Health and nursing
The health and medical care as a profession involves the care and support of people of all ages. Sick , disabled and dying people in particular are cared for and looked after in nursing, but the prevention of diseases and maintaining health are also part of the nursing duties.
The aim of nursing, as human action, is to restore the patient's life as independently as possible and to maintain the health of all members within a society.
While in the past the talk was primarily about nursing , the term health and nursing is also used today. This new value priority corresponds the Occupation Health and nurse or registered nurse , as well as health and nursing aide or health and nursing assistants in Germany and Austria.
Definition of the international care association
The International Council of Nurses (ICN) defines care as follows (here in German translation):
“Care includes the independent care and support, alone or in cooperation with other professional members, of people of all age groups, of families or partnerships, as well as of groups and social communities, whether sick or healthy, in all life situations (settings). Care includes the promotion of health, the prevention of diseases and the care and support of sick, disabled and dying people. Other key nursing tasks are the perception of interests and needs (advocacy), the promotion of a safe environment, research, participation in the shaping of health policy as well as in the management of the health system and in education. "
This definition is not an internationally valid guideline, but only a general specification. The individual countries and their legislators are responsible for the precise job description and field of activity.
History of nursing
The history of nursing is inextricably linked with developments in other disciplines such as medicine , social science and theology and, for large parts of its development, is part of their history, especially the history of medicine .
Development up to the Middle Ages
The role, the function, the self-image and the image of care have changed significantly over the years. The interpersonal help, initially provided as a survival strategy to secure the livelihood within the family or tribal association, turned into a structured and partially organized social task of medical assistance in the archaic high cultures and antiquity , while the basic care was mainly provided by the family.
With early Christianity , a new orientation sets in that has shaped care up to modern times : the ideal of active charity, charity . This basis of nursing activity developed in ancient Rome and spread with Christianity across Europe. In the Middle Ages, charity formed the basis for numerous religious orders, including the Beguines and the Orders of the Brothers of Mercy , which are dedicated to nursing the sick and the poor.
18th and 19th centuries
At the beginning of the 18th century there were calls for the professionalization of nursing, and the first nursing schools initiated by doctors emerged. In the 19th century, Theodor Fliedner tried to improve the training of religiously motivated nurses with the establishment of the Kaiserswerth Diakonissenanstalt . Florence Nightingale publishes the first theoretical nursing text Notes on Nursing and uses the Nightingale system to reform the denominationally independent nursing education.
At the beginning of the 20th century, a number of nursing associations and professional organizations emerged, including the International Council of Nurses and the Agnes-Karll Association. The first nursing science courses were introduced in the United States in 1910, and nursing research began to take off shortly thereafter. The two world wars interrupted the development of nursing care in Germany and Austria, and nursing under National Socialism was one of the darkest chapters in nursing history.
After 1950, the Anglo-American countries rapidly developed the theory of nursing, pioneering conceptual nursing models emerged , and nursing emancipated itself as an independent academic profession. At the same time, efforts are being made in Germany and Austria to bring nursing training up to international standards, the three-year vocational training program is being introduced and a number of specialist training courses are developing.
“Since nursing courses were introduced in Germany in the 1990s, nursing has become more professional; Efforts are made to develop and establish a common understanding of nursing and a common profile of professional nursing. The fact that independent knowledge is being developed through nursing research and expert standards is a sign of emancipation, but also of the independent profiling of nursing. "
Museums on the history of nursing
In the Düsseldorf district of Kaiserswerth with its traditional deaconess institution, there is a nursing museum with an extensive collection on the history of deaconry and nursing in 15 rooms of the former Tabea nurses' hospital. The hospital museums in Bielefeld, Bremen, Munich and Nuremberg also pay attention to this topic.
After care was increasingly professionalized and anchored academically in the 19th and 20th centuries, the need arose, especially towards the end of the 20th century, to understand the development of the job description and the change in the role of carers in society. Nursing research is carried out predominantly by lay people, interested nurses and scientists who do not have a historical education. Anglo-American nursing research, which works together with other departments, is a world leader. Similar research projects have started in Europe. Medical history and nursing history are now part of the training of nurses in all areas and are taught as part of professional studies.
Education, training and further education
Occupational nursing in Germany is differentiated according to the following qualification levels:
- Short-term training as a nurse assistant
- two-year training as a nursing assistant
- As a rule, three-year vocational school training as a health care profession in health and nursing or with other focal points in care for the elderly or children .
