The reasons that gave rise to the need for reform include low level quality of medical care to the population, low prestige of the profession, low social status of nurses, lack of prospects for professional growth, inconsistency of the level of nursing education with the requirements of the time, shortage of nursing teaching staff, lack of scientific research in the field of nursing and lack of knowledge of foreign experience.
Nursing reform in Russian healthcare has unfolded in several directions:
- conducting scientific research in nursing;
- reforming nursing education;
- reforming practical activities;
- development of international cooperation;
- self-government and consolidation of the nursing profession. Let us highlight the main events in the reform of nursing in Russia (table).
Opening in 1979 of the country's first advanced training school for workers with secondary medical and pharmaceutical education; held in 1986-1988. seminars and conferences; The certification of paramedical workers, which began in 1987, can be considered the starting points for subsequent changes in nursing, and, first of all, in the minds of both doctors and nurses.
In 1988, the First European Conference on nursing, the outcome documents of which noted the need for changes in training, practice and management of nursing services.
Within the framework adopted in Vienna practical recommendations for 1988-2000 The WHO European Office has put forward and implemented the following priority tasks: development of educational materials on AIDS for nurses; creation, translation, adaptation to local conditions and distribution of Educational Materials for Nursing (LEMON) package; leadership development in nursing; training of teachers and managers; promoting the creation of national nursing development plans, etc.

Table. Main events of the era of nursing reform in Russia

In 1989, the All-Union Meeting of Specialists with Secondary Medical Education discussed the place of nursing personnel in the domestic health care system and adopted recommendations for implementing the decisions of the Vienna Conference. This marked the beginning of a process that continues to proceed, despite socio-political cataclysms.
One of the most significant periods in the reform of nursing in Russia (see Table 2-1) can be considered 1993. In the summer of 1993, a conference on the theory of nursing was held in Golitsyn near Moscow within the framework of the International project “New Sisters for new Russia", carried out by the Interregional Association of Nurses of Russia and World Vision International with the financial support of the Agency International Development USA (USAID).
At the conference, an attempt was made to understand the meaning of nursing as a profession, its values ​​and to define such categories as patient, health, environment and nursing itself. In the mandatory minimum content professional programs in the specialties of nursing and pharmaceutical personnel, the concept of “philosophy of nursing” was included in 1997.
In the philosophy of nursing in Russia, a patient is defined as a person (individual) who needs and receives nursing care. At the end of 1993, the patient’s right to receive nursing care was legislatively enshrined in the Constitution of the Russian Federation, articles 41-42 of which guarantee the citizen health protection and medical care.
Based on it, the “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens” were adopted, which define the principles of protecting the health of citizens, the objectives of legislation, the rights of citizens in the provision of medical care. social assistance, duties and rights of medical and pharmaceutical workers, the procedure for medical examination, liability for causing harm to the health of citizens during the provision of medical care.
In 1997, the “Ethical Code of Nurses of Russia” was adopted, which defines the most important tasks professional activity nurses, relationships between nurses and patients, with colleagues, with society. For the first time, a document appeared directly relating to the activities of nursing staff. For the first time, in a document that distinguished the activities of a nurse from the total activities of other specialists in the healthcare system, the category “patient rights” appeared, thereby defining a qualitatively new, subject-subject, level of relationships in the nurse-patient system. Emphasizing the “humanistic person-centrism” of the profession, the Code defines ethical standards of behavior for nurses as professionally important qualities.
Unfortunately, in the “Concept for the development of healthcare and medical science in the Russian Federation”, adopted in 1997, there are, unfortunately, no direct instructions for nursing services, which still indicates an underestimation of the capabilities of nursing personnel in reforming the industry, although the state of healthcare is characterized as approaching the point “followed by the collapse of the entire health care system.”
However, already the Order of the Ministry of Health of the Russian Federation dated December 31, 1997? 390 “On measures to improve nursing in the Russian Federation” assigns one of the leading roles in health care reform, ensuring the quality, accessibility and efficiency of the health care system, strengthening the preventive focus, and solving the problems of medical and social care to specialists with secondary medical education. Therefore, with the aim further development nursing in Russia, streamlining the duties, responsibilities and functions of specialists with secondary medical education, it was decided to develop a State program for the development of nursing in Russia. The order also approved the “Regulations on the chief specialist in nursing of the healthcare authorities of the constituent entities of the Russian Federation.”
In 1998, the First All-Russian Congress of Paramedical Workers took place, which approved the project State program development of nursing in the Russian Federation.

Main objectives of the program:
- creating optimal conditions for the development of nursing;
- development of new organizational forms and technologies of nursing care;
- ensuring the quality of nursing care to the population;
- increasing professional and social status nursing profession;
- ensuring social protection of personnel;
- improvement of the nursing services management system;
- assistance in the development of professional associations and involving them in implementation public policy in the field of nursing development in Russia.
In October 2004, the II All-Russian Congress of Nursing Professionals “Quality of Nursing Care - Health Care Strategy of the 21st Century” was held, the main task of which was to formulate constructive proposals for the development of nursing, determining the place and role of nursing personnel in reforming Russian healthcare. The resolution of the congress noted the need to create a “Conceptual Model” of nursing in Russia, which should clearly define the place of the nurse in the healthcare system.
You can learn more about the activities of nursing staff on the pages of magazines published in our country: “Medical Sister”, “Nursing Business”, “Bulletin of the Association of Nurses of Russia”, “Chief Nurse”, “Medical Help”, “Sister of Mercy”, "Paramedic and midwife."

Reforming nursing education

In 1991, the first steps were taken to reform education: the first colleges providing an advanced level of education in the specialty “nursing” and the first faculties of higher nursing education (FHNE) were opened at medical academies and universities. They began to create a multi-level system for training nursing personnel (basic-advanced-higher).
Order of the Ministry of Health of the Russian Federation dated August 19, 1997 No. 249 “On the nomenclature of specialties of nursing and pharmaceutical personnel” introduces a nomenclature of 26 specialties of nursing and pharmaceutical personnel, a list of correspondence of specialties of nursing and pharmaceutical personnel to the positions of these specialists, and, what is especially important , provisions on specialists, including their responsibilities, rights, qualifications, requirements for general and special knowledge and skills.
Order of the Ministry of Health of the Russian Federation dated August 29, 1997 No. 261 “On the introduction of state educational standards for secondary vocational education» introduces standards that are based on a fundamentally new understanding of the professional activity of a nurse. Since September 2002, training in medical schools and colleges has been carried out according to second-generation standards.
Now in the country there are about 450 medical schools and colleges and more than 30 FVSO. The basic level prepares general nurses and nurses. An increased level of education is provided for the training of nursing specialists or specialists with advanced training in the field of family medicine, social care, anesthesiology, resuscitation, neonatology, rehabilitation treatment, oncology, palliative care and others.
To increase the efficiency of the use of nursing personnel in practical health care, it is necessary to begin everywhere to train junior nurses to care for patients, especially since there are such positions in health care facilities. The list of specialties of primary vocational education includes the specialty “Nursing” and the qualification “junior nurse for patient care.” The training system for nursing specialists has become four-level.

Reforming nursing practice

Important areas of activity for nursing staff:
- primary health care with an emphasis on preventive work;
- diagnostic and treatment assistance, including provision of intensive treatment;
- rehabilitation and medical and social assistance to patients with chronic diseases, children, the elderly and disabled;
- medical and social care for incurable and dying patients (palliative care).
In this case, nursing staff should first of all use modern technologies in its activities.
A number of new technologies have already been introduced into practical healthcare. They are developing a network of wards, departments, nursing and palliative care hospitals (hospices, pain therapy rooms), and creating nursing services for the elderly and disabled at home.
Develop and use nursing documentation for patient care and monitoring. They are creating educational and methodological centers to train medical personnel in the new organizational system
nursing, implementation of innovative technologies taking into account regional characteristics.
The restructuring carried out in the industry based on the development of “general medical practices” increases the demand for general practice nurses. The professional activity of such a nurse involves an independent division of work with the patient: conducting pre-medical examinations, incl. preventive; identifying and solving patient problems within their competence; providing nursing services to patients with the most common diseases, including diagnostic measures and manipulations (independently and together with a doctor); conducting classes with different groups of patients; receiving patients within their competence.
It is necessary to expand the participation of nursing staff in new organizational forms of out-of-hospital care: day hospitals, ambulatory surgery and medical and social care centers, consultative and diagnostic services and home care services, giving them greater independence.
A special place in the activities of nursing staff is occupied by the preventive direction. Schools for patients with chronic diseases are promising forms of preventive work. Already developed in some regions nursing programs on the prevention of the most important infectious and non-infectious diseases. In a number of territories, schools for patients with bronchial asthma, hypertension, diabetes mellitus, and family planning schools operate successfully.
The work of the schools is aimed at teaching patients with chronic pathology health-saving technologies, the basic principles of rational nutrition, drug and non-drug therapy, methods of self-control, and prevention of exacerbations of the disease. In addition, the task of schools is to improve the quality of life of the patient.
Quality management in healthcare involves improving the management of nursing services, creating an environment in practical healthcare for the work of nursing specialists of a new generation.
The creation of a nursing staff management system affects the quality of services provided in a medical institution medical services. To assess this quality, each medical institution traditionally uses state indicators statistical reporting: bed capacity, hospital mortality, frequency of coincidences or discrepancies between clinical and pathological diagnoses, and others. It has not become a practice to use such an indicator, widely used in foreign medicine, as patient satisfaction with the quality of medical care provided. However, customer focus is a key principle of a quality management system in healthcare.
Currently, work has been intensified to create professional standards (protocols) for medical and nursing activities, which can ensure the efficiency and quality of medical services. In 2002, the first protocols for the management of patients were approved: “Protocol for the management of patients. Heart failure”, “Patient management protocol. Bedsores." In 2003, the following were approved: “Protocol for the management of patients. Scabies”, “Protocol for the management of patients. Prevention of pulmonary embolism during surgical and other invasive interventions”, “Protocol for patient management. Gonococcal infection", "Patient management protocol. Syphilis”, “Protocol for the management of patients. Intestinal dysbiosis."
Industry standards related directly to the activities of nurses are at different stages of preparation: “Intravenous administration medicines", "Intramuscular administration of drugs", "Subcutaneous administration of drugs", "Care of a vascular catheter".

Self-government and consolidation of the nursing profession

In 1994, the Interregional Association of Nurses of Russia (IAMS) was registered. Its creation speaks volumes, and first of all, about the understanding of the need for strategic changes in nursing by the head and senior nurses of medical institutions, about the importance of joining forces to carry them out. The permanent president of the Association is V.A. Sarkisova.
Marsha Fowler (professor of nursing from California, USA) believes that the nursing association has many tasks. It is necessary to make nursing education continuous; introduce the principles of the Code of Ethics for Nursing into everyday practice; standards for general practice and specialized care should be created, and the well-being of the nurse, including socially, should be taken care of; it is necessary to increase the public prestige of nursing. It is necessary to standardize the process of licensing, certification and accreditation of nurses, develop professional communication through the media, and create conditions for nurses to be proud of their profession. An atmosphere that encourages innovation is needed. The nurse should be able to make suggestions without fear of reprisal. One of the main tasks of a nursing association is to guarantee the rights of nurses. The Association should become the organization where every nurse can turn in difficult times.
Today the Association unites more than 60 regional associations and departments and about 113,000 nurses.
Midwives in our country are united in the Russian Association of Midwives (president N.A. Dzhalalyan).
Operating room nurses in Russia are united in MOOOMS - the Interregional Public Organization of Operating Room Nurses (president O.G. Pozdnyakova).

