nursing education and practice from diploma to bachelor in ... · nursing education and practice...
TRANSCRIPT
Nursing education and
practice from diploma to
bachelor in Spain
Adelaida Zabalegui, RN, PhD, FEANS
November 30th , 2017
• Background
• Nursing education from
diploma to degree
• Nursing practice from
diploma to degree
• The Future of nursing
• Conclusions
OUTLINE
HEALTH CARE CHALLENGES
• Population aging and chronicity
• Immigration
• Technology growth
• Economic and sociopolitical globalization
• Increased level of patient’s knowledge and decision making
• Policies of health cost maintenance and reduction
• New health care procedures, quality improvement
• Evidence-based practice and advances in health science
06/12/2017 4
Healthcare expenditure, 2014
De media Europa dedica 8% de su PIB para sanidad, mientras
que España dedica 6,1% (Eurostat, 2007)
http://ec.europa.eu/eurostat/statistics-explained/index.php/
Physician & Nurse Ratios in EU
MD RN
Based on 2016 OECD/Eurostat/WHO-Europe Joint
7
RN ratio & mortality
8Aiken et al., The Lancet, 2014
SPAIN RESULTS (N = 5654 RN)
26% would like to move to another hospital
45% were moderately dissatisfied
48% had unfavorable/poor work environment
22% had high level of burnout
Lack of time to:
40% comfort the patient
46% update care plan
49% patient / family education
21% document the care
21% monitor the patient
20% mobilize the patient
9Fuentelsaz-Gallego, Consorcio RN4CAST-España. 2013. [Work setting, satisfaction and burnout of the nurses in critical
care units and hospitalization units. RN4CAST-Spain project]. Enferm Intensiva, 24(3):104-12
Nursing Education
in Spain
From Diploma to Degree
06/12/2017 11
LEGISLATIONEurope:
European directive 2005/36/CE, Nursing education requirements 4,600hrs (2,300 hrs of clinical practice).
Spain:
Law 44/2003, LOPS (Law on the organization of the health
professions)
Royal Decree 450/2005, Nursing Specialties approved
BOE 157/2006, Postgraduate Education Programs
Royal Decree 1393/2007, Degree Programs
BOE 2134/2008, General requirements to be a Registered
Nurse
BOE 1837/2008: Nursing Degree Objectives, 240 Credits,
Competencies, ....
“Nurses are responsible for the direction,
evaluation and provision of nursing care aimed
at the promotion, maintenance and recovery of
health, as well as the prevention of diseases and
disabilities”
LOPS (LEY DE ORDENACIÓN DE LAS PROFESIONES
SANITARIAS). Law 44/2003
Pre-Bolognia academic system
1st cycle 2nd cycle 3rd cycle
2 - 3 years 4 - 6 years
Diploma
Bachelor
Doctor
2 years
POST-BOLONIA system
Degree240 ECTS
Master60-120ECTS
Doctorate
L
L
L
Clinicaldevelopment
22 years old
SpecificPofessionalCompetencies
24 years old
Postdoctorate
30 years
Academic
development28 years
4 years + 1- 2 years +
Basic Professional Competencies
4 years
Nursing Specialty
By Residency
2 years
60 ECTS: Sciences, humanities, social, behavioral sciences,
technology, computer sciences, foreign languages, etc.
120 ECTS common for all universities:
- 15 ECTS: Anatomy and physiology, pharmacology,
microbiology.
- 105 ECTS of Nursing sciences: Fundamentals of nursing (10),
Clinical nursing (40), Psychosocial and mental health nursing
(9), Community nursing (20 ECTS), Nursing along the life cycle
(15), ethics, legislation and administration (5), and other nursing
related subjects (6 ECTS) such as bioethics or communication.
60 ECTS Clinical practicum.
Nursing Degree (240 ECTS)
Clinical Practice
Student nursing clinical practice
is performed with different
structures and protocols and not
all emplacements are
perceived as a powerful
learning environment for
students.
Nurses perceive lack of time
and sometimes knowledge in
front of the formative role.
05/31/2017Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A radical call for transformation.
