Improvement Of Nursing In Maternity Hospitals Depending On Training Nurses



According to the World Health Organization «quality of care» — is the content of the interaction of the doctor and the patient, based on the skills of health workers, and above all, doctors, which allows them to reduce the risk of disease progression and the emergence of a new pathological process, optimal use of the resources of medicine and provide patient satisfaction of its engagement with the medical subsystem» (1986).Until recently, the priority in improving the quality of care given to, basically, medical services as the most independent and suitably qualified.

Existing until recently believed that nursing activity is only auxiliary to the medical, not allowed to adequately determine the degree of influence of the quality of nursing services on the quality of health care in general.According to the modern concept of nursing nurse should be a highly qualified specialist — a partner of the doctor and the patient, able to work independently as part of a single team.

Improving the quality of nursing activities it is advisable to conduct the four areas recommended by the World Health institution:

 improving the performance of professional functions (technical quality);

 rational use of resources (efficiency);

 reduce the level of risk (risk of injury or illness as a result of medical intervention);

 improve the satisfaction of the patient medical care.Improving the quality of nursing practice in maternity homes possible by improving the training of nursing personnel.

Elevated levels of secondary vocational education is implemented in medical colleges.Training of nurses held in selected areas of in-depth training, approved by the educational standard.To date, provided specialized training for nurses in the maternity complexes, through the issue of midwifery nurses, both in college and in higher education.Determination of the effectiveness of such training can be one of the factors affecting the quality improvement of care women in labor.Elevated levels of nursing education is to provide a high level of theoretical specialized training, to promote the development of professional skills, improve the independence of the sisters in the solution of health problems, as well as to provide psychological training to work with heavy labor.

In addition, to evaluate the quality of nursing care in maternity complexes required standards. With this in mind, of particular relevance acquire scientific research in the development of criteria for evaluating the quality of nursing practice, depending on the level of training of nursing personnel.The aim of this work was to study the effect of the level of training of nursing personnel to improve the quality of health care to patients of obstetric facilities and the development of measures to optimize the continuous training of nursing personnel.

Research methods.Working with the medical and statistical documentation of the two maternity hospitals. Analysis of statistical data in these institutions. Drawing up and carrying out the survey among nurses and patients.In order to study the effect of the level of training of nurses on the quality of medical services, as well as explore the personal, emotional and motivational qualities of nurses with different levels of training.To analyze the satisfaction of doctors and patients the quality of the activities of nurses with different levels of training.Evaluation will be conducted through a questionnaire designed for doctors and patients.

Results of the study.In the course of the experiment were examined work organization of nurses and nursing quality of the population in conditions of Kibray maternity hospitals and maternity facilities Zangiota using a complex technique.А comparative analysis was carried out actually existing labor and the data obtained as a result of experimental verification, allowing to confirm the validity of their use in practice.Used complex method allowed a sufficient degree of representativeness of the study the actual state of the labor organization, content and scope of the work of nurses of obstetric facilities.Determine the costs of working hours of nurses on the various elements of the work, this technique made it possible to identify wasteful expenditure of time, free up time reserves for medical and diagnostic work, as well as to evaluate the quality of nursing care provided in maternity hospitals and to develop evidence-based recommendations for the improvement of quality and the efficiency of the labor nurses.Studied Labour Organization 63 nurses.Under these circumstances, all prohronometrirovano 105 days of Nurses (672 hours).During this time, all were filled and statistically processed 95 historical maps and observation sheets.Spend an expert assessment of the quality of the work of nurse’s two maternity hospitals.263 questionnaires were analyzed, including those obtained from 100 physicians, 63 nurses, and 100 questionnaires from the public about the quality of nursing care in maternity hospitals.

A survey interview 63 nurses at a pre-scheduled program of the organization and the quality of nursing care.Of the 63-year-took part in the survey of nurses, 47 (74.6 %) nurses had only a secondary special education, 13 (20.6 %) — IRR graduates 3 had another higher education (4.8 %).Most nurses do not have higher education and have not expressed the desire to get it. Nurses age group 30-40 years, mostly in a profession accidentally hit in the age group 40-50 years, working mostly by vocation.That is, nurses, graduates of medical schools 70-80s, had at one time a clear motivation to choose a profession — a calling.And the choice of their younger colleagues influenced advice of relatives and friends.