Conducting research in nursing

The development and improvement of the main areas of activity of nursing personnel must be accompanied by scientific support.
The main objectives of scientific research in nursing: development of scientific approaches to the development and improvement of nursing, sound norms, criteria and standards of nursing practice, new forms of organization and methods of work of nursing staff; testing the effectiveness of experimental models of nursing practice and others.
The first steps in this direction have demonstrated the high demand for scientific research in practical healthcare.
An analysis of specialized literature has shown that quite a lot of research is being carried out in the field of nursing. Have nursing research centers been created at the Kursk Medical College and in St. Petersburg on the basis of the advanced training school for workers with secondary medical and pharmaceutical education at the Central Medical School? 122. Nursing research is carried out, on the one hand, by doctors as part of research for the degree of candidates or doctors of medical sciences, on the other hand, by nurses at the faculties of VSO and in medical colleges.
In 1999, the first among VSO graduates to successfully defend her dissertation for the degree of Candidate of Medical Sciences was a graduate of the MMA named after. THEM. Sechenova S. Shlyakher. The topic of her dissertation is “Scientific substantiation of the organizational and regulatory foundations for the development of hospital-substituting forms of medical care.” The second candidate was also MMA graduate E. Demysheva (dissertation topic: “Quality of nursing care”).
Consideration of the research topics allowed us to highlight the following areas: research into the properties and personality states of future sisters; research into the personal qualities and characteristics of the activities of practicing nurses; studies of patient satisfaction with the quality of work of nurses; health worker health surveys; research of methodological aspects of activity; studying the use of working time by nurses; analysis of the features of psychological assistance to patients with various pathologies; study of objective indicators of the performance of nursing services in hospital medical departments, methods of their calculation and others.
For example, a study conducted in 11 regions of the Russian Federation on the costs of a nurse’s working time in the real working conditions of health care facilities showed that nurses spend more than 30% of their working time on performing auxiliary work that does not require nursing qualifications. This means that with the rational use of medical personnel and the optimal organization of their work, it is possible to free up time reserves for the main activities of nursing staff - direct patient care.
At the same time, the Resolution of the II All-Russian Congress of Paramedical Workers (2004) noted that there is no scientific research in the field of nursing.

Development of international cooperation

In 1899, the International Council of Nurses (ICN) was created. Today it is the largest association of specialists in the field of health
protection: it consists of more than 12 million nurses from 125 countries. Close cooperation between Russian nurses and MSM began only in 1999. Then Russian nurses participated as guests in an international conference dedicated to the 100th anniversary of the International Council of Nurses.
In 1971, the MSM decided to celebrate May 12, the birthday of the founder of nursing, Florence Nightingale, as International Nurses Day. Since 1988, each International Nurses Day has a specific theme. Familiarity with the topics and extensive material that MSM provides annually in the run-up to International Day on its website http:// www.icn.ch, allows you to evaluate the range of problems that attract the medical community, and primarily nurses around the world.
Here are some topics from recent years:
- 2001 - “Let's join forces against violence”;
- 2002 - “Caring for families”;
- 2003 - “The fight against injustice towards AIDS patients”;
- 2004 - “Poverty and health”;
- 2005 - “Nurses for patient safety: against counterfeit and substandard drugs.”
It is gratifying to note that Russian nurses have recently also celebrated their professional holiday together with nurses from all over the world.
In 2005, Russian nurses were accepted as members of the International Council of Nurses.
Russian nurses also actively cooperate with the second largest International organization of nurses - the Honorary Society Sigma Teta Tay International (STTI). The society was founded in 1922 by six student nurses from Indiana (USA). The students decided to create an organization that, through the dissemination of knowledge in nursing, would help improve the health of the world's population. STTI now unites more than 250,000 nurses who live and work in 90 countries. The organization spends more than $650,000 annually on research programs.
Russian nurses are vigorously developing cooperation with their Swedish colleagues. As part of a Russian-Swedish project with the support of the Swedish Health Workers Association, more than 2,000 Russian nurses from 15 regions of the country took part in “Bold Beginnings” leadership seminars.
Together with Canadian nurses, Russian nurses participated in the Health Education Link Project (HELP). The ROXY project - Russian-Canadian Sisterhood Initiative - is now being successfully implemented. Project goal: to assist the Ministry of Health and social development and the Russian Association of Nurses (RAMS) in creating mechanisms to ensure the quality of nursing care - educational standards for the postgraduate training system, modern protocols and models for organizing nursing care.
There are many such examples. Cooperation is developing both at the all-Russian level and at the regional level, and even between individual educational institutions. For example, the Sergiev Posad School of the Moscow Region cooperates with a sister college in the German city of Fulda (sister city of Sergiev Posad).
For the purpose of organization and development international relations in 1995 on the basis of the FVSO MMA named after. THEM. Sechenov, a Center for Nursing and Midwifery collaborating with WHO was created (the first director is Prof. G.M. Perfilyeva).
In May 1998, the world community adopted the “Health for All in the 21st Century” program, which determined the most important health care priorities for the first two decades of the 21st century. Based on WHO's global policy, the Regional Committee for Europe has determined its regional policy"HEALTH-XXI", which is based on three fundamental values:
- health as a fundamental human right;
- equity in health and solidarity in action, both between countries and throughout society in this process;
- the responsibility of individuals, population groups and organizations for the continuous development of health care, as well as their participation in this process.
At the same time, health is defined as the right of all people and a necessary condition for well-being, high quality of life and sustainable economic development. And its protection is perceived not as the exclusive responsibility of health services, but as a task of all departments and industries, non-governmental organizations, as well as individuals and population groups.
At the II WHO European Conference on Nursing and Midwifery (Munich, 2000), the Oath of nurses and midwives committed to the “HEALTH-XXI” policy was adopted. It contains these words:
“Adhering to the principles of the “HEALTH-XXI” policy, I undertake to use my knowledge, experience and humanistic attitude towards people for the benefit of protecting public health. My highest goal is to work collaboratively with the public to improve public health and ensure that everyone has the right to appropriate health care. Together with fellow nurses and midwives, and in collaboration with other health professionals and the public, I will continually strive to promote healthy image life and creation of healthy conditions in places of work and residence of the population. The criterion for the effectiveness of my work will be more high level health of individuals, families and communities. I will always be guided by the highest ideals of compassion and morality in providing care and providing professional care to patients.”

CONCLUSIONS
- The role of nursing personnel in the implementation of state guarantees of medical care to citizens of the Russian Federation has increased, meeting the population’s need for preventive, therapeutic, diagnostic, rehabilitation and palliative care.
- A multi-level training system for nursing personnel has been created (initial-basic-advanced-higher). There are about 450 medical schools and colleges and more than 30 faculties of higher education in the country. At the same time, the system of training specialists does not meet the needs of practical healthcare and the tasks of structural restructuring of the industry.
- The Russian philosophy of nursing has been adopted; An Ethical Code of Nurses in Russia has been developed, defining both the rights of the nurse and the patient.
- Conduct experimental work on the introduction of modern organizational forms and technologies of nursing activities. Work has been intensified to create professional standards for medical and nursing practice, which makes it possible to ensure the efficiency and quality of medical services.
- The number of public nursing organizations continues to grow. Registered and actively working: Russian Association of Nurses, Russian Association of Midwives, Interregional public organization operating room nurses and others.
- International cooperation between Russian nurses is expanding both at the national and local levels.
- In the same time basic research in the field of nursing are practically absent.
- There is no conceptual model of nursing that allows us to determine the boundaries of the competence of nursing staff and their place in today's healthcare system.

Fundamentals of nursing: textbook. - M.: GEOTAR-Media, 2008. Ostrovskaya I.V., Shirokova N.V.

SECONDARY VOCATIONAL EDUCATION

"KRASNOYARSK MEDICAL-PHARMACEUTICAL COLLEGE"

MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT

RUSSIAN FEDERATION

Specialty Nursing

Qualification Nurse

TO THEORETICAL LESSONS

Agreed at a meeting of the Central Committee

Protocol number…………….

"___"____________ 2011

Chairman of the Central Medical Committee "Nursing No. 2"

Cheremisina A.A.

Compiled by:

Cheremisina A.A.

Kamalutdinova V G.

Krasnoyarsk

Lecture 1

Topic 1.1: Subject, place and role of public health and health. History of nursing. Prospects for the development of nursing.

Lecture outline:

Health, as defined by WHO.

Basic medical, demographic and other indicators of public health and human environment.

Medical and demographic situation in the Russian Federation.

Structure of the health care system.

Main types of treatment and preventive institutions.

Structure and main functions of hospitals.

The role, goals and objectives of the Association of Russian Nurses.

Prospects for the development of nursing.

Prerequisites, essence and main directions of nursing reform in Russia.

Directions for development and improvement of the activities of nursing staff.

Program for the development of nursing in the Russian Federation for 2010-2020.

Timing and stages of program implementation

Continuation of the implementation of the national project “Health” in the following areas.”

Health, as defined by WHO(World Health Organization) - a state of complete physical, mental and social well-being, and not merely the absence of disease (1946)

As stated in the WHO European Health 21 policy, every period of a person's life affects their health, and it is necessary to strive to achieve the full health potential for all. At the same time, health is defined as the right of all people and a necessary condition for well-being, a high quality of life and sustainable economic development.

According to the definition of the I All-Russian Scientific and Practical Conference on the Theory of Nursing, held on July 27 - August 14, 1993 in Golitsino, new terms and concepts are introduced in nursing, one of which is the concept of health. Health- dynamic harmony of the individual with the environment, achieved through adaptation, a means of life.

It is known that human health is influenced by both internal and external factors that promote health or destroy it (risk factors), as well as a person’s lifestyle. Protecting public health is the professional duty of all medical workers.

Public health- a state, quality of society that provides conditions for a productive healthy lifestyle of people, not constrained by diseases, physical and mental defects.

A healthy lifestyle is a way of life, human activity aimed at improving health.

Preserving and promoting health is a process of raising awareness, changing habitual attitudes and searching for real ways to improve the quality of life.

Risk factors are factors that increase the likelihood of diseases (genetic (20%), environmental (20%), lifestyle (50%), medical (10%)).

Basic medical and demographic

and other indicators of the state of social

human health and environment

Indicators of the state of health of the population and determination of its quality are demographic indicators, morbidity indicators, indicators of disability, and physical development of the population. The sources of this information are: statistical materials in the form of reports from the Ministry of Health and the State Statistics Committee of the Russian Federation and materials based on accounting documents of medical institutions (HCI), special developments based on sample studies and special documentation in the form of maps, questionnaires, population censuses. Currently, the calculation and assessment of basic medical, demographic and other indicators characterizing the state of public health and the human environment is carried out V in accordance with WHO requirements.

Demography- the science of population in its socio-historical development, studying issues of natural population movement, the subject of which is the laws of natural reproduction of the population in their socio-historical conditionality. Demography consists of two sections - statics (fixed data) and dynamics (natural movement) of the population. Statistics studies the size and composition of the population by gender, age, employment and other characteristics.

Medical and demographic situation in the Russian Federation

The main demographic indicators include concepts about the number, migration, composition and natural reproduction of the population, mortality, birth rate, its causes, etc.

Population- the quantitative composition of the population in a certain territory for a certain period of time (calendar year); in the Russian Federation, the population is 142 million people.

Migration - movement of a population across a territory that changes its population in a certain period of time.

Population reproduction characterized by indicators of fertility, mortality and natural increase.

Mortality - the frequency of deaths in a certain territory over a certain period of time (calendar year). The mortality rate is influenced by three factors: child (infant), perinatal and general mortality. Child (infant) mortality is the mortality rate in the first year of life. Perinatal mortality is an indicator of mortality during the perinatal period, which begins at 28 weeks of pregnancy, includes the period of childbirth and ends after 7 full days of life of the newborn.

average life expectancy in 2000 it was 60 years for men, in 2001 - 58 years. For women - 72 years.

Mortality rates depend on the organization of medical and social assistance to the population, the state of the environment, economic factors and lifestyle. Reducing child mortality depends on measures to protect the fetus, improving the quality of medical care for children under one year of age, developing rational methods of feeding children, preventing and treating diseases in children in the first year of life.

Fertility - number of births per 100 inhabitants per unit of time ( calendar year). The difficult socio-economic situation in Russia and a number of other reasons have led to a catastrophic drop in the birth rate. Today 2/3 of families have one child. Fertility rate is the ratio of the birth rate to its average number. The total fertility rate was 8.4 in 1999 (13.4 in 1990), and 8.7 in 2000. There are ethnic differences in the birth rate. A high birth rate remains in the republics of Dagestan and Tuva.

Natural reproduction of the population - the ratio of the number of births to the number of deaths. For simple population reproduction, it is necessary that 210 children are born per 100 residents of Russia (2-3 children per family).

