La crisis del sector bancario

Mi-Sook Song

Ajou University, School of Medicine, Division of Nursing Science, Soul, Republic of Korea

1. Changing role of nurses and diversification of medical practice

Trend in diversification of medical practice

When I visited Turkey last November I had an opportunity to visit the so-called the world's first hospital. It was the Asklepion Mental Hospital established when Hippocrates was active. I was much impressed by its long history but its service might have been limited to mental patient care. In our times, however, medical and health care services have been diversified into the various spectrum such as ambulatory care, admission care, rehabilitative care, emergency care, hospice care, visiting care, geriatric care, crisis intervention, health promotion care, and so on.

Along this trend, medical and health care institutions have also been diversified into the various type of specified facilities such as women's hospital, geriatric hospital, emergency hospital, psychiatric hospital, cancer center, Hospice, nursing home, crisis intervention center, fitness center, and so on. This diversification and specialization trend of health care institutions, in turn, has triggered fundamental changes in the role of nurses and nursing intervention practice in those institutions.

Factors influencing diversifications of medical practice

Now, we need to examine the important factors that promoted such diversifications of medical practice. I think, the most important factor is the shift in the focus of medical and health care from disease treatment to health promotion and disease prevention. In fact, I am reminded of the Ottawa Charter of Health Promotion adopted at the first World Congress of Health Promotion in Canada in 1986. They resolved that to enhance the quality of life and contain the medical care cost medical professions policy makers must shift our emphasis in health care from disease treatment to health promotion and disease prevention.

This calls for the similar change in nurse's role, but it is unfortunate to report to you that such a change is not yet clearly reflected in nursing and medical school curriculum in Korea. Such a change is more obvious in schools of public health of the United States. Medical and nursing schools in US still couldn't make any real change. As you know, in the middle of 1970, Breslow has already published the results of his study conducted in Alameda country, California, pointing to the need for the concerted efforts among individuals, communities, and government to prevent the various chronic adult diseases by practicing Seven habits: non- smoking, non-alcohol and drugs, exercise, fitness, sufficient sleeping, regular breakfast, non- snack.

As the study results became available, all the medical schools, schools of public health and schools of nursing modified their curriculum. I benefited from it. I was able to learn this new concept and practice of health promotion when I studied at Yale the School of Public Health in 1986.

The second factor is the fact of diversified demand and specialization of medical and health care. Clients or Consumers used to seek for the help of medical professions after having a pain and symptom of disease. But, now many of them, even before having the confirmation of any disease, seek for the preventive health information and services in the

various fields such as in physical examination and monitoring, education and training for health habit in nutrition and exercise, customized health care, hospice care for convalescent patients (especially of chronic disease patient), in health care of the elderly persons, cosmetic role of dermatologist and plastic surgeons.

This trend of multiplicity and diversification of medical and health services became possible due to the people's desire to achieve their well being, continuous invention of new instruments and techniques in modern medicine, and the worldwide networking of Information Technologies. In the field of clinical nursing, to meet such demands, the nursing specialty and its respective role have also been differentiated in many ways such as clinical specialist, case manager, nurse practitioner, and physician assistant. To maintain such specialty, role and status, many nurses in Korea have been making many investments in receiving more specialized training and education in their respective fields. Recently, starting from this year, a small number of universities developed the advanced nursing education programs and increased a number of nursing educators to foster such programs.

The third factor is related to seeking the value of efficiency and productivity in medical care. In spite of the social goal that every one, regardless of their social and economic status, has right to receive an equal level of medical and health care, those countries under the market oriented economy provide a wide range of choices in purchasing medical care at different level depending on individuals' economic status.

Perhaps, this market oriented medical service may hardly be understood in those countries like Czech Republic where socialism has been practiced for a long time. Therefore, in order to produce much benefit from medical care, medical institutions have started to adopt the special management skills practiced by the various business enterprises. This effort called for more management oriented medical professionals (physicians and or nurses) who have their training and education in management.

Changing role of nurses

In 1980's, the US health care system started providing a variety of medical services such as ambulatory surgery, walk-in-clinic, home visiting care center, multi-hospital system, and various group practices. Recently, the Korean health care system witnessed a growing number of nursing homes for the elderly care.

As a result, the demand for professional nurses with management skills is emerging. In the developed countries, nurses are playing a variety of roles. Some examples are; hospital administrator, infectious disease control officer, health policy makers (e.g. legislators, Minister of Health and Welfare, Bureau Chiefs of central and local governments), and administrators and managers of various health programs.

Please allow me to quote my experience as an example, instead of working as a clinical nurse, I had received the MPH training and education in hospital administration and Health policy at Yale school of public health. After my return to Korea, I continued to receive the specific training and education in management equivalent to the MBA curriculum. Also, I participated twice in the construction planning of large hospitals with over 1,000 beds Hospital and contributed to the management system design of these hospitals.

In addition, I served as a management consultant for FSO motor company of Poland in designing the delivery system of medical services for their employees to enhance their productivity. In Korea, I do consult those health policy makers of large and middle-sized cities. In a number of cities, I had directly involved in managing the Primary Health Care Center entrusted by the provincial government. In this process, I was not only providing services but also undertaking evaluation studies of various service programs for Hypertension, Obesity, Cancer, women and elderly. Study results have been reported in domestic and

For other cases, some of my professors who taught me at my Nursing School are working at our National Assembly as legislators and one of them is now active as a Minister of Health and Welfare in Korean government. One of my seniors of my Nursing school is managing a nursing home for elderly patients with chronic diseases. Another is now working as a reporter for a broadcasting station. These nursing colleagues' social status and income is as high as some physicians and lawyers, they said.

