1. Nursing Licence Degree Tallinn Health College Nursing School of Lisbon Authors: Andreia Machado Cláudia Pedro Margarida Lança Nádia Cardoso 1

2. Summary Cultural and Geographic Context - Portugal - Lisbon Higher School of Nursing of Lisbon (ESEL) - Pole MFR Nursing Licence Degree - Length - Structure Health and Demography Indicators - Statistical Data - Foreign Nurses in Portugal - Etary Piramid - Aging Index Portuguese Health Care Sistem - National Health System Nursing in Portugal - Ordem dos Enfermeiros - Skills of nurses in general care - Quality standards of nursing care National Health Plan 2Tallinn, January 2009

3. Cultural and Geographic Context - Portugal Portugal has been a country since 1143 Almost 11 million people (in 2004) Official Language: Portuguese (6th most spoken in the world) Official Secondary Languages: English and French Immigration Country: African Countries of Portuguese Official Language (Angola, Cape Verde, Mozambique, Guine, etc.), some east European countries (Ukraine, Russia, Moldova, etc.) 3Tallinn, January 2009

4. Landscapes 4

5. National Futebol Team 5Tallinn, January 2009

6. Cultural and Geographic Context - Lisbon Capital of Portugal About 500 000 people live in Lisbon 3 million people live in the metropolitan area of Lisbon Traditional type of music: Fado (Faith, destiny) Cosmopolitan and globalising city, which still has been able to renew and keep old costumes 6Tallinn, January 2009

7. LISBOA 7

8. 8 Nursing School in Lisbon (ESEL) Founded in 24th September 2007, it is within the polytechnic education. The four Higher Nursing Schools became one, so as to have more power to fight for nursing and nursing students rights. There are now four poles in ESEL. We belong to the Maria Fernanda Resende Pole. There will be a unique building in the future. There are 6 other schools of Nursing in the city of Lisbon, but they are private schools. 8Tallinn, January 2009

9. 9

10. Andreia Nádia Cláudia Margarida 10Tallinn, January 2009

11. Nursing Licence Degree - Length The course gives a scientific training, technical, human and cultural, of the highest quality, in the provision, research and management of general nursing care to the person throughout its cycle of life, family, community groups and, given the different levels of prevention. Students who completed the course in Nursing Licence are able to provide general nursing to the individual, family and community; and can develop their practice into three distinct sectors: public sector, private sector (Health Centers, Hospitals, Clinics, Companies, Schools, Senior Centers, among others) or on a liberal exercise. Duration: 4 years 4665 total hours 2110 hours to theoretical classes 2555 hours to practical classes 11Tallinn, January 2009

12. 1st Year: Nursing Basic Principles  Basic concepts in Nursing I and II  History and Science of Nursing I  Microbiology and Parasitology  Anthropology and Sociology I  Anatomy, Physiology and Physiological Chemistry I and II  Psychology I  Systems and Policies on Health  Ethics of nursing I  Analysis of situations of nursing I  Option I  Clinical Teaching (CT) - Development of basic concepts in nursing (162hours)  Total of ECTS – 60 (ESCT – European System for Credit Transference) Nursing Licence Degree - Structure 12Tallinn, January 2009

13. Nursing Licence Degree - Structure 2nd Year: Nursing in Adult and Older Adults  Adult Nursing  Aged People Nursing  Ethics in Nursing II  Health Education  Pathology  Pharmacology  Research in Nursing I  Anthropology and Sociology II  Psychology II  Analysis of situations of nursing II  Options II and III  Clinical nursing to adult and Older Adults (459 hours) - Rendering of care to the adult and the elderly in acute illness situation, and in chirurgical and emergency situations  Total of ECTS – 60 13Tallinn, January 2009

14. Nursing Licence Degree - Structure 3rd Year: Nursing in Psychiatric and Mental Health; Nursing in Sexual and Reproductive Health; Nursing in Childhood and Youth  Nursing Women's health  Nursing in Childhood and Youth  Nursing in Psychiatric and Mental Health  Relationship of Aid  Management in Nursing  History and Science of Nursing II  Research in Nursing II  Option IV and V  Analysis of situations of nursing II  CT V – Rendering of care to the adult and the elderly in mental and chronic situation (216 hours)  CT VI – Rendering of care during the maternal cycle (216 hours)  CT VII – Rendering of care to the children and the youth in crisis situation (216 hours) 14Tallinn, January 2009

15. Nursing Licence Degree - Structure 4th Year: Nursing in Community; Development of Thesis; Transition from student to Nurse Community Health and Family Nursing Training in the Employment Context Nursing in Intensive Care Personal Project in Clinical Nursing I and II Analysis of Situations of Nursing IV CT VIII – Rendering of care to the individual, family and group in the community (324hours) CT IX – Rendering of care in hospital/community institutions (data collection for thesis – Personal Project in Nursing) (648hours) Total of ECTS - 60 15Tallinn, January 2009