General morbidity. Over the past 5 years, the overall morbidity rate of the population has increased by 15%. The incidence of congenital anomalies (developmental defects), diseases of the genitourinary system, diseases of the circulatory system, as well as diseases of the nervous system and sensory organs is growing rapidly. An increase in morbidity rates is observed in almost all classes of diseases. When analyzing general morbidity, the following indicators are calculated: primary morbidity, disease prevalence, incidence of diseases of the circulatory system and other diseases by age, gender, and professional groups, and the structure of morbidity is examined. The most accurate indicators are obtained from the dispensary population through sample studies.

Disease is a change in the physiological, psychological and spiritual state of a person thatleads to a decrease in his capabilities and life expectancy. (Twadell, 1977).

Disability. This is a health disorder with a persistent disorder of body functions caused by diseases, consequences of injuries or defects, leading to limitation of life activity and necessitating the need for social protection of the individual.

Limitation of life activity is a complete or partial loss of a person’s ability or ability to carry out self-care, move independently, navigate, communicate, control one’s behavior, study and engage in labor activity (Law on Social Protection of Persons with Disabilities in the Russian Federation, adopted in 1995).

Thus, the last decade of the twentieth century in Russia is characterized by negative indicators of the health of the population: morbidity and mortality rates have increased, and average life expectancy has decreased. It is known that every year 155-185 million cases of acute and chronic diseases are registered in the country, of which about 100 million are newly diagnosed.

Most economically developed countries have made significant progress in reducing morbidity and mortality from major chronic non-communicable diseases. At the same time, in the health care of these countries, primary prevention (prevention aimed at improving health and improving the well-being of the population) is a priority area of ​​activity. In order for the primary prevention service in practical healthcare in Russia to be formed and function effectively, it is necessary to have structures for identifying the main risk factors (pre-medical screening rooms and units for diagnosing the main risk factors and their correction with a group of relevant specialists and with the necessary equipment), the use of modern effective methods for identifying, diagnosing and correcting all the main risk factors, and not just some of them (arterial hypertension, diabetes mellitus or impaired glucose tolerance, excess body weight, metabolic syndrome, hypokinesia, psycho-emotional stress, smoking, alcohol abuse); the presence of personnel in these structures specially trained to work on primary disease prevention, material interest of medical workers involved in primary disease prevention; availability of an information system for monitoring the epidemiological situation of diseases.

The socio-economic crisis that hit Russia significantly changed the standard of living of the population. Declining real incomes, deteriorating quality of life, unemployment, narrowing opportunities for development and use of health potential - all this negatively affects indicators characterizing the state of public health and the human environment.

Health system structure

Russia has a healthcare system with different forms of ownership: state, municipal and private. It has three levels of management organization:

The Ministry of Health, which includes departments -

medical care organizations,

protection of maternal and child health,

scientific and educational medical institutions,

Ministry (Committee) of Health of the region, territory, autonomous republic.

Management (department, committee) of health care under the city administration.

The goal of health policy is to achieve a level of health that will allow a person to live productively with the longest possible life expectancy.

Main directions of health policy:

Development and adoption of laws to implement reforms that meet the needs of the industry,

Protection of motherhood and childhood,

Financing reform (health insurance, attraction of other funds for the treatment of socially vulnerable segments of the population),

Compulsory health insurance,

Reorganization of primary health care,

Medicine provision,

Preparation of medical and administrative

Computerization of healthcare.

The basis of the health care system is the laws “On the State Health Care System” and “On the Rights of the Patient”.

Currently, the medical services market is being formed, medical institutions are being created with various forms property, one-day hospitals, hospices - palliative care institutions for hopeless patients.

Main types of treatment and preventive institutions

They can be outpatient or inpatient. The first include: outpatient clinics, clinics, medical units, dispensaries, antenatal clinics, emergency medical services stations.

Inpatient institutions include hospitals, clinics, hospitals, maternity hospitals, sanatoriums, hospices.

In order to improve the quality of medical care in Russia, since 1947, clinics have been merging with outpatient clinics and hospitals. This helps improve the qualifications of doctors, and therefore quality improvement treating patients.

Structure and main functions of hospitals

There are general, republican, regional, regional, city, district, rural hospitals, which are often located in the center of the service area. Specialized hospitals (oncology, tuberculosis) are often located on the outskirts or outside the city, in green areas.

There are three main types of hospital construction: pavilion (building), centralized and mixed.

With the pavilion system, specialized buildings are located on the hospital premises. The centralized type of construction is characterized by the fact that all services are located in one building, often a high-rise building, or a number of buildings are connected by covered overground or underground passages. Most often in Russia, mixed-type hospitals were built, where the main non-infectious departments are located in one large building, and infectious diseases, dermatoveneral, and maternity hospitals are located in separate buildings.

The hospital's land plot is divided into three zones: buildings, a utility yard zone and a protective green zone. The medical and economic zones must have separate entrances. The hospital consists of the following units:

A hospital with specialized departments and wards.

Auxiliary departments (X-ray, laboratory, pathological).

Clinic.

Food block.

Laundry.

Administrative buildings.

Hospitals are designed to provide round-the-clock treatment and care for patients with diseases relevant to the hospital's profile.

The structure of a hospital of any profile includes rooms for accommodating patients, utility rooms and a bathroom, specialized rooms (procedure, treatment and diagnostic), a resident's room, a nurse's room, and the manager's office. department, older sister, etc.

The number of patients in the wards should not exceed four people. The room has beds (regular or functional), bedside tables, a table, a hanger, maybe a washbasin and a toilet. The beds are placed with the head end to the wall at a distance of one meter between them. Communication of a seriously ill patient with the nurse's station is carried out using a light or sound alarm. In specialized departments, each bed is equipped with a centralized oxygen supply.

The lighting of the wards complies with sanitary standards. It is determined in the daytime by the light coefficient, which is equal to the ratio of the window area to the floor area, respectively 1:5-1:6. In the evening, the chambers are illuminated with fluorescent or incandescent lamps. In addition to general lighting, there may also be individual lighting. At night, the wards are illuminated by a night light, which should be installed 30 cm from the floor near the door, but can also be installed near each bed (in children's hospitals, lamps are installed above doorways).

Ventilation of the chambers is carried out using a supply and exhaust system of ducts, as well as transoms and vents at the rate of 25 cubic meters. m. per person per hour. The concentration of carbon dioxide in the room should not exceed 0.1%, the relative humidity should be 30-45%.

The air temperature in the wards for adults is 20*C, in the intensive care unit, operating room and children's department - 22*C.

The department has a distribution room and a canteen, where 50% of patients can eat food at the same time.

The department corridor must ensure the free movement of gurneys and stretchers. It serves as an additional air reservoir in the hospital and has natural and artificial lighting.

The sanitary unit consists of several separate rooms designed for personal hygiene of the patient (bathroom, washroom), sorting dirty linen, disinfection and storage of vessels and urine bags, storage of cleaning equipment and clothing of service personnel.

Infectious diseases departments and hospitals have boxes, semi-boxes, regular wards and consist of several separate sections that ensure the functioning of the department when quarantine is established in one of them.

Each department has a daily routine that is mandatory for staff and patients, which ensures that patients comply with the medical and protective regime, sleep and rest, therapeutic nutrition, observation and care, and the implementation of medical procedures.

The role, goals and objectives of the Association of Russian Nurses

In Russia, in most cities, city councils of nurses were traditionally formed, where problems of nursing practice were discussed and resolved, but in most cases they remained only on paper. There was no real support from higher authorities, since nursing councils remained a subordinate organization.

The first association created in Russia on May 20, 1992 is the Moscow Association of Nurses (MAMS). The Moscow Association of Nurses is an independent professional organization that trains nursing personnel, protects professional rights, improves working conditions, increases wages, etc. This organization does not duplicate the work of the medical workers’ union or other public organizations. Its short-term goals have 3 directions: raising the prestige of the nursing profession, protecting professional rights, improving working conditions and increasing wages. And the third area is the education of nurses, including advanced training of practicing nurses.

Among the long-term goals, the most important are research and development in the field of nursing and the creation of practical standards.

Under the auspices of the association, Russian-American seminars were held on the problems of financing publishing activities and attracting new members.

Sister associations in developed countries have achieved many benefits for their members since they have been in existence for several decades.

In the West, a nurse acts within the framework of the law in parallel with a doctor, without replacing him and working with him in the same team. Our nurse has no legal rights to independence. The definition of today's categories is very arbitrary.

Thus, taking into account the current situation of nurses, the Interregional Association of Nurses in Russia was created in 1994. The most important document, the creation of which was initiated by this association, is the Ethical Code of Nurses of Russia, adopted in 1997. Currently in Russia there are about 50 regional sister associations, uniting about 42 thousand association members.

In 1998, participants (nurses and midwives) at the Munich Conference were invited to sign the Health 21 Pledge and disseminate it in their country.

Thus, ensuring the high quality of nursing activities requires from managers and organizers of nursing a complex of organizational, regulating educational measures, training, control, sufficient equipment of workplaces, drug supply, etc.

The formation of a domestic scientific research base in the field of nursing and the creation of new technologies is the most important task of the industry program for the development of nursing. The functions of medical personnel change significantly when modern technologies and new diagnostic and treatment technologies are introduced into their activities. Caring for patients is ensured by both the skill and patience of medical personnel, especially nurses and midwives.

In modern conditions, new approaches and content require the functional responsibilities of nurses and midwives. The provisions that define the duties, rights, and responsibilities of specialists with secondary vocational education are currently being revised. Promising and relevant in this regard is the development of clinical standards for practical skills of nurses and midwives.

A feature of modern requirements for the profession of a paramedic, nurse, midwife, along with therapeutic and diagnostic manipulations, is the possession of communication skills, knowledge of the basics of psychology, respect for the rights and dignity of the patient. The activities of a nurse, paramedic, and midwife are aimed at preserving the health of the population and ensuring high quality nursing care.

An important event in the history of nursing was the creation in 1992 of the Association of Russian Nurses. It was organized on the initiative of nurses as a non-governmental professional organization. The “Project for the Development of the Association of Russian Nurses” identified the following areas of work for the Association: increasing the role of the nurse in the healthcare system, increasing the prestige of the profession; improving the quality of medical care; dissemination of best practices and scientific achievements in the field of nursing; revival of traditions of nursing; protecting the interests of nurses in legislative, administrative and other bodies; organizing the collection of information on nursing, its analysis and dissemination; cooperation with international organizations and government agencies. The immediate objectives of the Association’s activities were:

Development of professional activity standards;

Implementation of quality control over the work of nurses;

Organization of continuous training of nurses in the system of advanced training and additional postgraduate education;

Participation in the development of certification and certification programs for nurses;

Involving members of the Association in scientific research in the field of nursing;

Legal protection of the interests and rights of nurses;

Participation in the work of expert and problem commissions of the Ministry of Health of the Russian Federation.

Prospects for the development of nursing.

Qualitative changes in nursing in Russia have been planned since the late 80s of the last century, but the level of organization of nursing practice lags significantly behind the development of science and the ability to effectively manage nursing activities.

By the beginning of the 90s, higher nursing education existed in most European countries, which allowed International organizations and councils - WHO (World Health Organization), the International Council of Nurses - to positively influence the development of scientific methods for organizing nursing in Russia.

Since 1966, the idea has been expressed, which is described in the WHO Report Series, N 347, p. 13, that “nurses should have the opportunity to develop and improve their abilities in order to provide the most qualified care to the population, as well as develop professional thinking to make independent decisions based on scientific, clinical and organizational characteristics."

Today, markets for medical services are being formed, medical and preventive institutions are being created with various forms of ownership, day-care hospitals, hospices - palliative medicine institutions, i.e. such institutions where it is impossible to help with medicines, where help is provided to the hopelessly ill and dying. Such assistance can be provided by a nurse who can think analytically, skillfully prepare for various studies, scientifically substantiate her actions when performing procedures and nursing care plans, and perform manipulations in strict accordance with the protocol and standard.

The state organizational structure dealing with nursing issues is the Ministry of Health of the Russian Federation. By 1994, a multi-level system of nursing education had been formed in Russia. Each level has its own State educational standard.

The nineties marked the beginning of the healthcare reform in the Russian Federation, the core of which was the transition to a compulsory model health insurance. The ongoing socio-economic and political transformations have put forward new requirements for personnel policy in the industry.