A year ago, at the Severance Hospital, one of the leading hospitals in Korea, a nurse was appointed as a vice president. It was moral boosting news to many nurses aspiring a higher position in management. This news has trashed our common practice to appoint physician as a top manager of the hospital in Korea.

2. World trend of nursing education

Now, we are living in a global community. So, we, all citizens living either in Czech or in Korea, are expected to follow the leading standards of the world, whether you like or not. Especially in the field of economy, we are forced to observe this rule, as we understand. In nursing education, we must pay attention to the trend of nursing education in the U.S. and Great Britons as their leading and influential role impinges upon us. It is especially true for Czech as, which is about to join EU as its member. In Korea as well as other Asian countries, many leaders in nursing are now playing an important role to change in their nurses' role after studying in US and/or England.

While it may be useful to review the history of nursing education, it may be more prudent to focus on the current and future trend of nursing education. Nursing education in the 20th century has focused on the development of theoretical system of nursing to establish the discipline of nursing as a part of medical science. Likewise, nursing curriculum has emphasized the development of nursing theory. (Florence Nightingale, 1859; Hildegard Peplau, 1952; Virginia Henderson, 1966; Dorothea Orem, 1980; Imorgen King, 1981; Martha E. Rogers, 1984).

Although nursing had actually started as an assisting role for physician's treatment services, there should be a continued effort to establish its independent and unique role by developing new nursing intervention techniques, applying them to the clients, and evaluating their effectiveness. Therefore, there is a strong demand to include research methods in the curriculum of nursing education at the university level. Most doctoral nursing programs require experimental or quasi-experimental research instead of descriptive research based on a survey.

While most of nurses are currently working as clinical nurses, there are a need for nurses to cultivate management skills and specialty expertise as health services increasingly diversified. The subject of management and/or administration is not yet included in the curriculum of nursing school or university but included in the curriculum of School of Public Health or School of business management.

In the United States, most of graduate nursing school programs includes speciality curriculum for anesthetics, cancer care, elderly care, public health nursing, industrial health, cardio-vascular control, hemo-dialysis, neurosurgery, nursing management, home care and so on. In Korea, the nursing speciality curriculum started in 2004, but there are still the arguments for and against within the nursing profession. The reason is that there is no specific social status and treatment established for them and also it is not so easy to estimate the cost and benefit of such programs. Another reason is that most nurses are not yet prepared to accept another category of nurses above the registered nurses in Korea.

3. Suggestions for setting a vision and direction of nursing education in Czech

So far, I intentionally compared the US nursing education as a leading country in the world and the Korean nursing education as an example of developing country making efforts to enter into the developed country. In doing so, I am wondering what the Czech nurses are thinking on this matter.

As far as I can see, Czech scholars in nursing need to play a leading role to meet changing environment of worldwide trend of medical and health services with accurate knowledge and information. In most countries, physicians usually take leadership in designing health and medical policies and in allocating resources, while nurses always face the difficulties in exercising their autonomy. The most eminent reason that physicians and some consumer groups usually point out is the lack or shortage of competent nurses. Therefore, Czech scholars in nursing must make considerable efforts in enhancing the quality of nurses and in turn to inform the public the improved quality of nursing care. In doing so, you must avoid organizing an interest group to protect your profession but prepare to inform the public that nurses are well equipped to manage, protect, and advocate people' s healthy life. I am aiming at participating in at least one multi-disciplinary international conference (not limited to nursing) to report my study results and obtain feedback. It is also important to demonstrate the role of nurses by actively participating in decision-making process of health policies as a consultant to the government and enterprises.

I am now involved in a committee to decide the level of insurance reimbursement, in which I am advocating a proper and equitable reimbursement for nursing services. My exposure to DRG (Diagnosis Related Group) reimbursement system during my study in U.S. helped me serve in that committee. Committee members recognized and appreciated my expertise on the subject. Starting from this year, I passed on the committee membership my junior colleague, demonstrating the high quality of nursing profession. During those days when I was studying nursing in Korea (almost twenty years ago), there was no curriculum to enable nurses to perform such role in health insurance. Therefore, after marriage, I challenged myself to study in the U.S. alone and I am now proud of myself in performing my role of specialized nurse in health insurance to meet the changing needs of my country. So, I must confess how fortunate I am to have such opportunity to serve my country as a specialized nurse. Based on my humble experience, I dare to suggest to Czech scholars in nursing that you should make continued efforts to train and educate more qualified nurses. So that they are able to exchange and communicate with EU countries, enjoying an equal right and privilege as qualified and specialized nurses. I also cautiously challenge you to overcome quickly the old image of nurses that prevailed under socialist system and surely build up responsible nursing profession which fits into the changing environment, keeping pace with nurses in other countries.

Our experience in Korea shows that accepting a new reality is painful. Creating a new image is not possible without overcoming inner conflicts and external pressure. While you may have a little pain when you try to accept expected and anticipated changes, you may experience much larger pain when you encounter unexpected changes. In this connection, I firmly believe that your Ostrava University can lead your nursing profession to accommodate the needed changes. Today' symposium would make the change less painful.

Mi-Sook Song, PhD. RN. MPH Ajou University School of Medicine Division of Nursing Science Soul, Republic of Korea

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