16. Health and Demography Indicators Population (2005): 10.569.600 Birth rate (2005): 10.4 birth/1000 OE, 2007 16Tallinn, January 2009 Ratio: 4.02 nurses/1000 habitants

17. Etary Piramid INE, 2008 17Tallinn, January 2009

18. Portuguese Health Care System Three Co-existing Systems National Health Service (NHS) Special Public and Private Insurances Schemes for certain professions Voluntary private Health insurance 18Tallinn, January 2009

19. National Health System  The main health care provider is the State, througt the public insitutions that constitute the NHS;  NHS is mainly financed througt taxes and provides health promotion, treatment and desease surveilance and prevention; 19Tallinn, January 2009

20. Nursing in Portugal  There are references to nurses in Portugal as early as 1120 and, as other parts of the world nursing care was provided by monks and nuns... Some historic facts about Nursing in Portugal: 20Tallinn, January 2009

21. Nursing in Portugal Present status:  In April 2007, there were 51.167 nurses registered in Ordem dos Enfermeiros,whose average age was of 39 years.  Since 1998, the initial education has been comprised of four school years and has awarded a higher education degree.  Portugal is among the 27 European Countries that sign the Bologna Declaration: This declaration sets the original objectives in order to establish, by 2010, the “European Area of Higher Education”. 21Tallinn, January 2009

22. Nursing in Portugal  Specialised training may be achieved at the post-graduation level in six areas: - Community nursing specialist; - Infant health nursing and paediatrics - Medical and surgical specialist; specialist; - Rehabilitation nursing specialist; - Maternal health nursing and midwifery specialist; - Mental health nursing and psyquiatrics specialist 22Tallinn, January 2009

23. Nursing in Portugal OE, 2007 23 Tallinn, January 2009 96% 19% 81% 4% 14%

24. Foreign Nurses in Portugal Tem most representative nationalities – OE (Dec.07) Gender distribution, OE (Dec. 07) Distribution of foreign nurses by activity sector, OE (Dec. 07)  On the 31st of December 2007 2135 foreign nurses worked in Portugal. OE, 2007 24Tallinn, January 2009

25. Nursing in Portugal OE, 2007 25Tallinn, January 2009 68% 15%

26. Ordem dos Enfermeiros (OE)  Is a public association, free and autonomous in the scope of its attributions with juridical personality, independent of the state and representative of nursing graduates who practice nursing in Portugal, in complience with the principles of their constitution and the applicable legislation. Main aim: - Promote the defence of the quality of nursing care rendered to the population; - Develop, regulate and control the practice of nursing, guaranteeing that ethical and professional deontology rules are respected 26Tallinn, January 2009

27. Ordem dos Enfermeiros (OE) - Deontology and Ethics -  The activity of Portuguese nurses must be guided by: - The responsabilitys inherent to the role played by nurses in society; - The respect for human ritghs in the relationship with clients; - Excellence in the practice of the profession in general and the relationship with other professionals in particular.  The nurses Deontological Code is included in the Constitution of the OE and states that nursing interventions have to guarantee the defense of the fredon and dignity of the human being and of the nurse. 27Tallinn, January 2009

28. Ordem dos Enfermeiros (OE) Some documents that regulate nursing practice: - Skills of nursing in general care; - Quality Standards of Nursing Care. Note: In 2004 OE became the representative of Portuguese nursing at the ICN (International Council of Nursing). 28Tallinn, January 2009

29. Article 8 Exercise training of nurses 1 - Nurses should adopt a responsible and ethical conduct and act with respect for the rights and interests of the citizens. 2 - The exercise of professional nurses have some fundamental objectives: health promotion, disease prevention, treatment, rehabilitation and social reintegration. 3 - Nurses have a complementary role of functional relation to other health professionals, but given the same level of dignity and autonomy of professional practice. Skills of nurses in general care 29Tallinn, January 2009

30. Skills of nurses in general care Article 9 Interventions of nurses 1 – Are autonomous and interdependent. 2 – Is considered autonomous actions when they are taken by nurses under its sole and exclusive responsibility and initiative, according to their skills, whether in the provision of care, management, education, training or advice, with contributions in research on nursing. 3 - Is considered interdependent actions when they are taken by nurses according to their skills, together with other experts, to achieve a common goal, resulting from action plans set by multidisciplinary teams in which they are integrated and regulations or guidelines previously formalized. 30 Tallinn, January 2009