Reform of the health service system is a priority in many WHO member states, which is caused by low levels of medical care, the financial crisis, dissatisfaction with consumer demand, negative attitudes towards structures controlled by central authorities and a number of ideological motives. Countries are faced with the difficult task of creating new systems that can more effectively solve pressing problems at a time when there are shortages of human resources and financial resources, and when the transition from a planned centralized economy to a mixed or market economy has already reached a stage where the old system is not applicable, and the new one does not work yet.

As noted in the report of the former Minister of Health of the Russian Federation Yu.L. Shevchenko, “in the most difficult socio-economic conditions of the past decade, the health care system as a whole fulfilled the tasks assigned to it and ... thereby ensured the implementation of the constitutional right of Russian citizens to health care.” State policy in the field of Russian healthcare is focused on obtaining the maximum effect from available resources and, in particular, nursing personnel, whose work is considered as the most valuable healthcare resource to meet the needs of the population for accessible, acceptable and cost-effective medical care.

However, the lack of a legal basis for the activities of nursing specialists, mechanisms for its regulation, means and methods social protection and motivation of qualified personnel leave the need for practical healthcare to use the existing nursing potential declared, but so far not realized.

According to European nursing researcher and promoter Dorothy Hall, “Many of the problems facing national health services today could have been avoided if nursing had advanced at the same rate as medical science over the past forty years.” “The reluctance to recognize,” she writes, “that the nurse occupies an equal position in relation to the doctor, has led to the fact that nursing care has not received the same development as medical practice, which has deprived both sick and healthy people of the opportunity to benefit from a variety of accessible, cost-effective nursing services."

In recent years, the Russian Ministry of Health, together with territorial health authorities, has been carrying out significant work to promote the revival, increase in social significance and prestige of the nursing profession. This is confirmed by the implementation of the state program "Development of Nursing", the implementation of decisions of the boards of the Ministry of Health of the Russian Federation dated 04/20/94 "On the state and prospects of nursing in the Russian Federation", dated 06/04/97 "On the development of medical and pharmaceutical education in the Russian Federation", a number of international seminars "New sisters for a new Russia."

Of particular note is the resolution of the 1st All-Russian Congress of Paramedical Workers, which reviewed the draft state program for the development of nursing in the Russian Federation. A key concept that focuses on improving the field of nursing is defining the nursing role to be more responsive to the health needs of the people than to the needs of the health care system. This represents a fundamental reconceptualization of the traditional role of the nurse as a physician's supporter and errand girl.

The nurse must be a well-educated professional whose unique and significant contributions to health care are welcomed by all colleagues and who are considered an equal partner in the health care team. The basis of her practical activity is directly working with a patient or population group, namely work aimed at improving people's health. Thus, reforming health care, bringing it organizational structure in accordance with modern requirements is impossible without improving and changing existing approaches to organizing the work of a nurse. Prerequisites, essence and main directions of nursing reform in Russia

Nursing is an essential component of the health care system, an area of ​​activity aimed at solving problems of individual and public health of the population in changing environmental conditions.

The role and tasks of the nurse are determined by historical, social and cultural factors, as well as the general level of health of a particular society. As a science, nursing is based on knowledge tested in practice.

For several decades in Russia, nursing issues have not received due attention. The development of nursing technologies, taking into account modern science in developed countries, has led to a lag in nursing in Russia.

Nursing reform in our country began in 1993. At the international conference "New Sisters for a New Russia", a philosophy of nursing was adopted, which marked the beginning of this process. Decree of the Government of the Russian Federation dated November 5, 1997 N 1387 “On measures to stabilize and develop healthcare and medical science in the Russian Federation” provides for the implementation of a reform aimed at improving the quality, accessibility and economic efficiency of medical care for the population in the conditions of the formation of market relations.

The essence of the reform is to implement the necessary changes in personnel policy based on evidence-based approaches to planning, training and use of nursing personnel, ensuring a rational relationship and partnership between doctors and nursing staff, reviving the category of junior medical personnel, organizing new types of care related not only to diseases or pathological conditions, but also with problems of preserving and maintaining individual and public health. Currently, our country is studying international experience, analyzing it, correcting it and adapting it to socio-economic conditions, taking into account the traditions of the peoples of the Russian Federation.

Order of the Ministry of Health of the Russian Federation No. 4 of January 9, 2001 approved a sectoral program for the development of nursing in the Russian Federation, reflecting the essence of nursing reform. Nursing has significant human resources and real potential opportunities. Today in Russia there are about 1.5 million paramedical workers. This is the most widespread medical profession.

The main goals and objectives of nursing reform are:

1. Formation of optimal conditions for increasing the efficiency and strengthening the role of paramedical workers, improving the management system.

2. Creation of a new conceptual Russian model of nursing. Each model reflects the basic principles of primary health care (PHC). Even today there is a medical (traditional) model, authored by F. Nightingale. In this model, one of the constituent elements is the role of the nurse as a physician's assistant with extremely limited professional autonomy.

3. Introduction of new technologies in nursing, bioethical, professional approaches that can meet the population’s need for affordable medical care;

4. Strengthening the preventive focus of healthcare.

5. Carrying out systemic changes in nursing - in the field of education, scientific research, practical healthcare, assistance in the creation and development of professional nursing associations.

6. Increasing the status of nursing staff, both professional and social, ensuring social protection of nursing specialists and much more.

The training of nursing specialists and the introduction of the nursing process into medical and preventive institutions are considered the top priorities of health authorities. For the rational and effective use of the existing human resources potential, the formation of state policy in the field of nursing and increasing the responsibility of authorities at all levels for its implementation is of great importance in the current situation.

In this regard, in the context of the Concept for the Development of Healthcare and Medical Science in the Russian Federation, a State Program for the Development of Nursing has been developed. The program was developed in accordance with the order of the Ministry of Health of the Russian Federation of December 31, 1997 N 390 “On measures to improve nursing in the Russian Federation.”

The following directions for the development and improvement of the activities of nursing staff have been identified:

primary health care with an emphasis on preventive work;

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

rehabilitation assistance and medical and social assistance to chronically ill people, the elderly and the disabled;

medical and social assistance to incurably ill and dying people.

Reform objectives nursing are determined by established directions for the development of the profession, namely:

increasing the role of nurses in health education of the population in such important areas as the formation of a healthy lifestyle, prevention of diseases, poisonings, accidents, etc.,

training the population in emergency care techniques and methods of caring for patients, expanding the participation of nursing staff in new forms of out-of-hospital care: day hospitals, ambulatory surgery centers and medical and social care, etc.

In connection with the restructuring of hospital beds in terms of the intensity of the treatment and diagnostic process, the profiling of activities and the rational use of nursing personnel become important. There is an increasing need for personnel who can work with modern medical equipment that monitors the condition of patients, masters the nursing process, the basics of psychology, and provides comprehensive comprehensive care and rehabilitation of the patient.

Reducing the duration of the hospital stage involves intensifying the nursing process in the hospital and disseminating the practice of maintaining nursing care plans and documenting the activities of nurses. Particular attention is planned to be paid to the formation of the administrative and managerial direction of nursing, since the decisive role in the organization of all areas of activity of nursing personnel belongs to the heads of nursing services at various levels.

The first steps have been taken to improve the management of nursing services. A new nomenclature unit has been introduced - chief nursing specialist of the healthcare management body of the constituent entities of the Federation. The position of deputy chief physician for work with nursing personnel is being introduced; in large health care institutions - several positions of chief nurses, as well as such a new unit as a nurse-teacher.

The uneven supply of nursing personnel to the population and the existing imbalance in the ratio between doctors and nursing staff put on the agenda the task of reorganizing the system of planning and distribution of human resources. This reorganization will make it possible to change the doctor/nursing staff ratio towards increasing the latter, with the transfer to nursing staff of some of the functions currently performed by doctors. In order to ensure an appropriate level of professional readiness and qualifications of specialists, guaranteeing the quality of medical services provided to the population, the task of creating an effective certification and attestation system is being put forward.

Healthcare reform could not but affect the system of medical and pharmaceutical education. The type of education reforms will take and what their content will be will determine what kind of specialists with medical education will be produced in the 21st century. The main goal of the education reform is to train a completely new generation of specialists who know their job well, focused on achieving high results in protecting public health, brought up in the spirit of the best traditions and achievements of domestic and world culture, capable of working in a market economy and a democratic society.

Accepted in last years laws and regulations of the Government of the Russian Federation, decrees of the President of Russia on health and education issues put forward requirements for improving the quality of basic and postgraduate training.

Professional education. The professional growth of specialists with secondary medical education can contribute to an increase in prestige in society. Hence, the system of additional professional education occupies a special place in the context of health care reform.

The Russian Ministry of Health, one of the few departments, managed not only to preserve the system of advanced training, but also to give a certain impetus to its development. In connection with the release of Order of the Ministry of Health of Russia dated 08/19/97 N 249 “On the nomenclature of specialties of paramedical and pharmaceutical personnel”, the list of areas of additional professional education was revised, the new list was approved by Order of the Ministry of Health of Russia dated 06/05/98 N 186 “On advanced training of specialists with secondary medical and pharmaceutical education."

The vocational education system is faced with the task of providing differentiated training of nursing personnel depending on the needs of the population and the service market. An important step in improving professional education and a necessary condition for ensuring the quality of nursing care to the population is the development of a state system of multi-level training of nursing personnel. The system includes four professional and educational levels, each of which corresponds to a mandatory minimum content and duration of training in the specialty:

basic level in colleges and schools;

advanced level in colleges;

higher nursing education in universities;

postgraduate education (internship, residency and postgraduate studies).

Higher education. Higher nursing education occupies a special place in the context of healthcare reform and increasing the prestige of the nursing specialty both in the industry and in society as a whole. All issues related to reforming the nursing training system were resolved on the basis of proposals from practical healthcare. In 1995, for the first time in Russia, the two-million-strong team of medical workers was replenished with new young specialists - nurses with higher education. In the same year, the first doctoral dissertation on the problems of training nursing personnel was defended in Russia; this work was carried out by the dean of the faculty of higher nursing education of the Medical Academy. THEM. Sechenova G.M. Perfilyeva.

However, the need of practical health care to use nursing potential is not fully realized, since the legal basis for the activities of nursing specialists, the mechanisms for its regulation, and the means and methods of social protection remain imperfect. The Ministry of Health of the Russian Federation considers the development of scientific research in the field of nursing and related disciplines as a priority direction for the development of medical science.

Scientific research is intended to inform practice the latest developments and ideas. The lack of systematic scientific research in the field of nursing does not allow, in particular, to give substantiated recommendations for the rational use of human resources.

Thus, we can conclude that among the directions for reforming nursing in Russia, there are clearly those points that were proposed by WHO back in the 70s and, for unknown reasons, not accepted in our country, namely:

nursing process,

Multi-level training of specialists,

Management,

Nursing Research.

Program for the development of nursing in the Russian Federation for 2010-2020.

