Shin, H. (2022). Advancement of nursing education in the Kyrgyz Republic [Policy Suggestion]. Bright Kyrgyzstan, Kyung Hee University. 

Introduction

In a recent decade, the government of the KR proposed strengthening the competencies and professionalism of health care providers as a strategy for establishing a national health system to improve population health indicators. Nurses are essential roles in the healthcare system, and the recent COVID-19 pandemic has highlighted their importance and the need to strengthen their capabilities. However, in the KR, nurses continue to play only the role of an assistant, with no responsibilities for independent decision-making or intervention in practice, and the level of social acknowledgment for nurses is still low. Furthermore, the ambiguity of nurses' professional identity, lack of competencies, and limited nursing education became barriers in the KR, where the past system remains.

Methods

This study was carried out in two phases of needs assessment and development a strategic plan to establish effective policies for the advancement of nursing practice and education in the KR. A Kyrgyz-Korean research team has performed this global collaborative study since May 2021. 

In the first phase, a needs assessment phase, an explorative sequential mixed method was used to investigate the current status and recognition of nursing practice and education and identify the actual need for improvement in the KR, from July to August 2021. We conducted Four meetings with 14 stakeholders, seven focus group interviews with 10 nurses, nine nurse managers, 11 faculties of nursing schools, and two officials in charge of nursing policy. And then, through an online survey, 215 participants including nurses, nurse managers, and faculties of nursing schools evaluated their job satisfaction and clinical nursing competence and responded to a questionnaire developed to identify the need for improvement in nursing and nursing education based on literature review and qualitative data. Qualitative and quantitative data were compared, analyzed, and integrated through narratives. 

In the next strategic plan development phase, a revised-Delphi method was used to establish a consented strategic plan for the policy improvement of nursing practice and education in the KR, from July to November 2021. Seventeen expert panels for round 1 and 14 expert panels for round 2, including government officials in charge of nursing policy, faculties of nursing in colleges and universities, and representatives of associations for nurses and nursing education, were involved through email or online individual meetings. The domains requiring improvement and strategies for policy development were derived from the responses of experts collected in the first round, through qualitative content analysis. In the second round, for those domains and strategies, the consensus achievement (defined as > 70% agreement) was identified and importance-urgency analyses were conducted. At the final expert hearing session, a total of 23 people attended, co-hosted by the research team and the Ministry of Health of the KR.

Results

Participants in the need assessment identified two areas for improvement in nursing in the KR: "low competencies of nurses" and "low job satisfaction of nurses." And “Improvement of nursing education”, “Professional development for nurses”, and “nursing quality assurance” are required to solve these issues. It was also proposed that these issues be addressed through "improvement of nursing education," "professional development for nurses," and "nursing quality assurance." Indeed, nurses reported significantly lower satisfaction in the extrinsic factors than intrinsic and general satisfaction, especially security, company policy, human relationship with supervisors, and responsibility(autonomy) area of their job. Also, the self-scored caring competence of nurses was lowest compared with their communication, management, and professional self-growth competence. As a solution to the presented problem, the need for policy improvement of the period, curriculum, and degree system in nursing education, and registration and accreditation for competence assurance of nurses were identified. Participants showed a willingness to utilize the professional development opportunities if provided.

Through the followed two rounds of individual Delphi, 20 domains of demand for improvement were identified, and 14 policy development strategies were proposed. 90.0% of the improvement-need areas reached consensus. Among them, low quality of nursing education, lack of nurses' competencies, short education period, and lack of practicum education showed high priorities on the importance-urgency matrix. Of the policy development strategies, 90.0% obtained consensus. Among them, the importance-emergency analysis showed improving the nursing education curriculum, introducing the bachelor's degree program, introducing the post-graduate degree program, strengthening faculties' competencies, and expanding educational resources should be prioritized.

In conclusion, we suggest the following strategies: 1) innovations in nursing education systems with the standardization of university education and the growth of nursing discipline, 2) Nursing education capacity building with nursing faculty preparation, standard for college entrance qualification, and accreditation of nursing institutions, and 3) Assurance of education outcomes with nursing graduates' and practicing nurses' competence improvement.

Conclusion

The results of this study suggest specific strategies to enhance professional development in nursing based on the needs assessment. These would be effective measures for quality improvement of healthcare providers and the level of national health status that the government of the KR has pursued. The KR has a high demand for effective policies to ensure the quality of nursing and train competent nurses to enhance national health status. This study also provided a guide for policy development of nursing practice and education, by focusing energy, resources, and time in consented and prioritized directions.

Copyright 2022 Bright Kyrgyzstan (Hyunsook Shin). All rights reserved. No part of this report may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the copyright owner. Unauthorized distribution or duplication is strictly prohibited and violates applicable laws.