Health and Social Care

The health systems of former Soviet Union countries are undergoing reform away from the highly centralised, resource-intensive, specialised and hierarchical Soviet system, towards a more generalist, efficient health service with greater focus on primary health care. Family Health Nursing is a new model designed by WHO Europe in which skilled generalist community nurses deliver primary health care to local communities. This paper presents a qualitative evaluation of the implementation of Family Health Nursing in Tajikistan. Using Stufflebeam's 'Context, Input, Process, and Product' model, the paper aims to evaluate the progress of this reform, and to understand the factors that help or hinder its implementation. A four-phase research design investigates the development of the Family Health Nurse role over time. In 5 rural areas, 6 focus groups and 18 interviews with Family Health Nurses, 4 observations of their practice, 7 interviews with families and 9 interviews with physicians were carried out. Data were analysed according to the components of Stufflebeam's model. Although the legacy of the Soviet health system did not set a precedent for a nurse who is capable of decision-making and who works in partnership with the physician, Family Health Nurses were successfully implementing new practices. Crucial to their ability to do so were the co-operation of physicians and families. Physicians were impressed by the nurses' development of knowledge, and families were impressed that the nurses could offer real solutions to their problems. However, failure to pay the nurses regular salaries had led to serious attrition of the workforce. We conclude that the success of the Family Health Nurse role in other countries will depend upon its position in relation to the historical health care system.

Background: This paper describes a Nursing Development Programme in Tajikistan where four organizations worked together to develop some innovative changes in nursing practice and education. Within the context of Health Care Reform the Government of Tajikistan provided a climate for Nursing Development. The joint efforts of the Ministry of Health, the World Health Organization (WHO), the WHO Collaborating Centre for Nursing and Midwifery at Glasgow Caledonian University, Scotland, and the Aga Khan Health Service in Tajikistan, have led to major changes in education and practice. Methods: The project focused on the development of new standards for practice in Gorno Badakhshan and a new Family Health Nurse curriculum for all students entering nursing programmes. A Nursing Centre was opened to provide leadership in education and practice and a coordinating Council was established to develop professional standards. Results: The project has demonstrated that nurses in Tajikistan have embraced the developments in both education and practice with the aim of improving the care they give to their communities and the support they provide for the teams within which they work. Conclusions: The project also illustrates how different organizations can work effectively together. Key principles identified from this project for effective collaborative working include: communication, common goals, shared expertise, pooled funding and close alignment with Government strategies for Health Reform.

Background: This paper describes a Nursing Development Programme in Tajikistan where four organizations worked together to develop some innovative changes in nursing practice and education. Within the context of Health Care Reform the Government of Tajikistan provided a climate for Nursing Development. The joint efforts of the Ministry of Health, the World Health Organization (WHO), the WHO Collaborating Centre for Nursing and Midwifery at Glasgow Caledonian University, Scotland, and the Aga Khan Health Service in Tajikistan, have led to major changes in education and practice. Methods: The project focused on the development of new standards for practice in Gorno Badakhshan and a new Family Health Nurse curriculum for all students entering nursing programmes. A Nursing Centre was opened to provide leadership in education and practice and a coordinating Council was established to develop professional standards. Results: The project has demonstrated that nurses in Tajikistan have embraced the developments in both education and practice with the aim of improving the care they give to their communities and the support they provide for the teams within which they work. Conclusions: The project also illustrates how different organizations can work effectively together. Key principles identified from this project for effective collaborative working include: communication, common goals, shared expertise, pooled funding and close alignment with Government strategies for Health Reform.

A practical approach to creative teaching: an experiment The purpose of this experiment was to see if creative teaching methods would prove effective when included in a school of nursing teaching programme. This would be demonstrated by significant differences in levels of achievement in assessments and a demonstration that: the knowledge gained was applied to the clinical situation. Didactic teaching methods were exchanged for a more creative approach without alteration of the course structure. The quasi experimental method was used, with four introductory courses of 20 nursing students at two separate district schools as the sample, two groups acting as the control groups and two as the experimental groups. The teaching sessions introduced medical problems associated with poor oxygenation, particularly those consequent to heart disease. The teaching was supported by appropriate care planning within the Roper et al. (1981) theoretical framework. Three distinct areas were identified; fact leaming, e.g. anatomy and physiology, problem identifications and planning for nursing, intervention and skill learning. Students in the experimental groups were given work sheets and facilities for self leaming whilst those in the control groups continued with a traditional lecture/demonstration format. The results of the experiment were evaluated by testing all four groups using multiple choice objective tests, essays, problem solving and nursing intervention exercises and practical assessments. The findings showed that the experimental groups did no better in the multiple choice objective tests or in the essays than the control groups but they did do significantly better in the problem identification and planning for nursing intervention exercise. In the assessment of practical skills there was no difference between the groups in skill performance but the experimental groups were able to apply the theory significantly better than the control groups.

Background: The Tajik medical education system is undergoing a complex reform to enhance the transition of the healthcare system from its soviet legacy of emphasizing secondary level care/specialisation to become more family medicine and primary health care oriented. The current study presents the first empirical evaluation of the educational environment for nursing students in Tajikistan using the Dundee Ready Educational Environment Measure (DREEM). The study results contribute to the benchmarking efforts of monitoring and positively steering the educational environment over time. Method: The study was based on a cross-sectional survey involving 630 nursing students at two nursing colleges in Tajikistan. Students' perception of the learning environment was measured using the DREEM. Internal consistency was examined using Cronbach's alpha. General scores were calculated and measured against international benchmarks. Data was further interpreted by comparing DREEM scores between students of different sex, at different colleges and different study years using T tests. Results: Cronbach's alpha ranged from 0.30 to 0.75 with an overall alpha of 0.89. General DREEM scores were slightly above average compared to similar studies with nursing students in other countries. In particular, results showed that students' academic self-perception and teachers' technical competences were generally favourably rated. Teachers' pedagogical skills were critically perceived by the study participants and teaching was generally viewed as too teachercentred with an over-emphasis on factual learning. Conclusions: Statistical results indicated acceptable levels of reliability of the DREEM tool when applied to the Tajik nursing educational context. Students rated the learning environment as generally satisfactory with average scores similar or slightly higher than comparable scores from similar studies involving nursing students. However, the ongoing educational reform could have placed more emphasis on developing faculty pedagogical skills in nursing schools. Teaching approaches would benefit from being more competency based rather than so heavily focused on factual knowledge.