours - 960, of which: 485 theoretical and 315 practical hours and 160 hours for self-training, as well as in specialist training of nurses in palliative care [14, p. . 12-18].
In addition, the qualification course in palliative and hospice nursing is 456 teaching hours. Of these - 205 theoretical hours, 175 practical hours and 76 hours for self-study. It includes a basic course of palliative care and pediatric home palliative care [11, p. 4-12]. Qualification course in nursing in geriatrics is 366 hours, of which - 180 theoretical hours, 125 practical and 61 hours for self-study [13, p. 15-23]. Qualification course on long-term nursing care for seriously ill patients, inpatient and home conditions, is 360 hours, of which - 164 theoretical, 196 practical and 72 hours for self-training [12, p. 25-32].
When training nurses in Ukraine, it is necessary to study the course of palliative and hospice care, both at the pre-diploma and post-graduate stages of training, should be allocated to a separate discipline.
It is necessary to increase the total number of hours for the study of this discipline, and to introduce additional topics for the provision of palliative care to children.
Increase the number of practical hours and conduct these classes (if possible), both in specialized departments where there are terminally ill patients (cancer, hematology, neurology, etc.) and in hospices.
Conflict of interest: The author notes the complete absence of any conflicts of interest.
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