How effective education of nurses will help to transform the rehabilitation system in Ukraine

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There are two studies on the impact of health workers’ strikes on the treatment and condition of patients. What did they discover? When doctors strike, the death rate remains stable or… decreases When nurses strike, the death rate increases by an average of 18.3%. A professional nurse is an incredibly important person for a patient’s recovery. However, some areas of medicine require additional training from nurses. Such a field is the field of rehabilitation. You cannot be a pediatric nurse and simply transfer to the rehabilitation team and perform your duties effectively. However, the understanding of the need for special education comes only now, when the need for both specialists and rehabilitation is huge. And what some nations have gone through in tens of years, we have to learn faster. We face a number of challenges. And most of them are before our education. Education that grazes the rear The leading countries in the field of nursing and rehabilitation are the USA, Australia and Canada. The Lviv Medical Academy, where I teach the discipline “Nursing in rehabilitation”, was almost the first to change the training program. We took American and British manuals and training programs as a basis and adapted them to our needs. And the main need is the work of a medical rehabilitation nurse in a team. What can the professional path of a rehabilitation nurse look like now? If we describe it dryly and briefly, then first it will be an undergraduate level of general nursing, which will last three years (junior bachelor’s level) and then – a separate specialization of a rehabilitation nurse, which will be studied for approximately 3 months. Why is additional specialization so necessary? A nurse is a person who provides care. And it is not only about certain hygienic or medical procedures. In rehabilitation, it is important to be able to communicate with the patient, to understand his needs and problems, and most importantly, to know how to communicate this to the team. And in order to understand the problems and needs of the patient, it is necessary to have a sufficiently high level of training. For this general profession will not be enough. With the specialty “223 nursing” in Ukraine, nurses of a general profile are graduated. And after such general preparation, a person may well end up in the rehabilitation department of a hospital. General training is not enough for such a job. So specialists usually undergo specialization. Now in the classifier of professions there is already a specialty “Nurse/Medical brother in rehabilitation”. And accordingly, there is a specialization for this, so many educational institutions retrain specialists. Training in this specialization lasts approximately 150 hours. And it is in this specialization that critical skills for a rehabilitation nurse or nurse are improved, for example, the ability to communicate with the patient and the ability to build a trusting relationship with him. There are also important topics that are practically not covered during undergraduate education. First of all, this is the care of a patient with spinal cord and craniocerebral injuries. This question may be in the curriculum, but there are too few hours allocated to it. And then there are brain injuries and strokes, which are among the top three diseases in terms of disability and mortality worldwide. If we take the programs in the USA, there are separate manuals called “Rehabilitation nursing for helping patients who have suffered a stroke.” We currently do not have the opportunity to create such separate specializations, but we must and can train nurses in proper rehabilitation care. First of all, it is: care without bedsores; care with respect for the patient’s dignity; care taking into account all additional means that the patient needs – tracheostomies, gastrostomies, etc. These are all additional skills that need to be developed both at the undergraduate and postgraduate levels. Critically important knowledge. And empathy, without which they are nothing. Let’s take spinal and brain injuries as an example. In these cases, the patient has serious problems in all periods: both in the acute stationary period and in the post-acute period. At each stage and in each period of recovery, the nurse must find problems or conduct a nursing diagnosis. And nursing diagnosis is precisely the identification of the patient’s problems. For example, the patient’s problem is shortness of breath. The nurse should identify it and report it to the team. And here this cooperation is critically important – a physical therapist and a nurse. Nurses are essentially the only specialists who spend time with the patient 24/7. And sometimes they can notice things that a physical therapist who has a 6-8 hour work day won’t always notice. Also, sometimes additional loads are needed by the patient even after the working day. Or he is visited in the evening by relatives who need a lot of explaining, and the physical therapist is no longer available. The issue of family training is a separate block of knowledge that a rehabilitation nurse must master, because after discharge, they