- University degree in nursing science or advanced practice nursing
Nursing training is divided into theoretical and practical classes on the one hand and practical training on the other. In Germany , lessons are usually held at nursing schools or vocational schools , while practical training is partly completed in hospitals , nursing homes or outpatient care services . In accordance with the respective training regulations, practical instructions must take place there. This training structure is quite similar to that in the dual training of craftsmen, but represents a separate branch within vocational training .
The basic vocational training is comparable in its function to teaching or studies in other professions; advanced and advanced training build on it. Colloquially, these terms are often used as synonymous.
The proportion of men is 14%.
In Austria, in contrast to other European countries, the matriculation examination (Matura (A) / Abitur (D)) is not a prerequisite for training in the health and nursing profession until 2016. The training has been standardized since 1997. It lasts three years for the senior service for health and nursing and one year for nursing assistants. As of the amendment to the Health and Nursing Act (GuKG) in 2016, the health and nursing profession has been newly regulated. There are three professional groups: the former health and nurse becomes the upscale service for health and nursing (also called Dipl. Gesundheits- und Krankenpflege (DGKP) or Bachelor of Science Nurse (BScN)), the nursing assistant (PFA) and the Nursing Assistant (PA). The training for the BScN takes place in universities of applied sciences or for the DGKP until 2024 in schools for health and nursing (expiring model). The PFA training takes place in nursing schools or is also planned as an integrated model in higher schools. The PA training takes place in schools for social care professions or in various health and nursing institutions.
The upscale service for health and nursing will receive new (core) areas of competence as part of the amendment to the GuKG 2016.
- These include the core nursing skills (health promotion and prevention)
- the competence in emergencies
- Competencies in medical diagnostics and therapy
- Competencies in the multi-professional care team
Both types of training include practical and theoretical training, which alternate over and over again in the course of the training. The alternation of theoretical and practical blocks has the advantage of being able to put theoretical knowledge into practice more quickly and to bring practical experience into the classroom.
Particularly for the upscale service for health and nursing care, attention is paid in the training to combine a broad knowledge of basic and specialist medical knowledge and nursing knowledge. Networked thinking is particularly important in training and professional practice.
After completing training as a qualified nursing staff or BScN, specializations such as B. Intensive care, anesthesia or surgical care, care for renal replacement therapy, leadership and management as well as teaching tasks etc. are required for the selected special areas in the practice. These take place on the basis of further academic training in technical colleges and universities. In Austria, employees in health care and nursing are obliged to keep their knowledge up to date with the current state of science and to familiarize themselves with the latest findings. In order to be able to check this in practice, every nurse has to provide proof of education and training and prove at least 60 hours of training over the course of 5 years. PFA and PA are obliged to 40 hours of advanced training within 5 years. If a nurse does not comply with this obligation, she can be temporarily prohibited from using the professional title or withdrawn. Since 2017, all employees in health professions have to register, including health and nursing staff. This should make it transparent how many people have which qualifications in which areas of the health professions.
Academic path in nursing
In all Scandinavian countries, caring is an academic profession - this applies equally to care for the elderly and the sick. In Sweden, the first nurse received a doctorate in 1980 and the first nurse was appointed professor in 1982. In many other countries, too - but not in Germany and Austria - twelve years of schooling and academic training are prerequisites for taking up the nursing profession.
While nursing in the Anglo-Saxon region has had an academic tradition in addition to the professional one since around 1920, nursing science was only able to establish itself in German-speaking countries in the last decades of the 20th century. A number of courses of study (e.g. in nursing education , nursing management or nursing science ) are now offered there , mostly at universities of applied sciences .
In Austria, the diploma entitles the holder to take a vocational matriculation examination and thus access to university studies.
The course lasts eight semesters and leads to the academic degree Magistra / Magister of Philosophy. In the bachelor's and master's programs in Health and Nursing Science at the Medical University of Graz, the academic degrees of Bachelor of Science (BSc) or Master of Science (MSc) can be acquired after six or four semesters.
International training and nostrification
In the European Union , many countries implemented comprehensive training reforms in the 1990s that go beyond EU standards. The Bologna Process intensified these developments. The upper secondary level qualification is required for the training . Exceptions are: Germany , Luxembourg and Austria . The nursing training courses take place at technical colleges and universities . Exceptions are: Germany, France , Luxembourg and Austria. The majority of qualifications in academic nursing training in the EU countries lead to a bachelor's degree and the degrees obtained in the respective countries are largely mutually recognized. A recognition of European qualifications in the American professional system ( nursing board certification ) has not yet been implemented.
Nursing training takes place at universities and colleges around the world. a. in the following countries: Norway , Iceland , Canada , the USA , Mexico , Brazil , Australia , New Zealand , the Philippines , South Korea and Japan .
