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Nursing in Europe. a Resource for Better Health O He,, Os/ \'e>, 15°'INIZO WHO Regional Publications, European Series, No. 74 EUROPE The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this Organization, which was created in 1948, the health professions of over 180 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world of a level of health that will permit them to lead a socially and economically productive life. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region embraces some 850 million people living in an area stretching from Greenland in the north and the Mediterranean in the south to the Pacific shores of Russia. The European programme of WHO therefore concentrates both on the problems associated with industrial and post -industrial society and on those faced by the emerging democracies of central and eastern Europe and the former Soviet Union. In its strategy for attaining the goal of health for all the Regional Office is arranging its activities in three main areas: lifestyles conducive to health, a healthy environment, and appropriate services for prevention, treatment and care. The European Region is characterized by the large number of languages spoken by its peoples, and the resulting difficulties in disseminating infor- mation to all who may need it. Applications for rights of translation of Regional Office books are therefore most welcome. Nursing in Europe A resource for better health WHO Library Cataloguing in Publication Data Salvage, Jane Nursing in Europe : a resource for better health / edited by Jane Sal- vage and Serge Heijnen (WHO regional publications. European series ; No. 74) 1.Nursing 2.M idwifery 3.Europe1.Heijnen, Serge II.Title Ill.Series ISBN 92 890 1338 9 (NLM Classification: WY 16) ISSN 0378 -2255 Text editing: Mary Stewart Burgher Cover design: Sven Lund World Health Organization Regional Office for EuropeV Copenhagen Nursing in Europe A resource for better health Edited by Jane Salvage and Serge Heijnen WHO Regional Publications, European Series, No. 74 ISBN 92 890 1338 9 ISSN 0378 -2255 The Regional Office for Europe of the World Health Organization wel- comes requests for permission to reproduce or translate its publications, in part or in full. Applications and enquiries should be addressed to the Publications unit, WHO Regional Office for Europe, Scherfigsvej 8, DK -2100 Copenhagen 0, Denmark, which will be glad to provide the latest information on any changes made to the text, plans for new edi- tions, and reprints and translations already available. © World Health Organization 1997 Publications of the World Health Organization enjoy copyright protec- tion in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization con- cerning the legal status of any country, territory, city or area or of its au- thorities, or concerning the delimitation of its frontiers or boundaries. The names of countries or areas used in this publication are those that obtained at the time the original language edition of the book was pre- pared. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The views expressed in this publication are those of the contributors and do not necessarily represent the decisions or the stated policy of the World Health Organization. PRINTED IN DENMARK Contents Page Acknowledgements ix Contributors x Abbreviations xii Foreword xiii Introduction - Jane Salvage 1 The need for good information 2 Nursing, health for all and health care reform 3 Visions, policies and actions 8 Shaping the future 10 A note on terminology 10 Conclusion 11 References 11 PART I. NURSING IN EUROPE: THE CURRENT SITUATION 1 Introduction - Jane Salvage & Serge Heijnen 15 Objectives of the study 17 A word of warning 19 References 19 2Nursing and midwifery in Europe - Jane Salvage & Serge Heijnen 21 Policy 23 Leadership 25 Regulatory frameworks 39 The role of the nurse 50 v Specialized roles: midwifery, community nursing and mental health nursing 55 Human resources 67 Terms and conditions of work 81 Education 91 Research 110 Quality assurance 117 Conclusion 120 References 121 PART II. STRATEGIES FOR ACTION 3Nursing up to and beyond the year 2000 - Jane Robinson & Ruth Elkan 127 Inequalities in health in Europe 128 What nurses and midwives can do 131 Challenges to nursing in pursuing a health for all approach . 137 References 142 4National action plans for nursing and midwifery - Felicity Leenders & Jane Salvage 145 Why make a national action plan for nursing? 