Program Goals:

Creation of legal, organizational, economic and methodological conditions for the development of nursing in the Russian Federation as one of the links in the healthcare system, the rational use of which leads to a significant improvement in the quality, accessibility and cost-effectiveness of medical care, efficient use of healthcare resources, reduction of direct and indirect losses to society by reducing morbidity and mortality of the population . Program Objectives determination of the general medium-term strategy for the development of nursing in the Russian Federation; determination and justification of resource support for the development of nursing in the Russian Federation; improvement of the regulatory framework defining the role and functions (characteristics legal status) nursing specialists in the Russian healthcare system; development of the state and public system for managing nursing activities in accordance with the common goals and objectives of healthcare development; level up professional competence specialists with secondary medical education through the development and improvement of the system of continuous and multi-level professional education; ensuring management of the field of scientific activity in the field of nursing, coordinating and increasing the volume of activities to create a new generation of information products for nursing specialists. improving the regulatory framework that defines the role and functions (characteristics of the legal status) of nursing specialists in the Russian healthcare system; development of the state and public system for managing nursing activities in accordance with the common goals and objectives of healthcare development; standardization and technologization of professional activities of specialists with secondary medical and pharmaceutical education; formation of a unified information environment for the industry, including a system of vocational education, through the use of information and telecommunication systems and technologies; Directions for program implementation defining a general strategy for the development of nursing in the Russian Federation; improving the quality and accessibility of medical care provided by specialists with secondary medical education; reforming the existing regulatory framework that defines the competencies and responsibilities of nursing professionals; development of human resources for nursing specialists and solving health care personnel problems; formation of a procedure for the provision of pre-hospital medical care and standards for the performance of personnel with secondary medical education in accordance with the common goals, objectives and principles of healthcare development for the transition to modern system organization of medical care; improving the current range of specialties for workers with secondary medical and pharmaceutical education, preparing proposals for its improvement; justification and preparation of standards for the professional activities of specialists with secondary medical and pharmaceutical education; creating decent working conditions and social protection for nursing specialists; increasing the prestige of the nursing profession; ensuring the creation of a unified information environment through the use of information and telecommunication systems and technologies; creating motivation among the population to lead a healthy lifestyle; improving the ethical aspects of the activities of nursing specialists; development of fundamental and applied scientific research in nursing, with its subsequent use in practical healthcare, the system of professional training and retraining of nursing personnel; development international relations and cooperation with Russian public organizations. Timing and stages of program implementation 2010-2020 First stage: 2010-2015 Preparation of regulations regulating the activities of specialists with different levels of nursing education in the healthcare sector and determining the differentiated workload on nursing staff, taking into account the patient population, development and implementation of new nursing technologies and types of nursing care. Completion of the development of professional standards and procedures for the provision of pre-hospital medical care by specialists with secondary medical education, preparation for the start of informatization of the activities of nursing staff and the introduction of an information system for personalized recording of medical care provided to citizens. Implementation of preparatory measures for the transition to a new system of organizing medical care, the formation of an integrative system of continuous personnel training based on a unified personnel policy. Preparation and implementation of a program of technologies for the prevention, diagnosis and treatment of socially significant diseases and pathological conditions by specialists with secondary medical education. Continuing the implementation of the national project “Health” in areas: development of primary health care and improvement of preventive measures; increasing the availability and quality of specialized, high-tech medical care; improving medical care for mothers and children; improving cancer care, reducing morbidity and mortality; surveying the population to identify tuberculosis, treating patients with tuberculosis, carrying out preventive measures, reducing morbidity and mortality; improving medical care for disabled children; medical examination of adolescent children, orphans, children who find themselves in difficult life situations; perinatal diagnosis of hereditary diseases; formation of motivation for a healthy lifestyle among the population of the Russian Federation; development of blood and donation services; reducing mortality from socially significant diseases. Second stage: 2016-2020 It is planned to create a system of social protection for medical workers in health care facilities and implement, through standardization, a phased transition to a self-regulating system for organizing the provision of medical care. It is planned to carry out widespread computerization of workplaces, create a federal database on nursing technologies used in health care facilities, standardize and informatize the activities of personnel with secondary medical education, taking into account the priorities of innovative development of healthcare.

improving the regulatory framework that defines the role and functions (characteristics of the legal status) of nursing specialists in the Russian healthcare system;

development of the state and public system for managing nursing activities in accordance with the common goals and objectives of healthcare development;

standardization and technologization of professional activities of specialists with secondary medical and pharmaceutical education;

increasing the level of professional competence of specialists with secondary medical education through the development and improvement of the system of continuous and multi-level professional education;

formation of a unified information environment for the industry, including a system of vocational education, through the use of information and telecommunication systems and technologies;

ensuring management of the field of scientific activity in the field of nursing, coordinating and increasing the volume of activities to create a new generation of information products for nursing specialists.

Ministry of Health of the Russian Federation dated December 31, 1997 N 390 “On measures to improve nursing in the Russian Federation”

Creation of optimal conditions for increasing efficiency and strengthening the role of nursing personnel in providing medical and medical-social care to the population:

Improving the regulatory legal, material, technical, organizational and methodological base to improve the organization of work of nursing staff;

Improving the system of training and effective use of nursing personnel;

Improving the nursing staff management system;

Development of new organizational forms and technologies for providing medical care by nursing staff;

Ensuring social protection of nursing specialists;

Promoting the development of professional nursing associations and involving them in reforms in the field

State of the problem and justification for the need to solve it using software methods

A complex of political, socio-economic, demographic and environmental factors that have arisen in the country in recent years have had an extremely negative impact on the health of the population. The increase in demand for medical services occurs against the backdrop of an ever-increasing shortage of material and financial resources. Health care financing from budgets at all levels and from compulsory health insurance cannot provide the population with universally available free medical care.

Nursing- the most important component of the healthcare system, which has significant human resources and real potential to meet the needs of the population for accessible and acceptable medical care.

Nursing staff- these are employees who have a secondary medical education in the specialties of Nursing, Midwifery, General Medicine and are admitted to professional activities in the prescribed manner.

The variety of functions performed by nursing personnel requires an understanding of the factors influencing health, the causes of diseases, methods of their treatment and rehabilitation, as well as the environmental, social and other conditions in which medical care is provided and the health care system operates.

The World Health Organization (WHO) considers the nursing workforce to have real potential to meet the population's growing needs for affordable health care.

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

developing a strategy for workforce planning and nursing training;

creating a regulatory framework for the development of nursing;

providing conditions for the effective work of nursing staff, the opportunity to fully realize their professional potential in collaboration with other categories of medical workers.

Over the past decades, nursing has not received due attention in the country. This has led to a significant lag in development in this area of ​​health care modern science and medical technologies, was the reason for the departure of qualified nursing personnel from the profession, a widespread decrease in the supply of medical institutions with nursing personnel, an increase in the imbalance in the ratio between doctors and nurses, and, as a result, a deterioration in the quality of medical care provided.

Foreign experience in organizing nursing shows that the activities of nursing staff are changing, and the traditional practice of nurses in hospitals is being replaced by new types of care associated not only with diseases or pathological conditions, but also with the problems of preserving and maintaining individual and public health.

It is possible to use international experience in reforming nursing. However, the futility of its use is obvious without conducting an in-depth analysis, the necessary correction and adaptation to the socio-economic conditions of our country, as well as established traditions, which can have a restraining influence on the success of nursing reform.

To carry out reforms in nursing in the Russian Federation, the following problems must be solved:

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

Improving the regulatory, legal, material, technical, organizational and methodological base;

Improving the management of nursing activities;

Information support for nursing organizations.

The urgency of the problem and the need to implement the provisions of the Concept for the Development of Healthcare and Medical Science in the Russian Federation require the adoption of a set of measures in the form of an industry-wide Program for the Development of Nursing in the Russian Federation.

The priorities of this Program are:

Universality, social justice and accessibility of medical care to the population;

Security effective management nursing staff;

Increasing the level of qualifications of nursing staff;

Formation of a new breed of nurse, a highly qualified specialist, capable of making decisions and having independence within the limits of his competence;

Activities of nursing personnel aimed at preventing diseases, promoting health and improving the quality of life of the population.

Achieving the priorities of the Program is carried out:

Development of legal and economic mechanisms to ensure the further development and improvement of nursing;

Improving the system of professional training of nursing personnel;

The use of modern and economically acceptable organizational forms and resource-saving technologies in the work of nursing personnel, ensuring the quality of medical and medical-social care, preventive focus, increasing the population’s satisfaction with the medical care provided;

Information, scientific, methodological and material and technical support for nursing activities.

Consistent and gradual reform of nursing is expected, with the preservation of accumulated potential and maximum use of existing nursing personnel in the health care system.

Goal and objectives of the Industry Program

The program aims to create conditions for increasing the efficiency and strengthening the role of nursing personnel in providing health care and medical and social assistance to the population, specifying and implementing its directions and provisions related to all aspects of nursing.

Achieving the goals of the Industry Program involves solving a number of tasks:

Improving the regulatory, legal, organizational, methodological and material and technical base for reforming nursing;

Improving the system of training, advanced training and use of nursing personnel;

Promoting the creation of conditions for the development and improvement of nursing;

Improving the nursing management system;

Development of new organizational forms and technologies of nursing activities;

Increasing the efficiency of using human and financial resources in healthcare;

Ensuring the quality of nursing activities;

Ensuring the development of scientific research in nursing;

Improving the professional and social status of nursing staff;

Ensuring social protection of nursing staff;

Promoting the development of professional nursing associations and involving them in nursing reform.

Main directions of implementation of the Industry program

1. Regulatory legal support for nursing activities

Improvements are envisaged legal framework organization of nursing activities. It is planned to prepare a package of normative legal acts and methodological documents regulating nursing activities in medical and preventive institutions, as well as medical and social care institutions, and develop documents defining the organizational structure, forms, volume and nature of nursing activities.

It is required to carry out a set of measures to create standards/protocols for professional nursing activities in medical institutions, their testing and further implementation in practice in the constituent entities of the Russian Federation, to develop methodological recommendations for the management of the nursing process, nursing documentation for monitoring the patient.

It is expected to develop:

proposals for methods of remuneration of nursing specialists depending on the quality, volume of work performed and level of education based on new technologies of nursing activities;

sectoral regulatory legal acts on labor protection in healthcare institutions.

2. Main areas of activity and improvement of the organization of work of nursing staff

Based on the role of nursing in optimizing the use of resources, improving medical care for the population and implementing the provisions of the Concept for the Development of Healthcare and Medical Science in the Russian Federation, this Program provides for a set of activities carried out using regional and international experience in the development and improvement of nursing:

development of a model for the activities of nursing specialists, taking into account the restructuring of inpatient care, expansion of the outpatient clinic network with a phased transition to general medical (family) practice and changes in the ratio of doctors and nursing staff towards an increase in the latter;

development of a model for the activities of nursing specialists in medical and social departments, including specialists with an advanced level of education and higher medical education in the specialty "nursing";

development of a list of positions for specialists with an advanced level of education and higher medical education in the specialty "nursing" for healthcare institutions;

transition to a 3-tier service system in hospital institutions and the introduction of the position of a junior care nurse into the staffing table.

It is planned to develop nursing programs to promote a healthy lifestyle, family planning and the prevention of socially significant diseases: arterial hypertension, pulmonary, endocrinological, gastroenterological, allergic diseases, as well as sexually transmitted diseases, etc. for use in working with patients, families and organized teams;

revision of the Regulations on the nursing specialist of the feldsher-midwife station (FAP), taking into account modern conditions;

step-by-step certification of nursing specialists’ workplaces in accordance with the standards of their professional activities.

3. Development of a system of professional education and personnel policy in the field of nursing

A set of measures is envisaged to improve the vocational education system of secondary and higher medical educational institutions for the training of nursing personnel, as well as to improve personnel policy in the field of nursing, taking into account the reform of the healthcare system.

It is planned to develop professional training and advanced training of nursing personnel, taking into account the restructuring of the industry, including the transition to general medical (family) practice.

It is planned to continue the development of methodological documentation for conducting the final state certification of graduates of secondary and higher medical educational institutions for the training of nursing personnel;

provision of educational and methodological literature to secondary and higher medical educational institutions for the training of nursing personnel;

development of a program for interaction between medical educational and treatment and preventive institutions to provide practical training for nursing specialists;

formation of a target order for the training of specialists in medical educational institutions to provide secondary educational institutions teaching staff;

development of programs for organizing advanced training and retraining of managers and teachers of medical educational institutions.

It is planned to form a bank of unified test tasks for certification and assessment of nursing personnel, development of recommendations for the creation of services in educational institutions to assist in the employment of graduates.

4. Development of scientific research in nursing

It is planned to ensure the implementation of a scientific research program on priority areas in the field of nursing and applied disciplines for 2001 - 2005.

It is planned to develop new and improve existing technologies for training specialists with secondary and higher medical education in the specialty "nursing".

It is planned to ensure regular holding of scientific and practical conferences on current problems in the field of nursing.

Scientific support for the implementation of the Program will help accelerate the process of nursing reform.

5. Information support and management of nursing activities

It is necessary to carry out work to form a positive public opinion about nursing activities in the health care system. It is important to publish and distribute among medical workers and the population special printed information materials about the importance of the contribution of nursing activities to the process of improving health and improving the quality of life of the population.

It is planned to create information systems and enhancing communication in nursing.

It is planned to develop and stage-by-stage introduce automated workstations (AWS), which will allow for effective management of nursing activities and ensure quality control of medical care provided by nursing staff.