Bennett, M., & McGowan, B. (2014). Assessment matters-mentors need support in their role. British journal of nursing, 23(9), 454-458.
Henderson, A., & Eaton, E. (2013). Assisting nurses to facilitate student and new graduate learning in practice settings: What 'support' do nurses at the bedside need? Nurse Education
in Practice, 13(3), 197-201
O'Mara, L., McDonald, J., Gillespie, M., Brown, H., & Miles, L. (2014). Challenging clinical learning environments: Experiences of undergraduate nursing students. Nurse Education in
Practice, 14(2), 208-13.
NURSING DEGREE
General Degree Competencies
Associated with professional values and the role of the nurse
Associated with nursing practice and clinical decision making
Ability to properly use a range of skills, interventions and activities
to provide optimal care
Knowledge and cognitive skills
Interpersonal and communication skills
Competencies related to leadership, management, research and
teamwork
06/12/2017 19
NURSING SPECIALTIES, LAW, 2005
Obstetric-gynecological nursing (midwife)
Mental health nursing
Family and community nursing
Geriatric nursing
Pediatric nursing
Work nursing
Medical-surgical nursing
New requirements for Professors
The same requirements for all health care sciences
Professors have to be Accredited by National agencies: ANECA, AQU
Teaching assignment based on
Academic activity
Research activity
Management activity
Impact Index applied: CSI
Peer review
Consequences
Improvement of competencies in:
Problem solving
Knowledge & skills
Evaluation of interventions
Health care/services outcomes
Increase in professional autonomy
Nursing care
From Diploma to Degree
By our Law: Diploma = Degree in Nursing
Time to find the first RN job
3 m 3-12 m +12 m
Source. CIE Spain: In 2017: 247.974 nurses, in 2014: 4,41% unemplyed
EVOLUTION OF FIRST JOB BY CONTEXT
(Hospitalization, primary care & long term care)
Hospital Primary care LTC Others
Degree of satisfaction with work (0 to 10)
Primary care Hospital LTC
Work
description
Possibilities for
profesional
development
Salary Knowledge
application
General
satisfaction
PROFILE OF GRADUATES WITH RESPECT TO DIPLOMATES
Much worst WorstThe
sameBetter Much better
PROFILE OF GRADUATES WITH RESPECT TO DIPLOMATES
Primary care Hospitalization
Much worstWorst
The
same Much betterBetter
Importance of the competencies of new graduates
in Nursing according to employers
The most important competencies
identified were:
• Responsibility at work
• Learning capacity
• Teamwork
The less important competencies
were:
• Leadership
• Creativity
• Foreing languages
QUÈ S’AVALUA?
- 30 -
GenericCompetencies
1. Skills associated with professional, ethical and deontological values.
2. Care process (procedures / protocols, prevention and promotion of health,
empowerment, good practices, EBP).
3. Communication with the user or significant other persons and with the
multidisciplinary team.
4. Teamwork and inter-professional relationship
SpecificCompetencies
5. To be determined by the field of specialization (anesthesia, peri-surgical,
midwives, ICU nurses, emergency nursing, surgical or medical hospitalization
floors, ...).
InstitutionalCommitment
6. Institutional commitment (participation, involvement, adaptation to changes,
etc.)
Teaching and research
7. Accredited training / permanent apprehension competence.
8. Teaching activity
9. Research and innovation activity (publications, participation in congresses,
research projects).
10. Other merits.
PROFESSIONAL DEVELOPMENT
Career Development PathwayProfessional career: Requirements for each level
LEVEL Work experience:
Previous working
years
General and specific
competences
Corporate
commitment Curriculum description Minimal
Credits
Title
1 5 150 - 250 20 - 40 Internal Continuous Professional
Development
5 Clinical Nurse 1
2 5 140 - 250 20 - 40 Continuous Professional Development
Presentation of Poster/talk in a conference
21 Clinical Nurse 2
3 5 130 - 250 20 - 40 Official post-graduate or specialist nursing
MSc
Research partner
Conference presentation/ Talk
60 Advanced
Clinical
Nurse
4 5 110 - 250 30 - 40 MSc
Specialist Nursing Degree
Publication in National Journal as
main author
120 Senior
Clinical
Nurse
5 5 100 - 250 30 - 40
PhD
Research project as PI
Doctorat + IP Expert
Nurse
Historical evolution in the prevalence of nosocomial infection
Implementation and evaluation of Dedicated Educational Units in
Europe
Sandra Martin, MsN; Adelaida Zabalegui, PhD, FEANS;
Mariana Carolino Pereira, PhD; Ewa Dmoch – Gajzlerska,
PhD; Fisun Senuzun, PhD; Working group iDEUs-EU
07/31/2017
Implementation of
Dedicated Education Units
A clinical site that is modified to an optimal teaching
and learning environment.