The majority of respondents ages 30-40 years and 40-50 years, their work is not considered prestigious (simple performer doctor will, lack of motivation for personal growth).But at the same time, they believe that their profession is important for the prosperity and well-being of society.

We are ready to recommend the profession m / s 41 % of the respondents, 86 % believe that the m / s is the only performer of a physician, and some believe that the work can show their skills (76 %), skills (55 %) and knowledge (41 %).However, the ranking of nurses in terms of education, it turned out that all indicators nurses graduated from the Faculty of Graduate Nursing have the highest score.

Nurses age group 30-40 years, they describe themselves as responsible to a certain degree of employee initiative, however, recognize that it is peculiar and formal approach to work, although its end result is interesting to them.

Nurses age group 40-50 years, they describe themselves as responsible, interested in the end result of their work, while not particularly eager to take the initiative and often refer to the work carried out formally.

Nurses age group>50 years, with the greatest seniority, are responsible for operation, perform only the instructions of doctors, cherish the end result.

The study of the content, scope and organization of work of nurses showed that the main activities of the implementation of nurse pay 59,1±0,85 % of working time.

Significant time required to come to work with medical documentation 36,4±1,7 %, which significantly reduces the time devoted to direct contact with diseased and adversely affects the quality of nursing care. Medical manipulation in the structure of working time costs amounted to only 17,5±0,35 % from nurses.

Analysis of the working hours of nurses structure showed that particularly little time is devoted to prevention work 5.2, including sanitary and educational work is spent only on 3,6±0,63 times.On improving personal qualifications nurses spend 4,6±0,4 % of working time.Lack of knowledge of the relevant regulations and guidance materials leads to deficiencies in the organization of the work of nurses.

A large share in the structure of working time nurses take other kinds of work 21,6±0,99, which include service calls, the execution of public works in the workplace, participation in meetings and conferences outside the clinic, transitions (crossings), and others irrational. Сosts averaged 14,7±4,31 % of the working time of nurses.

In order to identify the advantages of working nurses with higher education, graduated from the higher nursing, have been studied labor organization and structure of the working time costs nurses with secondary education and nurses with higher education. The analysis of the study showed that for performance of medical procedures nurses with higher education spend 2 times more time than nurses with secondary medical education (13.5 vs. 6.8 %).Significantly in the cost of working time difference in the performance of preventive (19.1 vs. 6.9 %) and, in particular, health education (8.3 vs. 4.9 %) work.

After analysis of multiplicity and consistency of performance of nurse’s activities in the course of the working day, it was found that they often switch from one activity to another, which considerably reduces the quality of nursing care due to a lack of planning in the work.For example, a nurse with a secondary medical education during the working day 16 times back to work on filling of medical records 8 times engaged in official conversations, 5 times perform medical manipulations, 12 times engaged in performing other work, etc.A nurse with higher education 8 again returns to the filling of medical records 12 times perform medical manipulations and 5 times is engaged in other work.

The study of the views of patients showed that personal characteristics of nurses are not satisfied 59.1 % of respondents;health education — 54.8 %;psychology of communication with the patients — 44.3 %;appearance nurses — 42.1 %;level of service culture — 39.5 %; fulfillment of medical prescriptions — 37.4 %;quality nursing care — 35.2 % of respondents.

Conclusion.The analysis of the study showed that for performance of medical procedures nurses with higher education spend 2 times more time than nurses with secondary medical education (13.5 vs. 6.8 %).Significantly in the cost of working time difference in the performance of preventive (19.1 vs. 6.9 %) and, in particular, health education (8.3 vs. 4.9 %) work.

The study of the views of patients showed that personal characteristics of nurses are not satisfied 59.1 % of respondents;health education — 54.8 %;psychology of communication with the patients — 44.3 %;appearance nurses — 42.1 %;level of service culture — 39.5 %;fulfillment of medical prescriptions — 37.4 %;quality nursing care — 35.2 % of respondents.

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