6. Development of professional nursing associations, associations and unions

It is planned to develop and conclude a cooperation agreement between the Russian Ministry of Health and the Interregional Association of Nurses of Russia, as well as the development of cooperation between the Interregional and regional nursing associations with international associations and professional associations in the field of nursing.

Resource support for the Industry Program

The industry program is implemented using funds federal budget and extra-budgetary sources attracted for its implementation that do not contradict the legislation of the Russian Federation.

Mechanism for implementing the Industry Program, organization and control over its implementation

The sectoral program for the development of nursing in the Russian Federation is carried out within the framework of the Concept for the development of healthcare and medical science in the Russian Federation, approved by Decree of the Government of the Russian Federation of November 5, 1997 N 1387 “On measures to stabilize and develop healthcare and medical science in the Russian Federation.”

The implementation of the Industry Program is determined by an action plan indicating the timing and responsible executors of these events.

The main directions and provisions of the Industry Program are annually clarified and adjusted based on the progress of its implementation and the effectiveness of the use of allocated funds.

Management and control over the implementation of the Industry Program is carried out by the Ministry of Health of the Russian Federation. The coordination of work on the implementation of the Industry Program for the Development of Nursing in the Russian Federation is carried out by the Council of the Russian Ministry of Health for Nursing.

Expected final results of the implementation of the Industry program

The implementation of the activities provided for by the Industry Program for the Development of Nursing in the Russian Federation will allow:

Strengthen the system of measures to promote the development of lower-cost medical care to the population;

Improve the system of training and advanced training of nursing specialists

Satisfy the population's demand for accessible and effective medical and medical-social care provided by nursing specialists;

Rational use of human and financial resources;

To restructure health care institutions with the involvement of nursing staff, which will really increase the preventive focus of medical care. The implementation of the Industry Program will lay the foundation for the further development of nursing in the Russian Federation, will allow the constituent entities of the Russian Federation to transition to resource-saving models of nursing activities, will reduce morbidity, reduce the level of hospitalization and the duration of the hospital stage, and will create the prerequisites for improving the health status of the population.

Having studied this topic, you will learn:

• reasons, directions and events of the era of nursing reform in Russia;
• periodicals for nursing staff in Russia;
• main areas of activity of nursing staff in medical organizations;
• prerequisites, essence and main directions of nursing reform in Russia;
• decisions of the international scientific and practical conference on nursing reform in Russia (Golitsyno, 1993);
• content of resolutions of the I and II All-Russian Congresses of Paramedical Workers;
• level of training of nurses in Russia;
• role and tasks Russian Association nurses (RAMS);
• the importance of scientific research in nursing;
• further prospects for the development of nursing in Russia.

Basic concepts: nursing personnel training system, FVSO,

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

MAIN DIRECTIONS AND EVENTS OF NURSING REFORM IN RUSSIA

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

Nursing reform in Russian healthcare has unfolded in several directions:

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

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

Table 7.1

Main events of the era of nursing reform in Russia

	Fundamental Events
	Opening in Moscow of the country's first advanced training school for workers with secondary medical and pharmaceutical education
	Conference on nursing in Tula
	National nursing seminar in Rostov-on-Don
	The emergence of the specialty “nursing” in the nomenclature of educational specialties in the field of health care instead of “nursing”
	Conference on nursing in Zvenigorod
	I European Conference on Nursing (Vienna)
	All-Union meeting of specialists with secondary medical education (Tula)
	Opening of the first hospice in Russia (St. Petersburg)
	Order of the USSR State Committee for Public Education dated June 28, 1991 No. 313 “On the opening of the specialty “nursing” (in higher education)
	Opening of the first colleges and first faculties of VSO (MMA named after I.I. Sechenov, Samara State Medical University, Kursk State Medical University...). First steps to create a multi-level system for training nursing personnel (basic - advanced - higher)
	Education initiative group on the creation of the Interregional Association of Nurses of Russia
	Opening of the St. Demetrius School of Sisters of Mercy (Moscow)
	Opening of a faculty for advanced training of specialists with secondary medical education at RMAPO
	Termination of publication of the magazine "Nurse"
	Conference on nursing within the framework of the international project “New Sisters for a New Russia” in Golitsyn
	Founding of the journal "Medical Help"
	Adoption of the “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens”
	Creation of the country's first experimental nursing care department (mini-hospital) on the basis of the St. Petersburg Medical Center named after L. Sokolov (at TsMSCh-122)
	Registration of the Interregional Association of Nurses of Russia (IAMS)

	Fundamental Events
	Defense of the dissertation for the degree of Doctor of Medical Sciences G.M. Perfileva “Nursing in Russia (social and hygienic analysis and forecast)”
	Creation of a Center for Nursing and Midwifery collaborating with WHO on the basis of the Faculty of Higher Nursing Education of the Moscow Medical Academy named after. THEM. Sechenova (director - Prof. G.M. Perfilyeva)
	Publication of the first issue of the magazine “Nursing”
	Start of classes part-time training of trained nurses at FVSO (St. Petersburg, Samara, Orenburg)
	All-Russian Conference on Nursing “Problems and Prospects for the Development of Nursing” (June 27-28, St. Petersburg). At the conference, the “Ethical Code of Nurses of Russia” developed by IALA was adopted in the first reading
	Publication of a package of educational materials on nursing within the framework of a WHO project "LEMON" (Leaning Materials On Nursing)
1996-	Introduction of State educational standards for 10 medical specialties
	All-Russian Conference on Nursing (May 26-28, St. Petersburg). Adoption of the Russian Nurse Ethics Code. Creation of a permanent Ethics Committee at IALA (Chairman A.Ya. Ivanyushkin)
	Participation in the XXI MSM Congress (Vancouver, Canada) of two Russian nurses as guests. Danish nurse Kirsten Stalknecht was elected President of the YSM
	Order of the Ministry of Health of Russia dated July 24, 1997 No. 217 “Improving postgraduate training of medical and pharmaceutical personnel in internships”
	Opening of the inpatient department of the First Moscow Hospice (September 18). A field service has been operating since 1994
	Decree of the Government of the Russian Federation of November 5, 1997 No. 1387 “0 measures to stabilize and develop healthcare and medical science in the Russian Federation”
	Opening of the Center for Nursing Research on the basis of the advanced training school for workers with secondary medical and pharmaceutical education at TsMSCh-122 (St. Petersburg, November)
	Order of the Ministry of Health of Russia dated December 31, 1997 No. 390 “0 measures to improve nursing in the Russian Federation”
	Adoption by the world community of the “Health for All in the 21st Century” program
	All-Russian Conference on Nursing (June, St. Petersburg)
	I All-Russian Congress of Paramedical Workers (November 3-5, St. Petersburg). The draft State Program for the Development of Nursing in the Russian Federation was mainly approved
	Resumption of publication of the magazine "Nurse"

	Fundamental Events
	Creation of the Institute of Leadership by the American International Health Union for the training of nurses from the CIS and Central and of Eastern Europe to the role of international leaders
	Participation of Russian sisters as guests in the international conference dedicated to the 100th anniversary of the International Council of Sisters
	Approval of the Doctrine of Secondary Medical and Pharmaceutical Education in the Russian Federation
	Creation of the Nursing Council under the Russian Ministry of Health. The emergence of the position of chief nursing specialist in the Ministry of Health of the Russian Federation
	Order of the Ministry of Health of the Russian Federation dated January 09, 2001 No. 4 “On the sectoral program for the development of nursing in Russia”
	Creation of the Interregional public organization of operating room nurses. The main activities of the organization are aimed at holding interregional and international conferences dedicated to general and individual problems of the activities of operating room nurses
	A public organization of nurses of the Republic of Tatarstan has been registered, which this moment already unites about 11 thousand members
	Acceptance of Russian nurses as members of the International Council of Nurses
	III All-Russian Congress of Paramedical Workers (October 15-16, Yekaterinburg). It approved the draft Program for the Development of Nursing in the Russian Federation for 2010-2020.
	The latest mass enrollment of students in the specialty “Nursing” at Russian universities
	Creation of the Non-Profit Partnership “Association of Specialists with Higher Nursing Education” (NP “ASVSO”),
	The Ministry of Education and Science of the Russian Federation approved and put into effect the Federal State Educational Standard of Higher Professional Education (FG0S VP0) in the field of training 060500 Nursing (qualification (degree) “Bachelor”)

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

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

Within the framework of practical recommendations adopted in Vienna for 1988-2000. The WHO European Office has put forward and implemented the following priority tasks: development of educational materials on AIDS for nurses; creation, translation, local adaptation and dissemination of a nursing education package (LEMON); leadership development in nursing; training of teachers and managers; promoting the creation of national nursing development plans, etc.

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

One of the most significant periods in the reform of nursing in Russia (see Table 7.1) can be considered 1993. In the summer of 1993, a conference on the theory of nursing was held in Golitsyn near Moscow within the framework of the International project “New Sisters for a New Russia”, carried out by the Interregional Association of Russian Nurses and " World Vision International" with financial support from the US Agency for International Development (USAID).

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

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

Based on it, the “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens” were adopted, which define the principles of protecting the health of citizens, the objectives of legislation, the rights of citizens in the provision of medical and social assistance, the duties and rights of medical and pharmaceutical workers, the procedure for conducting a medical examination, liability for causing harm health of citizens when providing medical care.

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

Unfortunately, in the “Concept for the development of healthcare and medical science in the Russian Federation”, adopted in 1997, there are, unfortunately, no direct instructions for nursing services, which still indicates an underestimation of the capabilities of nursing personnel in reforming the industry, although the state of healthcare is characterized as approaching collapse. the line “followed by the collapse of the entire health care system.”

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

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

• creating optimal conditions for the development of nursing;
• development of new organizational forms and technologies of nursing

• ensuring the quality of nursing care to the population;
• improving the professional and social status of the nursing profession;
• ensuring social protection of personnel;
• improvement of the nursing services management system;
• assistance in the development of professional associations and their involvement in the implementation of state policy in the field of nursing development in Russia.

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

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

By order of the Ministry of Health of the Russian Federation dated January 9, 2001 No. 4, the sectoral program for the development of nursing in the Russian Federation was approved.

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ORDER

About the sectoral program for the development of nursing in the Russian Federation

Revoked based on
Order of the Ministry of Health and Social Development of Russia dated December 28, 2010 N 1214
____________________________________________________________________

In accordance with the Concept for the development of healthcare and medical science in the Russian Federation, approved by Decree of the Government of the Russian Federation dated 05.11.97 N 1387, order of the Ministry of Health of Russia dated 31.12.97 N 390 “On measures to improve nursing in the Russian Federation”, as well as the resolution of the First All-Russian Congress of Paramedical Workers

I order:

1. Approve the sectoral Nursing Development Program in the Russian Federation (Appendix 1).

2. Approve the Action Plan for the implementation of the Nursing Development Program in the Russian Federation (Appendix 2).

3. Heads of healthcare authorities of the constituent entities of the Russian Federation should develop regional programs for the development of nursing and an action plan taking into account the sectoral Program.

4. Entrust control over the implementation of the order to the First Deputy Minister of Health of the Russian Federation A.I. Vyalkov.