31. Skills of nurses in general care 4 – Nurses according to their qualifications: a)Organize, coordinate, implement, evaluate and supervise the assistance of nursing in three levels of prevention; b)Decide on techniques and methods to be used for the provision of nursing care, and enhance existing resources, creating the trust and active participation of individual, family, community groups; c)Use their own techniques of the nursing profession for the maintenance and restoration of vital functions. 31Tallinn, January 2009

32. Skills of nurses in general care d)Participate in the coordination and promotion of activities inherent in the situation of health/disease, whether the client is followed in hospital, clinic or home; e)Carry out the administration of therapy prescribed, detecting their effects and acting accordingly, should, in an emergency situation, act in accordance with the qualifications and knowledge they hold, with the aim to maintain or restoration of vital functions; f)Participate in the drafting and implementation of protocols for standards and criteria for administration of medicines and treatments; g)Promote the education of the client on the administration and use of drugs or treatments. 5- Nurses design, promote and carry on research aimed to the advancement of nursing in particular and health in general. 32Tallinn, January 2009

33. 6 - Nurses help in carrying out their activity in the area of management, research; teaching, training and advice for the improvement and development of the provision of nursing care, including: a) Organizing, coordinating, executing, monitoring and evaluating the training of nurses b) Evaluating and providing human resources needed to provide the nursing care, setting standards and criteria for action and to evaluate the performance of nurses; c) Proposing protocols and information systems for adequate provision of care; d) Giving technical advice on facilities, materials and equipment used in providing nursing care; Skills of nurses in general care 33Tallinn, January 2009

34. e ) Collaborating in the development of protocols between health institutions and schools, drivers and facilitators of the learning of the trainees; f) Participating in the evaluation of needs of the population and resources in the field of nursing and proposing the general policy for professional practice, teaching and training in nursing; g) Promoting and participating in the studies needed to restructure, upgrade and enhancement of the nursing profession. Article 10 Delegation of tasks  The nurses may delegate tasks to staff witch are functionally dependent of them, when this have the necessary preparations for run then, combining always the nature of the tasks with the degree of dependence of the patient in nursing care. Skills of nurses in general care 34Tallinn, January 2009

35. Quality Standards of Nursing Care Conceptual framework The Health The Person The Environment The Nursing Care Good care means different things to different people!! 35Tallinn, January 2009

36. In the permanent search for excellence in professional practice, the nurse: Pursues the highest levels of clients’ satisfaction; Helps clients to achieve the maximum potential for health - Health Promotion; Ensure the prevention of complications for clients’ health; Maximizes the well being and the self-care; With the client develops processes to adapt effectively to health problems - The functional upgrading; Contribute for maximum efficiency in the organization of nursing care. Quality Standards of Nursing Care DESCRIPTIVE SET OUT Aim: clarify the nature and gather the various aspects of the social mandate of professional nursing 36Tallinn, January 2009

37. National Health Plan - Portugal - Main Strategies Priority to poor people Programmatic approaches Approach base in settings (School, work places and prisons) Strategies to acquire health to everyone Central approach in family and on the life cycle Integrated Approach to the disease (leave with more functionality, client empowerment, self-control and self-vigilance) 37Tallinn, January 2009

38. Strategies to change management Central changes in citizens (more chose options, citizen voice) Accessibility and rational of medicines Reorientation of health system Empowerment the health system to innovation  Strategies to guarantee the plan execution National Health Plan - Portugal - – Development a communication plan – Development an information system – Focuses in priority areas – Development of national programs – Mobilise the principal actors – Mobilise the recourses – Professional training – Investigation and development – Following and assessment 38 Tallinn, January 2009

39. Erasmus Experience - What it means for us! - 39Tallinn, January 2009

40. Bibliography INE- Estimativas de população residente, Portugal, Nuts II, Nuts III e Municípios 2005, in www.ine.pt, consultado a 15 January 2009 www.ine.pt www.esel.ptwww.esel.pt – Nursing school in Lisbon official site http://www.ordemenfermeiros.pt/index.php?page=463http://www.ordemenfermeiros.pt/index.php?page=463 - Nursing in Portugal http://www.ordemenfermeiros.pt/index.php?page=470http://www.ordemenfermeiros.pt/index.php?page=470 - Foreign Nurses in Portugal http://www.ordemenfermeiros.pt/index.php?page=8#article60http://www.ordemenfermeiros.pt/index.php?page=8#article60 – Skills of Nursing in General Care http://www.ordemenfermeiros.pt/index.php?page=8#article62http://www.ordemenfermeiros.pt/index.php?page=8#article62 – Quality Standards of Nursing Care 40Tallinn, January 2009

41. Questions, Doubts? 41 Tallinn, January 2009