One-on-one coaching
Duration of at least 6 weeks of internship
Focus on assumption of responsibility and care coordination
Presents the link teacher in the unit
Motivation and support from unit head nurse and team
The joint experience of knowledge, skills and attitudes
among nurses/midwifes, head nurses, students and
faculty.
05/31/2017
Mentoring my future colleagues, What way to go?
Be Dedicated to Education in your Unit!
Do you also lack the time to be well informed?
Do you want to be on the lead track with your medical
organisation?
Do you want to share your experiences and competences with
colleagues?
Just join the DEU society and learn from the best about practical
education in medical care!
Soon find out more at http://www.ideus.ips.pt/
SAVE THE DATE
25th of Mai 2018
Venue: The institute for Ireland in Europe, Leuven
Keynote speakers
Professor Susan Moscato, USA
DEU pioneer
Professor Peter Rosseel, BE
Expert in organisational/cultural change and the learning organisation
EMERGING COLLABORATIVE RESEARCH ON
ROLES OF ADVANCE PRACTICE NURSING
(CRER-APN)
• Understanding how the APN roles emerge
• Analysis of contextual factors at different levels
• Comparison of results between Canada and Catalonia
Context
SPANISH VERSION OF THE MODIFIED ADVANCED PRACTICE ROLE DELINEATION TOOL
68%
36%
51%
28%
34%
CUIDADO INTEGRALAL PACIENTE
SISTEMAS DE APOYOINTERPROFESIONAL
EDUCACIÓNINVESTIGACIÓN
PUBLICACIONES YLIDERAZGO
Interprofessional
Team
work
Leadership
Research Teaching
Integral
Patient care
APN AT HOSPITAL CLÍNIC OF BARCELONA
The Future of Nursing (USA, 2010)
Remove barriers to professional practice
Increase residency and NP / APN programs
Increase the proportion of registered nurses to 80% (2020)
Double the number of doctors in nurses by 2020
Ensuring that nurses are on continuous education (LLL)
Allow nurses to lead the change (improvement of care)
Analyze inter-professional care data
Global Issues in Nursing & Health Care
Outcomes
Structural
Empowerment
Exemplary
Professional
Practice
New Knowledge
Innovation &
Improvement
* American Nurses Credentialing Center
Transformational Leadership
Values of Magnetism
Transformational Leadership: Quality of nursing leadership and management style.
Structural Empowerment: Organizational structure, Personnel policies and programs, Community and the healthcare organization, Image of nursing, and Professional development.
Exemplary Professional Practice: Professional models of care, Consultation and resources, Autonomy, Nurses as teachers, and Interdisciplinary relationships.
New Knowledge, Innovation, & Improvement: Quality improvement.
Empirical Quality Results: Quality of care.
Outcomes: Sources of evidence
Indicators sensitive to nursing care:
Clinical indicators (Falls, UPP, UI, ...)
Patient satisfaction
Nurse satisfaction
Nursing research
Changes in care and work environment
Professional development
Participation in community activities
44
Conclusions Nurses must apply the acquired knowledge to the fullest possible extent
Nurses must achieve higher levels of advanced education
Health care institutions need to invest in nursing care
We need to:
Increase collaboration between university-hospital-community
Identify and assign nursing positions in relation to competencies
acquired and with advanced education
Create joint positions (university-healthcare setting) and
interdisciplinary training
Increase the participation of the nurses from clinical setting in the
design of training programs and the participation of the nursing
professors in healthcare decision making
- 46 -
46¡ Thank you!