146 What is a national action plan for nursing? 150 Why does a country need a national action plan for nursing? 151 How can nurses develop a national action plan? 153 What goes into a national action plan? 161 Progress so far: some notes from countries 162 Conclusion 165 References 165 5The role of nurses and midwives in government - Colin Ralph, Jane Salvage & Ruth Ashton 167 The current situation 168 Existing policy statements 171 The chief nurse 173 Contribution of midwifery to policy -making and action at national level 182 Conclusion 189 References 189 6"It ain't what you do; it's the way that you do it" - Adèle Beerling 191 Introduction 192 vi LEMON project 192 Support for change 192 Management approaches 194 Motivation and its relation to working methods 197 Networks and their role 202 Characteristics of effective multicultural cooperation 204 Conclusion 205 References 206 PART III. WORK IN PROGRESS 7The role of nursing in primary health care - Sally Campbell 209 The strategy of PHC 211 Nursing in PHC 219 Examples of innovative practice 223 The way forward 229 Conclusion 234 References 236 8Measuring nursing - Gunnar Nielsen 241 Measuring nursing and developments in nursing 241 Measurement in theory 242 Measurement in practice 244 The next step 253 References 254 Annex 1.Declaration and Recommendations of the First WHO Meeting of Government Chief Nurses of the Newly Independent States, Almaty, Kazakstan, 30 August -1 September 1993 257 Annex 2.Statement and Recommendations of the Second WHO Meeting of Government Chief Nurses of the Newly Independent States, Bishkek, Kyrgyzstan, 24 -26 August 1994 261 Annex 3.Statement and Recommendations of the Fourth WHO Meeting of European Government Chief Nurses and WHO Collaborating Centres for Nursing and Midwifery, Glasgow, United Kingdom, 1994... 264 Annex 4.Statement from the Third WHO Meeting of Government Chief Nurses of the Newly Independent States, Stockholm, Sweden, 17 -21 June 1995 268 vii Annex 5.Participating in international meetings 271 Annex 6.Running small group meetings 273 Annex 7.Fund -raising: a simple guide 276 viii Acknowledgements This book could not have been published without the contribution of many nurses, midwives and other health professionals throughout the WHO European Region who offered their knowledge, opinions, time and writing skills to help us understand the sociopolitical context and professional environment in which they live, work and try to fulfil their mission. Special thanks are due not only to the contributors but also to the following people, who reviewed sections of the text: Ruth Ashton, mid- wifery consultant, London, United Kingdom; Gulnar Asimova, WHO collaborating centre for primary health care and nursing, Almaty, Kazakstan; Ainna Fawcett -Henesy, WHO Regional Office for Europe; Randi Mortensen, WHO collaborating centre for nursing, Copenhagen, Denmark; Bakhyt Munaidarova, former Chief Nurse, Ministry of Health, Kazakstan; Galina Perfilyeva, Head, WHO collaborating centre for nursing, Moscow, Russian Federation; Jane Robinson, Professor and Head, Department of Nursing and Midwifery Studies, University of Nottingham, United Kingdom; Tamara Sakhtanova, Chief Nurse, Min- istry of Health, Kyrgyzstan; Klara Sövényi, Chief Nursing Officer, Ministry of Welfare, Hungary; and Saadet Ulker, Chief Nursing Officer, Ministry of Health, Turkey. We are also indebted to those who helped in the production of the book: Tina Andersen and Yelena Egorenkova, formerly programme as- sistants, Nursing and Midwifery unit, WHO Regional Office for Eu- rope; and Mary Stewart Burgher, Publications unit, WHO Regional Office for Europe, who offered invaluable editorial assistance. ix Contributors Ruth Ashton Formerly Director, WHO collaborating centre for midwifery, Royal College of Midwives, London, United Kingdom Adèle Beerling Acting Technical Officer for Nursing, WHO Regional Office for Europe Sally Campbell Nurse practitioner, London, United Kingdom Ruth Elkan Department of Nursing and Midwifery Studies, University of Not- tingham, United Kingdom Serge Heijnen Consultant, Health Care Policy and Administration, WHO Region- al Office for Europe Rob Keukens Department of Nursing, State High School of Nijmegen, Nether- lands Felicity Leenders Formerly Nursing Officer, Department
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