For vocational training in different countries, see also: geriatric nurses (D), midwives / maternity carers , health and nurses (D), qualified health and nurses (A), nursing assistants (D), nurses (historically ), Nurse (CH).
Further training in Austria and Germany
Continuing education in nursing aims to provide additional qualifications in order to develop professionally or to advance. The advanced training usually lasts two years, in contrast to advanced training, it always ends with an examination (oral / written / practical) and leads to a new job title or an expanded job title.
After the basic training in nursing (GuK) or children's nursing ( KGuK) etc., there are so-called advanced training courses, e.g. B. "Certified specialist for managerial tasks in nursing". In the meantime there are specialist training courses for almost every specialized direction in the hospital . But differentiation is also advancing in the outpatient area. The best known are those for pediatric nursing, oncology , surgery , pain therapy , anesthesia , intensive care , nephrology and psychiatry . The specialist training for psychiatry is shown as an example:
Admission requirements are successfully completed training as a health and nurse and proof of two years of professional experience in a psychiatric facility. The training itself lasts two years and takes place part-time. In these two years, one must have completed four areas in psychiatry (e.g. admission ward, institute outpatient clinic, geriatric psychiatry and inpatient addiction treatment). The areas can be negotiated with the respective training center. For each area, you get a special task (practical reports) from the training center for processing (relevant to the exam). The training concludes with oral, written and practical exams. Then you can use the title “Specialist nurse for psychiatry”, depending on the state law.
In addition to these subject-related training courses, there are other options. Anyone who wants to continue working with their training outside of practical care in the hospital can B. train to become a hygiene specialist or case manager .
Further qualification options are also available in the academic courses in nursing science , nursing education and nursing manager / nursing host . Activities in nursing research institutions, nursing services management or training institutions (e.g. nursing schools) increasingly require a completed degree.
The high ethical requirements and the professional reality, which is characterized by deficiency and cost efficiency in some areas, create a tension that is difficult to bear for many in this profession. The moral stress factors and burdens include dealing with dying, oncological and geriatric patients. In addition, the increased workload , the limited work-life balance and the poor recognition of the work done by nursing staff are perceived as stressful. In particular, nursing staff who work in intensive care units, in the field of internal medicine or in a rotating shift system with night shifts are affected by psychologically stressful working conditions.
The ideal of the helper often leads to nursing staff trying to compensate for material and organizational deficiencies through increased commitment. In the long term, however, together with an often high level of physical stress, e.g. B. the spine , not infrequently to a job dissatisfaction and ultimately to an escape from the job. It is assumed that only in a few other occupations does the length of stay of trained workers in the profession are as short as in nursing professions, especially in elderly care . In Austria, female nurses were included in the Heavy Workers Act.
The pay in the nursing professions is often perceived as rather low in relation to the physical and psychological strain; Work income is improved by various allowances, but such allowances usually do not have any effect on pension entitlement later.
For years there has been a public discussion as to whether the daily stress of those working in the care professions permanently exceeds the reasonable level and, among other things, leads to burnout . Apparent or really serious care errors occasionally make headlines as a “ care scandal ”, but in most cases they do not result in a systematic improvement in working conditions for all employees. In fact, experience has shown that excessively high demands on the care staff can lead to care errors. Likewise, the renouncement of a possible natural food intake (still or in addition) in favor of an automatic machine feeding because of insufficient nursing capacity can trigger the question of a humane treatment of the patient.
While the nursing profession is the numerically largest profession in any health system, it does not have a strong political position in any country. His influence is limited. The main reasons:
- Political decision-makers often lack competence and proximity to the carers. Therefore, their interests are not supported strongly enough.
- Politicians (especially financial politicians) often strive to avoid escalating costs in a healthcare system that is expanding anyway (mainly due to medical advances and demographic aging) and see better conditions in the care sector primarily as a cost factor.
- Nursing care workers are not involved enough in professional policy in trade unions (FRG: ver.di ) and professional associations (e.g. DBVA, DBfK ). The low level of organization among workers in the care sector weakens the ability to organize industrial disputes.
- Private small businesses are not bound by collective agreements if they do not belong to an employers' association.
- Nursing chambers are not designed as pressure groups where they exist , but only provide advice.
- Nourishing obtained by the media much less attention compared to doctors.
Care and politics in Austria
Since the Lainz scandal , which moved the population in Austria due to the inhuman elements of this case, nursing has repeatedly been a topic of election campaigns, for example after an incident in Vienna's Otto Wagner Hospital , in which it was claimed that nursing staff were the patients "Punish".