Minister
Yu.L.Shevchenko

Appendix 1. Industry program for the development of nursing in the Russian Federation

Annex 1

Russian Federation
dated 01/09/2001 N 4

PASSPORT OF THE INDUSTRY PROGRAM for the development of nursing in the Russian Federation

Program name	Development of nursing in the Russian Federation
Basis for the development of the Program
Customer of the Program	Ministry of Health of the Russian Federation
Main developers of the Program	Ministry of Health of the Russian Federation, Moscow Medical Academy named after I.M. Sechenov of the Ministry of Health of Russia, Interregional Association of Nurses of Russia
Goal and objectives of the Program	Creation of optimal conditions for increasing efficiency and strengthening the role of nursing personnel in providing medical and medical-social care to the population:
	Improving the regulatory legal, material, technical, organizational and methodological base to improve the organization of work of nursing staff;
	Improving the system of training and effective use of nursing personnel;
	Improving the nursing staff management system;
	Development of new organizational forms and technologies for providing medical care by nursing staff;
	Ensuring social protection of nursing specialists;
	Promoting the development of professional nursing associations and involving them in reforms in the field
Timing and stages of the Program implementation	2001-2005:
	the first stage - 2001-2002 - includes the creation of a regulatory, legal, material, technical and organizational framework;
	the second stage - 2003-2005 - includes the implementation of economic effective forms and methods of work of nursing staff
List of main sections of the Program	regulatory legal support for nursing activities;
	Main areas of activity and improvement of the organization of work of nursing staff;
	Development of a system of professional education and personnel policy in the field of nursing;
	Development of scientific research in nursing;
	Information support and management of nursing activities;
	Development of professional nursing associations, associations and unions
Performers of the main activities of the Program	Ministry of Health of the Russian Federation, MMA named after I.M. Sechenov of the Ministry of Health of Russia, State Research Center for Preventive Medicine of the Ministry of Health of Russia, VUNMC for Continuing Medical and Pharmaceutical Education of the Ministry of Health of Russia, Research Institute of Social Hygiene, Economics and Health Management named after N.A. Semashko RAMS (as agreed ), Interregional Association of Nurses of Russia
Sources of funding for the Program	Federal budget funds, extra-budgetary funds and other sources that do not contradict the legislation of the Russian Federation
Expected final results	Improvement of medical and economic efficiency activities of medical institutions based on indicators of efficiency and quality of work of nursing staff
System for organizing control over the implementation of the Program	Management and control over the implementation of the Program is carried out by the Russian Ministry of Health. The implementation of program activities is coordinated by the Council of the Russian Ministry of Health for Nursing. The main directions and provisions of the program are updated annually based on the progress of its implementation and the effectiveness of the use of funds

State of the problem and justification for the need to solve it using software methods

A complex of political, socio-economic, demographic and environmental factors that have arisen in the country in recent years have had an extremely negative impact on the health of the population. The increase in demand for medical services occurs against the backdrop of an ever-increasing shortage of material and financial resources. Health care financing from budgets at all levels and from compulsory health insurance cannot provide the population with universally available free medical care.

Nursing is a critical component of the health care system, with significant human resources and real potential to meet the population's needs for accessible and acceptable medical care.

Nursing personnel are workers who have a secondary medical education in the specialties of nursing, midwifery, and general medicine and are admitted to professional activities in the prescribed manner.

The variety of functions performed by nursing personnel requires an understanding of the factors influencing health, the causes of diseases, methods of their treatment and rehabilitation, as well as the environmental, social and other conditions in which medical care is provided and the health care system operates.

The World Health Organization (WHO) considers the nursing workforce to have real potential to meet the population's growing needs for affordable health care.

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

- development of a strategy for workforce planning and nursing training;

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

- providing conditions for the effective work of nursing staff, the opportunity to fully realize their professional potential in collaboration with other categories of medical workers.

Over the past decades, nursing has not received due attention in the country. This has led to a significant lag in this area of ​​health care from the development of modern science and medical technologies, caused the departure of qualified nursing personnel from the profession, a widespread decrease in the supply of medical institutions with nursing personnel, an increase in the imbalance in the ratio between doctors and nurses and, as a result, deterioration in the quality of medical care provided.

it is envisaged to implement a reform aimed at improving the quality, accessibility and economic efficiency of medical care to the population in the conditions of the formation of market relations.

An important role in health care reform, ensuring accessibility and quality of services provided to the population, strengthening the preventive focus, and solving the problems of medical and social care is assigned to specialists with a secondary medical education, an advanced level of education and higher medical education in the specialty “nursing” and who make up the largest category healthcare workers.

In the context of economic transformations in Russia, the strategy for the development of nursing must meet the changing needs of healthcare, be socially acceptable, and at the same time guarantee high quality of medical care to the population.

The most important determinants determining the need for the development of nursing are: negative medical and demographic processes, especially the decline in the birth rate and the aging of the population; deterioration of the population's health, chronic pathology; the emergence and spread of new diseases, in particular AIDS; increase in the cost of medical services.

This requires a wider use of nursing personnel, strengthening the activities of nursing personnel in the preventive area of ​​healthcare.

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

- development of primary health care aimed at preventing diseases and promoting health, hygienic training and education of the population;

- restructuring of medical and preventive institutions aimed at reducing the length of hospital stay;

- expanding the scope of home care;

- increasing rehabilitation measures;

- formation of hospitals/departments with different intensity of treatment;

- introduction of hospice and provision of palliative care to the dying.

The listed factors require improvement of the educational system for training and advanced training of nursing specialists, taking into account the needs of the healthcare system and the composition of the nursing workforce.

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

The decision of the board of the Ministry of Health of Russia dated April 20, 1999 “On the state and prospects for the development of nursing in the Russian Federation” noted the need to develop and improve secondary, advanced level and higher medical education in the specialty “nursing”, the development and implementation of State educational standards in all profiles and skill levels, State standards practical activities of nursing staff, conducting comprehensive scientific research in nursing.

In accordance with the decisions of the Russian Ministry of Health, measures are being taken to improve the quality of professional training of nursing specialists. Changes have been made to the content of teaching with a reorientation towards health and medical and social prevention, training in new technologies of nursing practice, increasing the responsibility and ethical standards of nursing staff.

The healthcare system as a whole suffers from an imbalance of medical personnel and ineffective use of nursing personnel in practical healthcare, which has a significant impact on the quality of medical care. The real personnel disposition "nursing staff - doctors" is accompanied by interrelated negative trends:

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

- belittling the role of nursing staff in the treatment process, whose functions are reduced to performing technical work, often requiring no professional training.

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

Implementing the necessary changes in human resources policy in the field of healthcare requires scientifically based approaches to the planning, training and use of nursing personnel, effective management of nursing personnel, ensuring a rational ratio and partnership between doctors and nursing staff.

More than 20 faculties of educational institutions of higher medical education in the country train managers - heads of nursing personnel, but at present the problem with their employment remains unresolved. In the vast majority of cases, senior and chief nurses of medical institutions are specialists who have demonstrated certain organizational skills, but do not have the necessary knowledge in the field of management, psychology, pedagogy, economics, law, etc. These specialists need additional training in medical educational institutions majoring in nursing.

Foreign experience in organizing nursing shows that the activities of nursing staff are changing and the traditional practice of nurses in hospitals is being replaced by new types of care associated not only with diseases or pathological conditions, but also with problems of preserving and maintaining individual and public health.

It is possible to use international experience in reforming nursing. However, the futility of its use is obvious without conducting an in-depth analysis, the necessary correction and adaptation to the socio-economic conditions of our country, as well as established traditions, which can have a restraining effect on the success of nursing reform.

To carry out reforms in nursing in the Russian Federation, the following problems must be solved:

- improving the system of professional training and use of nursing personnel;

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

- improvement of management of nursing activities;

- information support for the organization of nursing.

The urgency of the problem and the need to implement the provisions require the adoption of a set of measures in the form of an industry-wide Program for the Development of Nursing in the Russian Federation.

The priorities of this Program are:







- formation of a nurse of a new formation, a highly qualified specialist capable of making decisions and, within the limits of his competence, having independence;

- activities of nursing personnel aimed at preventing diseases, promoting health and improving the quality of life of the population. Achieving the priorities of the Program is carried out:

- development of legal and economic mechanisms to ensure further development and improvement of nursing;

- improving the system of professional training of nursing personnel;

- the use of modern and economically acceptable organizational forms and resource-saving technologies in the work of nursing personnel, ensuring the quality of medical and medical-social care, preventive focus, increasing the population’s satisfaction with the medical care provided;

- information, scientific, methodological and logistical support for nursing activities.

Consistent and gradual reform of nursing is expected while preserving the accumulated potential and maximizing the use of existing nursing personnel in the health care system.

Purpose and objectives of the industry program

The program aims to create conditions for increasing the efficiency and strengthening the role of nursing personnel in providing health care and medical and social assistance to the population, specifying and implementing its directions and provisions related to all aspects of nursing.

Achieving the goals of the sectoral Program involves solving a number of tasks:















- ensuring the development of scientific research in nursing;

- improving the professional and social status of nursing staff;

Main directions of implementation of the industry program

1. Regulatory legal support for nursing activities

It is planned to improve the legal framework for organizing nursing activities. It is planned to prepare a package of normative legal acts and methodological documents regulating nursing activities in medical and preventive institutions, as well as in medical and social care institutions, and develop documents defining the organizational structure, forms, volume and nature of nursing activities.

It is required to carry out a set of measures to create standards/protocols for professional nursing activities in medical institutions, their testing and further implementation in practice in the constituent entities of the Russian Federation, to develop methodological recommendations for the management of the nursing process, nursing documentation for monitoring the patient.

It is expected to develop:

- methodological recommendations to review the differentiated workload on nursing staff in medical institutions;

- proposals for methods of remuneration for nursing specialists, depending on the quality, volume of work performed and level of education based on new technologies of nursing activities;

- sectoral regulatory legal acts on labor protection in healthcare institutions.

Based on the role of nursing in optimizing the use of resources, improving medical care for the population and implementing the provisions of the Concept for the Development of Healthcare and Medical Science in the Russian Federation, this Program provides for a set of activities carried out using regional and international experience in the development and improvement of nursing:

- development of a model for the activities of nursing specialists, taking into account the restructuring of inpatient care, expansion of the outpatient clinic network with a phased transition to general medical (family) practice and changes in the ratio of doctors and nursing staff towards an increase in the latter;

- development of a model for the activities of nursing specialists in medical and social departments, including specialists with an advanced level of education and higher medical education in the specialty “nursing”;

- development of a list of positions for specialists with an advanced level of education and higher medical education in the specialty "nursing" for healthcare institutions;

- transition to a 3-tier service system in hospital institutions and the introduction of the position of junior nursing nurse into the staffing table.

It is planned to develop nursing programs to promote a healthy lifestyle, family planning and the prevention of socially significant diseases: arterial hypertension, pulmonary, endocrinological, gastroenterological, allergic diseases, as well as sexually transmitted diseases, etc. - for use in working with patients and families and in organized teams; revision of the Regulations on a nursing specialist at a paramedic-midwife station (FAP) taking into account modern conditions; step-by-step certification of nursing specialists’ workplaces in accordance with the standards of their professional activities.

A set of measures is envisaged to improve the vocational education system of secondary and higher medical educational institutions for the training of nursing personnel, as well as to improve personnel policy in the field of nursing, taking into account the reform of the healthcare system.

It is planned to develop professional training and advanced training of nursing personnel, taking into account the restructuring of the industry, including the transition to general medical (family) practice.

It is planned to continue the development of methodological documentation for conducting the final state certification of graduates of secondary and higher medical educational institutions for the training of nursing personnel; provision of educational and methodological literature to secondary and higher medical educational institutions for the training of nursing personnel; development of a program for interaction between medical educational and treatment and preventive institutions to provide practical training for nursing specialists; formation of a target order for the training of specialists in medical educational institutions to provide secondary educational institutions with teaching staff; development of programs for organizing advanced training and retraining of managers and teachers of medical educational institutions.

It is planned to form a bank of unified test tasks for certification and attestation of nursing personnel, and develop recommendations for the creation of services in educational institutions to assist in the employment of graduates.

It is planned to ensure the implementation of a program of scientific research in priority areas in the field of nursing and applied disciplines for 2001-2005.

It is planned to develop new and improve existing technologies for training specialists with secondary and higher medical education in the specialty "nursing".

It is planned to ensure regular holding of scientific and practical conferences on current issues in the field of nursing.

Scientific support for the implementation of the Program will help accelerate the process of nursing reform.

It is necessary to carry out work to form a positive public opinion about nursing activities in the health care system. It is important to publish and distribute among medical workers and the population special printed information materials about the importance of the contribution of nursing activities to the process of improving health and improving the quality of life of the population.

It is planned to create information systems and expand communication links in nursing.

It is planned to develop and stage-by-stage introduce automated workstations (AWS), which will allow for effective management of nursing activities and ensure quality control of medical care provided by nursing staff.

It is planned to develop and conclude a cooperation agreement between the Russian Ministry of Health and the Interregional Association of Nurses of Russia, as well as the development of cooperation between the Interregional and regional nursing associations with international associations and professional associations in the field of nursing.

Resource support for the sectoral Program

The Industry Program is implemented at the expense of the federal budget and extra-budgetary sources attracted for its implementation, which do not contradict the legislation of the Russian Federation.

