Solar Energy in Rural Health Facilities: Experiences from the Field, Solafrica

### **Nurses Can! Survey on Roles and Responsibilities in Primary Health Care in Ukraine**

#### **Daryna Bogdan, Tetiana Stepurko, Mladena Kachurets, and Martin Raab**

Ukrainian - Swiss Project "Medical Education Development", Kyiv, Ukraine

The introduction of new payment mechanisms on a per capita base in increasingly autonomous healthcare facilities has stimulated organizational development and service growth of primary healthcare (PHC) providers since 2018. Ukraine has been almost right in time to strengthen its healthcare system in the pre-COVID-19 time. Still, family doctors seem to be overloaded, while nurses are rarely considered professional partners in service provision. We aim to compare de jure and de facto arrangements in the role distribution among PHC personnel. Revealing the attitudes towards stronger involvement of nurses in clinical practice is further envisaged. Semi-structured interviews with 24 experts, PHC providers (qualitative study), and 592 CATI/CAWI (computer-assisted telephone/web interviews) with family doctors, nurses, and administrators (survey) were completed in 2021. The survey was conducted by a sociological agency, and the sample drawn was based on a list of PHC providers from the National Healthcare Service following a stratified representative approach. The current legal base of (family) nursing is outdated and confusing; however, it allows the determination of the scope of work of a nurse to be specified at the level of each healthcare facility. According to survey results, managers and doctors mostly support the idea of expanding the role and responsibilities of nurses (84% and 65%) and believe that nurses can strengthen service provision, especially in the COVID-19-affected context. Nurses confirmed this to a lesser extent but still support the idea of redistribution of functions (52%). Doctors, nurses, and managers indicate that nurses can be fully responsible for taking samples (express tests, etc.), conducting diagnostics (ECG, blood pressure, pulse oximetry), vaccination, and revealing life habits (including eating habits, level of physical activity, etc.). Experts drew attention to the imbalance of theoretical and practical parts of nurses' training, as well as the obsolescence of the formats of their training. There is a clear need to develop the nurse's communication and counseling skills and to develop a holistic and patient-centered approach to care. Expanding the role of nurses has received support from involved stakeholders but would require modernized educational programs to build new competencies, especially considering the COVID-19 crisis.

Daryna Bogdan, Tetiana Stepurko, Mladena Kachurets, and Martin Raab

Ukrainian - Swiss Project "Medical Education Development", Kyiv, Ukraine

### Methods

Review of normative legislative documents that outline the role of nurses in primary health care.

Previous research and international approaches to the definition of nursing competencies.

#### Semi-structured interviews:

Eleven interviews with experts (including representatives from NHS, MOH, PHC facilities, WHO, international projects, etc.). Thirteen provider interviews (including four with nurses, four with PHC managers, and five with GPs, representing both private and public PHC facilities from Western, Eastern, Southern and Central UA).



Data were collected by the research agency Infosapiens.


#### Conclusions

#### Introduction

Ukraine was right on time in strengthening its health care system pre-COVID-19. The introduction of new payment mechanisms on a per capita basis in increasingly autonomous health care facilities has been stimulating the organizational development and service growth of primary health care (PHC) providers since 2018.

Still, family doctors seem to be overloaded, while nurses are rarely considered to be professional partners in service provision. We are currently seeing an increase in the number of countries where nurses are taking on more primary care responsibilities. The level of autonomy and accountability of nurses with extended roles depends on the context of the country in which they practice and its regulatory policies.

The aim of this study is to compare de jure and de facto arrangements in the role distribution among PHC personnel in Ukraine. Revealing the attitudes towards a stronger involvement of nurses into clinical practice is further envisaged.

#### Results

The current legal base of (family) nursing is outdated and confusing.

According to survey results, managers and doctors mostly support the idea of expanding the roles and responsibilities of nurses and believe that nurses can strengthen service provision, especially in a COVID-19 affected context.

A total of 38% of nurses disagree with the delegation of the doctors' tasks and they give less support to responsibilities changes (52%). All audiences chose absence of financial motivation as the greatest barrier for expanding the role of family nurses.

The real situation is when a nurse takes over the functions of a doctor and does it herself, but officially all the documents are signed by the doctor.

A total of 592 CATI/CAWI (computer assisted telephone/web interviews) including: **part**

"At the beginning it was very difficult. It turned out that a doctor cannot do anything without a nurse. S/He can only think but cannot do. So, the doctors were the first to oppose this. "How can I work alone? Who will do the paperwork?"

They straightened their shoulders, they felt like a specialist, as they say. Well, they like it. Because also in the eyes of the patients, they have become more professional, it seems to me.

Doctors, nurses and managers indicate that nurses can be fully responsible for taking samples (express tests, etc.), conducting diagnostics (ECGs, blood pressure, pulse oximetry), vaccination, and investigating life habits (including eating habits, level of physical activity, etc.).

Experts drew attention to the imbalance in theoretical and practical parts of nurses' training, as well as the obsolescence of the formats of their training. According to survey results, only 46% of nurses' knowledge and skills were gained during pre-graduate education.

Unfortunately, from what I see now, the level of knowledge that nurses come up with is very theoretical. There are very few practical skills. We are provided with theoretical baggage in our universities or in our specialized medical education institutions, which we often do not use at all. They need more practical skills. Because they come quite like a blank slate. And you start saying: this is your workplace, here you are doing something, here you are doing something. Have you tried an intravenous injection on a patient? He says, "I tried, but something doesn't work," or "I'm afraid".

All audiences believed in the positive effects of the re- distribution of roles between nurses and doctors. Managers believed in reducing doctors' workloads significantly more than doctors and nurses did.


The Project is financed by Swiss Agency of Development and Cooperation. Views and ideas, published here, belong to the author(s) and do not necessarily reflect views of Swiss Agency of Development and Cooperation.

**Quantitative**

**Qualitative**

**part**

**Desk research**