will also have to adapt to the new condition of a loved one. Also, the nurse stays alone with the patient for the weekend. She monitors the patient’s condition and takes over the duties of other specialists. A nurse of this level should not only “know” and “be able to”. It should also analyze. But it was necessary to introduce specialization. It is necessary to implement programs that would cover the needs of such specialization. Ukraine still uses programs that do not differ in terms of content from the programs of 2004. I have seen these programs in medical colleges and universities that talk about the importance of electrophoresis and hydrotherapy. But this knowledge will not be able to prepare the nurse/brother to work in active rehabilitation. Rehabilitation is not only practical knowledge. This is a philosophy of understanding that the ultimate goal of her work is to help the patient as much as possible in mastering their own level of independence, which, unfortunately, was lost due to injury or illness. Separately, a nurse of this profile needs to understand how to care for a patient and not harm herself. In our Academy, we included a separate topic in the educational program: “Biomechanics of movement and kinesiology in the work of a nurse.” Knowing the mechanics, you can transfer a patient who is much heavier than you and not hurt yourself. I have a colleague who weighs 50 kilograms, but without any problems moves and positions patients who weigh under 100. And if a nurse knows mechanics, then she can teach it to relatives, because, as we have already mentioned, it is the relatives to live with a person and her new condition. At our first pilot training for nurses, we also talked about such life hacks. And also about bedsores, communication and safe patient movement and positioning. Education must also meet needs. We plan to continue developing and organizing trainings. But for this you need to understand educational needs. Educational programs should not just exist on paper. Stakeholders should write them for rehabilitation nurses, a team of professionals should be assembled, namely physical therapists, doctors of physical and rehabilitation medicine (FRM doctors), nurses of rehabilitation departments and, of course, educators. And here another problem arises – there are very few doctors of the Federal Republic of Moldova who studied rehabilitation. These are often retrained gynecologists, traumatologists, etc. Physical therapists with an educational “vein” are also very few, and many of them currently have an insane workload as a practitioner. I am a physical therapist and I know what a nurse should be like to work in my team. Physical therapists probably know more than anyone what kind of nurse/brother is needed for a multidisciplinary team. If I were choosing a nurse for my rehabilitation team, the first thing I would evaluate is her level of empathy. This is key. It’s not just about compassion, it’s about understanding a person’s emotions without plunging into their condition. First of all, it is about understanding human emotions, the ability to work with them, providing the patient with the necessary support. Is she attentive enough? Is it sensitive enough? It is possible to brilliantly perform medical manipulations and not understand the person, not see the changes that are important to convey both to the team and to the patient’s relatives. And in rehabilitation, this is critical, because often our patients do not speak. But empathy and an empathetic attitude can and should be taught. There are entire manuals for this that are specially designed for healthcare professionals. For me, as an educator, manuals that have not changed since 2004 and where 70% of the information is unsubstantiated, outdated are a personal pain. Manuals that cannot pass critical review because they are written by professors who have either never worked in rehab or have seen live patients in their undergraduate years. Much information is devoted to equipment that does not help a person in recovery – personal pain. Or programs where all surgical diseases are combined in one 3-hour class. In essence, this is profanation. In order to write a professional nurse/brother specialization program, a task force must be assembled that clearly understands the ultimate goals and what competencies the nurse/brother should develop for acute rehabilitation units, for the post-acute period, and during long-term recovery. In my opinion, we should attract specialists to write such programs from other countries, who in 70 years have gone the way that we have to go in the last two. Nataliya Rudakova, Master of Rehabilitation, teacher of the Department of Mental and Physical Health of the Lviv Medical Academy, graduate student of the Department of General Pedagogy and Pedagogy of the I. Franko Higher Secondary School of LNU, certified facilitator of the peer group for medical educators within the framework of the Ukrainian-Swiss project “Development of Medical Education”, co-author of the course “Humanity and Empathy in Health Care”. Practicing physical therapist Publications in the “View” section are not editorial articles and reflect the author’s point of view exclusively

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