The mechanism for implementing the sectoral Program, organization and control over its implementation

The sectoral program for the development of nursing in the Russian Federation is carried out within the framework of the Concept for the development of healthcare and medical science in the Russian Federation, approved by Decree of the Government of the Russian Federation of 05.11.97 N 1387 “On measures to stabilize and develop healthcare and medical science in the Russian Federation”.

The implementation of the sectoral Program is determined by an action plan indicating the timing and responsible executors of these activities.

The main directions and provisions of the sectoral Program are annually clarified and adjusted based on the progress of its implementation and the effectiveness of the use of allocated funds.

Management and control over the implementation of the sectoral Program is carried out by the Russian Ministry of Health. The coordination of work on the implementation of the sectoral Nursing Development Program in the Russian Federation is carried out by the Council of the Russian Ministry of Health for Nursing.

Expected final results of the implementation of the sectoral Program

The implementation of the activities provided for by the industry program for the development of nursing in the Russian Federation will allow:

- strengthen the system of measures that promote the development of the provision of less expensive medical care to the population;

- improve the system of training and advanced training of nursing specialists;

- satisfy the population’s demand for accessible and effective medical and medical-social care provided by nursing specialists;

- rational use of human and financial resources;

- to restructure health care institutions with the involvement of nursing staff, which will really increase the preventive focus of medical care.

The implementation of the sectoral Program will lay the foundation for the further development of nursing in the Russian Federation, will allow the constituent entities of the Russian Federation to transition to resource-saving models of nursing activities, will reduce morbidity, reduce the level of hospitalization and the duration of the hospital stage, and will create the prerequisites for improving the health status of the population.

Appendix 2. Action plan for the implementation of the sectoral Nursing Development Program in the Russian Federation

Appendix 2
to the order of the Ministry of Health
Russian Federation
dated 01/09/2001 N 4

	Event name	Period of execution	Responsible executors
1. Regulatory support for nursing activities
	Develop regulatory legal documents, determining the reform of the organizational structure, content and nature of nursing activities	2001-2002
	Implement a set of measures to create standards/protocols for professional nursing activities in medical institutions	2001-2005	Ministry of Health of Russia, Research Institute of Social Hygiene, Economics and Health Management named after N.A. Semashko RAMS (as agreed)
		2001-2002	Ministry of Health of Russia, Research Institute of Social Hygiene, Economics and Health Management named after N.A. Semashko RAMS (as agreed)
	Develop proposals for methods of remuneration of nursing personnel depending on the quality, volume of work performed and level of education based on new technologies of nursing activities	2001-2002	Ministry of Health of Russia, Research Institute of Social Hygiene, Economics and Health Management named after N.A. Semashko RAMS (as agreed)
	Develop industry regulations legal acts on occupational safety in healthcare institutions	2001-2002	Ministry of Health of Russia, Research Institute of Social Hygiene, Economics and Health Management named after N.A. Semashko RAMS (as agreed)
2. Main areas of activity and improvement of the organization of work of nursing staff
	Develop models of activities for nursing specialists	2001-2002	Ministry of Health of Russia, Research Institute of Social Hygiene, Economics and Health Management named after N.A. Semashko RAMS (as agreed)
	Develop a list of positions for specialists with advanced and higher medical education in the specialty "nursing" for healthcare institutions	2001-2002	Ministry of Health of Russia
	Ensure the transition to a 3-tier system of patient care in federal hospitals	2001-2005	Ministry of Health of Russia
	Develop nursing programs to promote a healthy lifestyle, family planning, and prevent socially significant diseases	2001-2002	Ministry of Health of Russia, State Research Center for Preventive Medicine of the Ministry of Health of Russia
	Revise the Regulations on the nursing staff of the feldsher-midwife station, approved. by order of the USSR Ministry of Health N 900 dated September 26, 1978 “On staffing standards for medical and obstetric stations”, taking into account the new requirements of modern conditions	2001-2002	Ministry of Health of Russia
	Conduct stage-by-stage certification of nursing specialists’ workplaces in accordance with the standards of their professional activities	2001-2005	Ministry of Health of Russia
3. Development of a system of professional education and personnel policy in the field of nursing
	Develop methodological documentation for conducting final state certification of graduates of secondary and higher medical educational institutions for the training of nursing personnel
	Ensure the creation of educational and methodological literature for secondary and higher medical educational institutions for the training of nursing personnel	2001-2005		Ministry of Health of Russia, VUNMC for continuous medical and pharmaceutical education of the Ministry of Health of Russia
	Develop programs for interaction between educational medical and treatment-and-prophylactic institutions to provide practical training for nursing staff			Ministry of Health of Russia, VUNMC for continuous medical and pharmaceutical education of the Ministry of Health of Russia
	Form a targeted order for the training of specialists in medical educational institutions to provide secondary educational institutions with teaching staff			Ministry of Health of Russia, VUNMC for continuous medical and pharmaceutical education of the Ministry of Health of Russia
	Develop programs for advanced training and retraining of managers and teachers of medical educational institutions providing nursing education			Ministry of Health of Russia, VUNMC for continuous medical and pharmaceutical education of the Ministry of Health of Russia
	To create a bank of unified test tasks for certification and certification of nursing personnel			Ministry of Health of Russia, VUNMC for continuous medical and pharmaceutical education of the Ministry of Health of Russia
				Ministry of Health of Russia, VUNMC for continuous medical and pharmaceutical education of the Ministry of Health of Russia
4. Development of scientific research in nursing
	Ensure the implementation of the Research Program in priority areas in the field of nursing and applied disciplines for 2001-2005	2001-2005
	To develop new and improve existing technologies for training specialists with secondary medical and higher medical education in the specialty "nursing"	2001-2005		Ministry of Health of Russia, MMA named after I.M. Sechenov of the Ministry of Health of Russia, VUNMC for continuous medical and pharmaceutical education of the Ministry of Health of Russia
	Ensure regular holding of scientific and practical conferences on current issues in the field of nursing	2001-2005		Ministry of Health of Russia, MMA named after I.M. Sechenov Ministry of Health of Russia
5. Information support and management of nursing activities
	Develop and test models of automated workstations for nursing managers	2001-2005		Ministry of Health of Russia, Research Institute of Social Hygiene, Economics and Health Management named after N.A. Semashko RAMS (as agreed)
	Strengthen the role of the Russian Ministry of Health Council on Nursing in the implementation of the sectoral Nursing Development Program	2001-2005		Ministry of Health of Russia
	Organize a sister column on the pages of the Medical Newspaper publication			Ministry of Health of Russia
	Create a section "Nurse" on the website of the Russian Ministry of Health on the Internet			Ministry of Health of Russia
	Develop conditions for holding a competition for the best nurse and nursing manager
	Ensure the preparation and holding of the II All-Russian Congress of Nursing Specialists			Ministry of Health of Russia, Interregional Association of Nurses of Russia
6. Development of professional nursing associations, associations and unions
	Develop a cooperation agreement between the Russian Ministry of Health and the Interregional Association of Nurses of Russia in the field of nursing			Ministry of Health of Russia, Interregional Association of Nurses of Russia
	Establish partnerships with the International Union of Nurses to exchange experience in the field of nursing			Ministry of Health of Russia, Interregional Association of Nurses of Russia
	Ensure liaison with WHO collaborating center			Ministry of Health of Russia

Explanatory note to the sectoral Nursing Development Program in the Russian Federation

The basis for the development of this sectoral Program is the Concept for the development of healthcare and medical science in the Russian Federation, approved by Decree of the Government of the Russian Federation dated 05.11.97 N 1387 “On measures to stabilize and develop healthcare and medical science in the Russian Federation”.

The object of the program is nursing - the most important component of the health care system, which has significant human resources and real potential opportunities to meet the needs of the population for accessible and acceptable medical care.

With the transition to the compulsory health insurance (CHI) system, the need arose for a new resource-saving system of organization in healthcare. In the current situation, nursing personnel, who constitute the largest category of health care workers, and the services they provide are considered a valuable health care resource to meet the population's needs for accessible and cost-effective health care.

As shown world practice, the rational use of nursing personnel leads to a significant improvement in the quality, accessibility and cost-effectiveness of medical care, the effective use of resources in healthcare, more attention is paid to the prevention of diseases and the promotion of public health, since nursing practice is characterized by accessibility, versatility, focus on the individual patient, family and community groups.

The development of nursing in the country is hampered by the lack of perfect regulatory and legal financial base, information support, scientific research in nursing. The system of professional training of nursing specialists is noted to be imperfect. The industry maintains a significant personnel imbalance between doctors and nursing staff, the outflow of qualified nursing personnel from state and municipal healthcare institutions continues, the workload on nursing staff, staff dissatisfaction and social tension are increasing.

The developed industry program for the development of nursing in the Russian Federation is aimed at solving these problems.

An important role in health care reform, ensuring the accessibility and quality of medical services provided to the population, strengthening the preventive focus, and solving the problems of medical and social care is assigned to specialists with secondary, advanced levels of education and higher medical education in the specialty "nursing" and making up the largest category of workers healthcare.

The goal of the sectoral Program for the Development of Nursing in the Russian Federation is to create conditions for increasing the efficiency and strengthening the role of nursing personnel in providing medical and medical-social assistance to the population, specifying and implementing its directions and provisions related to all aspects of nursing.

To achieve it, it is planned to implement a number of tasks, in particular:

- improvement of the regulatory, legal, organizational, methodological and material and technical base for reforming nursing;

- improving the system of training, advanced training and use of nursing personnel;

- promoting the creation of conditions for the development and improvement of nursing;

- improvement of the nursing management system;

- development of new organizational forms and technologies of nursing activities;

- increasing the efficiency of using human and financial resources in healthcare;

- ensuring the quality of nursing activities;

- ensuring the development of scientific research in nursing;

- improving the professional and social status of nursing staff;

- ensuring social protection of nursing staff;

- promoting the development of professional nursing associations and involving them in nursing reform.

The priority areas of the sectoral Nursing Development Program in the Russian Federation are:

- universality, social justice and accessibility of medical care to the population;

- ensuring effective management of nursing staff;

- increasing the level of qualifications of nursing staff;

- formation of a nurse of a new formation, a highly qualified specialist, capable of making decisions and, within the limits of his competence, having independence;

- activities of nursing personnel aimed at preventing diseases and promoting public health.

The Industry Development Program for Nursing in the Russian Federation is being implemented from 2001 to 2005.

The industry program is implemented at the expense of the federal budget, as well as extrabudgetary funds and other sources that do not contradict the legislation of the Russian Federation.

Financing of activities within regional programs The development of nursing is expected to be carried out at the expense of the budgets of the constituent entities of the Russian Federation, in the amounts determined by the relevant decisions of the executive authorities of the constituent entities of the Russian Federation, as well as extra-budgetary and other sources that do not contradict the legislation of the Russian Federation.

The implementation of program activities will allow:

- promote the development of less expensive medical care;

- improve the system of training and advanced training of nursing personnel to work in medical and preventive, medical and social institutions;

- satisfy the population’s demand for affordable and effective medical and medical-social care;

- rational use of human and financial resources;

- carry out restructuring of medical institutions with the involvement of nursing staff.

The implementation of the sectoral Program will lay the foundation for the further development of nursing in the Russian Federation, will transition the constituent entities of the Russian Federation to resource-saving models of nursing activities and create the prerequisites for improving the health status of the population, reducing morbidity, reducing the level of hospitalization and the duration of the hospital stage, and ultimately will contribute to the protection health of citizens.

The implementers of the sectoral Nursing Development Program in the Russian Federation are the Ministry of Health of Russia, the I.M. Sechenov Moscow Medical Academy of the Ministry of Health of Russia, the State Scientific Research Center for Preventive Medicine of the Ministry of Health of Russia, VUNMC for Continuing Medical and Pharmaceutical Education of the Ministry of Health of Russia, the Research Institute of Social Hygiene, Economics and Health Management named after. ON THE. Semashko RAMS (as agreed), Interregional Association of Nurses of Russia.

Management and control over the implementation of the sectoral Program is carried out by the Russian Ministry of Health. The Council of the Russian Ministry of Health for Nursing coordinates the implementation of the industry program. The main directions and provisions of the sectoral Program are annually clarified and adjusted based on the progress of its implementation and the effectiveness of the use of allocated funds.

Electronic document text
prepared by Kodeks JSC and verified against:

Healthcare,
N 3, 2001