Other heatedly discussed topics in recent years were care allowance, 24-hour care (which in Austria has nothing to do with the profession of qualified health care professional ), as well as cases of patients and long-term clients who were found dead or hypothermic . It should be noted that in Austria a patient may not be restrained at will and that there are often no trained security staff in hospitals.
Ethics in Nursing
In principle, the rules of medical ethics apply to nursing, especially in medical institutions. But there is also the care area, where the carers must and can act independently. The conviction that it is the duty of every individual as well as society to help sick people is a central part of the professional ethics in nursing. However, nursing is not all about compassion and commitment. In addition to the strength to support deep crises of patients and possibly to make situations perceived as humiliating (for both patients and carers) as dignified as possible, extensive specialist knowledge is required in order to meet the requirements of the profession. However, due to the massive cost pressure in the health care system, the field of nursing is also marked by a lack of time, personnel and money. The competitive pressure in the care sector increased significantly with the introduction of the Care Insurance Act on April 1, 1995. A market that was previously dominated by non-profit care services has now been significantly supplemented by private outpatient care services. Almost at the same time, the federal states' financial subsidies were severely restricted, which led to a further increase in cost pressure.
From the German Nursing Council a framework Professional Code was published in 2004, in which the general principles and rules of conduct are fixed for professional nurses in Germany. This framework professional regulation replaced the professional regulations previously issued by the German Professional Association for Nursing Professions and the Working Group of German Sister Associations and Nursing Organizations.
Labor disputes in nursing
The working conditions for employees who work in the care sector can be regulated autonomously by trade unions and employers in collective agreements (e.g. amount of wages, working hours, vacation). This also applies to church employers , who almost without exception refuse to negotiate collective agreements with the unions at all. In the context of a collective bargaining dispute, the question arises for the union and its members as to whether it is opportune to also call nursing staff to a strike to enforce the collective bargaining policy goals or to participate in such a strike.
Under German law, strikes are also generally permitted in care. However, it must be ensured that the patient's life and limb are not endangered by the work stoppage. This means that, as a rule, an emergency service must be available and that care activities that are essential for the health of the patient must not be omitted. Insofar as the nursing staff works in a company that belongs to the public service and which therefore falls within the scope of the collective agreements applicable there, colleagues in other areas outside of nursing, such as B. bus drivers, garbage collectors or lifeguards of the public service "strike" for them. The wage increase won then applies to all union members.
In Finland , nurses took a different path in the 2007 collective bargaining dispute. They had announced collectively that they would terminate their employment relationships on a certain date if their demands had not been met by then. Since care workers are rare in Finland too, the union hoped to be able to exert so much pressure on the mostly municipal care employers that they would make concessions by threatening mass dismissals. According to surveys, their demands and also their threat of mass layoffs as a means of industrial action were very popular among the Finnish population because the nursing staff is really considered to be underpaid. In November the government responded with an emergency law and an agreement was finally reached.
Trust in the carers and professional prestige
|Table 1||Table 2|
A survey in Switzerland on trust in various professions in 2003 led to the result in Table 1 in the assessment categories “Very high trust” and “Fairly high trust” . The 2005 Allensbach professional prestige scale is shown in Table 2 .
Reader's Digest survey was repeated in 2006. The trust ranking (European average): 1. Firefighters 95% very high or fairly high trust. 2. Pilots 92%. 3. Pharmacist 89%. 4. Nurses 86%. 5. Doctors 85%.
Nursing errors are serious incidents in nursing, which usually lead to a deterioration in the overall medical situation. Nursing errors have steadily decreased proportionally in recent years, the reason for this was the professionalization.
Situation in Germany
In around 10% of the inpatient facilities in Germany, tests of the documentation revealed serious care errors with possible health damage to the home residents (2003: 17%). In 34 percent of those in need of care in inpatient facilities, there were deficits in the supply of food and fluids (at least as evidenced in the documentation). Around 5.7% of the outpatient facilities show such care errors (2003: 8.8%), with around 30% there were possible deficits in the supply of food and fluids.
Misinterpretation by relatives
One problem that nurses are increasingly struggling with is misinterpretation by relatives or third parties. The mistake here lies in old moral and value concepts that are still partially applied to caregivers. Older generations in particular see the caregiver as a servant subordinate to the doctor who is supposed to help the patient. This often leads to conflicts with relatives whose image of the elderly and nursing is shaped by the outdated deficit model . While maintaining or achieving independence is in the foreground for the caregiver, relatives often think they recognize a care mistake. This creates the impression that the caregivers are either overwhelmed or do not take sufficient care of those in need of care.
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