Health and Demography Indicators

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					            Nursing Licence Degree
Tallinn Health College   Nursing School of Lisbon

                                                    Andreia Machado
                                                     Cláudia Pedro
                                                    Margarida Lança
                                                     Nádia Cardoso
   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

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Cultural and Geographic Context - Portugal
   Portugal has been a country since

   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.)

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National Futebol Team

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              Cultural and Geographic Context -
   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,

    Cosmopolitan and globalising city, which
    still has been able to renew and keep old

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 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.

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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
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Nursing Licence Degree - Structure
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)

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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

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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)
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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)

•   Total of ECTS - 60

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 Health and Demography Indicators
Population (2005): 10.569.600
Birth rate (2005): 10.4 birth/1000           Ratio: 4.02 nurses/1000 habitants

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                                                                                 OE, 2007
Etary Piramid

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                                        INE, 2008
Portuguese Health Care System

                     Three Co-existing

                     Special Public and
   National Health    Private Insurances      Voluntary private
   Service (NHS)     Schemes for certain      Health insurance

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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

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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:

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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
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Nursing in Portugal
   Specialised training may be achieved at the post-graduation level in six

- Community nursing specialist;              - Infant health nursing and paediatrics
- Medical and surgical specialist;             specialist;
- Rehabilitation nursing specialist;        - Maternal health nursing and midwifery
                                            - Mental health nursing and psyquiatrics

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       Nursing in Portugal



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                                                 OE, 2007
Foreign Nurses in Portugal
  On the 31st of December 2007 2135 foreign nurses worked in Portugal.

                                                                                Gender distribution, OE (Dec. 07)

 Tem most representative nationalities – OE (Dec.07)

                                                                         Distribution of foreign nurses by activity sector, OE (Dec. 07)
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                                                                                                                               OE, 2007
      Nursing in Portugal



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                                      OE, 2007
    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

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    Ordem dos Enfermeiros (OE)
    - Deontology and Ethics -
     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.

   The activity of Portuguese nurses must be guided by:

-   The responsabilitys inherent to the role played by nurses in

-   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.

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Ordem dos Enfermeiros (OE)

                                  Some documents that regulate
                                    nursing practice:

                                  -   Skills of nursing in general care;

                                  -   Quality Standards of Nursing

Note: In 2004 OE became the representative of Portuguese nursing at the ICN
(International Council of Nursing). Tallinn, January 2009                     28
Skills of nurses in general care
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

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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.
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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.

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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

5- Nurses design, promote and carry on research aimed to the advancement of
   nursing in particular and health in general.
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Skills of nurses in general care
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;
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Skills of nurses in general care
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.
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Quality Standards of Nursing Care
                                      Conceptual framework

                   The Health
                  The Person
                The Environment
                The Nursing Care

   Good care means different things to different
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        Quality Standards of Nursing Care
DESCRIPTIVE SET OUT                               In the permanent search for excellence in
                                                         professional practice, the nurse:
Aim: clarify the nature and gather the
various aspects of the social mandate       •    Pursues the highest levels of clients’ satisfaction;
of professional nursing
                                            •    Helps clients to achieve the maximum potential for
                                                 health - Health Promotion;

                                            •    Ensure the prevention of complications for clients’

                                            •    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.

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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)

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National Health Plan                                               - Portugal -
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

     – Development a communication                           – Mobilise the recourses
     plan                                                    – Professional training
     – Development an information                            – Investigation and
     system                                                  development
     – Focuses in priority areas                             – Following and assessment
     – Development of national
     – Mobilise the principal actors                                                      38
                                           Tallinn, January 2009
 Erasmus Experience
- What it means for us! -

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INE- Estimativas de população residente, Portugal, Nuts II, Nuts III e Municípios 2005, in, consultado a 15 January 2009 – Nursing school in Lisbon official site - Nursing in Portugal - Foreign Nurses in Portugal – Skills of Nursing in
    General Care – Quality Standards of
    Nursing Care

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Questions, Doubts?

       Tallinn, January 2009

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