Applied bachelor nursing graduates' perceptions of the image of nursing profession in kazakhstan based on a literature review

SUMMARY

Kazakhstan is considered to be one of the countries where nursing and education are rapidly developing nowadays. Moreover, there are graduates of applied baccalaureate in nursing who have the status of a nurse with extended practice. The main purpose of the given research is to describe medical college applied bachelor nursing graduates' perception of the image of the nursing profession now and in the future in Kazakhstan in order to support the development of the nursing profession in Kazakhstan.

In this review, international articles that described the graduates' perception of the image of the nursing profession and public image as well as values and practice were studied. World practice shows that graduates who have good understanding of their profession will respect and appreciate it, and the image of the nurse can also be improved in society.

Based on the literature review, it was shown that in many countries, nursing students have a positive understanding of their profession. It was concluded that nurses will play a new role and the opinion of them will change for the better as the applied baccalaureate will be implemented in Kazakhstan. The nursing profession will receive the status of an independent profession, which will be equal at the international level.

Introduction. As world practice shows, great attention is paid to the prevention of diseases. The strengthening of public health, the availability and costeffectiveness of medical care, efficient use of resources in health care, and the rational use of nursing personnel leads to a significant improvement in quality of nursing care. Nursing practice is characterized by diversity of activities for family and society as well. [1]

In Kazakhstan, nursing is developing intensively at the moment. If previously a nurse was considered only a physician's assistant and provided care as prescribed by a doctor, now nursing practice is based on a scientific approach and utilizes evidencebased practices. The nurse is a doctor's partner who can make decisions, plan, and provide evidence-based nursing care. [2] Changes that have occurred in health care in recent years have led to the fact that nurses should receive a decent education as in developed countries.

On September 1, 2014, it was ordered to introduce an applied bachelor program in nursing corresponding to the international requirements for registered nurses, in six higher medical colleges in Kazakhstan on an experimental basis for nurses to conduct independent receptions. [3] This was later in 2016 also formalized by state order. The training of applied bachelors of nursing plays a large role in Kazakhstan. This is a new generation of nurses. [4] According to the Order of the Minister of Health of the Republic of Kazakhstan dated December 19, 2018 No. 43,

Applied nurses will conduct an individual reception within their competence with patients who suffer from acute respiratory viral infections and the most common non-communicable diseases. They have competency to carry out the patronage of children, pregnant women, and women after childbirth, dispensary patients and the elderly. In addition to that nurses with extended practice carry out nursing examinations, determine nursing diagnosis, plan nursing, and educate patients and his/her family on general nursing and disease management activities. They will also work as a senior nurse and head nurse. Although in 2025 from January 1, head nurses must have a master's degree [5].

The perception of the nursing profession from the point of view of graduates and nursing values, public image and practice.

The word “nursing” itself is more than a simple definition. This is the framework of communication and the language of a particular group that reflects who the nurses are. This word also carries perception [6]. Perception is the understanding and awareness of information that interacts with the past experience of culture and the interpretation of the perceived. In addition, perception is changed during nursing education. [6]

Students' perception about the nursing profession varies. American nursing students perceive that nursing is a physically difficult profession and is not respected by patients. [7] In other studies, it was reported that students perceive nursing as a decent and respectful profession, which should serve humanity and receive the blessing of the people. In this profession, it is also possible to develop the opportunity for personal growth. [8]

In addition, the culture that nurses themselves create in the workplace is very important for the image. New graduates should recognize that the role of nurses in the future is very important. It is expected of the new graduates that they will improve the role of nurses. Moreover, it depends on the nurses how they will morally influence their profession. One thing that nurses need to say is: «if we recognize our profession and know the values of what we do, we will be people who are highly required to care in society.» This will help create a more gratified and confident profession. [9]

To improve the opinion of the public image of nurses, or any profession, it requires motivation. In addition, the historical opinion of nurses as assistants to a doctor did not allow the profession to openly express the image. When the medical profession and the nursing profession were mentioned together, the image of nurses remained in the shadows. Improving the public image, preserving the knowledge of experienced nurses, and recruiting new employees has lifted professional organizations. It turned out that nurses do pay attention to what the public is saying of them. In order to improve nurses' image, a lot depends on their careers, motivation, education, the education system change, multi-professional education, and promotion. In the opinion of nurses, they should be leaders in the eyes of the public, intellectually and professionally, in order to improve the image of nurses and nursing practice. [10]

The professional image of nurses and midwives continue to be a problem for them as they are faced with problems associated with building an image. At this stage they must take responsibility and have the courage to enhance their professional image. Previously, the image was presented as irresponsible and merely as doctors' assistants and so on, but today, nurses and midwives are becoming an independent profession. By obtaining licensing or registration in order to be allowed to practice, nurses and midwives provide high standards of services to the public. Moreover, the profession requires professionalism with the purpose to provide society with highly trusted medical services [11].

Although in research that was conducted in Bahrain showed that nursing is a highly respected profession and patient care has a positive image. In addition, concerning students' perception of nursing as a career choice, the results showed that they were highly motivated to study care. The result of the study concluded that the enrolled nursing students in Bahrain have a positive understanding of the nursing profession in their future careers [12].

Also according to WHOs report on health care, 50% of the workforce is nurses, and such a problem as a shortage of nurses exists throughout the world. Already by 2030, around 9 million nurses and midwives would be needed. And of course everyone knows that nurses play an important role in preventing disease and helping with primary and social assistance [13].

The international views of applied baccalaureate nursing graduates on the image of nursing as a profession today.

According to a study in Qatar, bachelor student researchers, supporting the nurse's image, concluded that nurses could strengthen the link between education, research, and practice. Nurses work with health technologies to ensure the provision of coordinated patient services and their families. In addition, the image that only doctors have knowledge and professional skills is a myth. Nurses play a vital role in global advocacy efforts to address health inequalities around the world. The profession of nurses influences all these experiments and observations. This added to the importance of solid education based on science, ethics, research, pathophysiology, and caring for a person. Nurses acquire valuable organizational, leadership, communication, and problem-solving skills. The profile of a nurse entails leadership, knowledge, compassion, technical skills, cultural competence, based on actual justification of the data. [14]

Also, there was a study conducted in Turkey about the way students' perceptions changed during the period of the undergraduate studies. The results showed that students' positive perception continues throughout their education and they positively perceive the professional qualities of the nursing profession. The analysis showed that the opinion of graduates on professional qualities has increased in the last year of study compared to the initial perception of the first years of study. In addition, changes in the perception of students will help to revise the training plan for other candidates to enter the nursing profession in the future. [15]

Similar research about the perception of graduates has been conducted a lot, but the perception of the nursing profession in the future was first studied using Indian nursingstudents. It was also reported that students' perceptions of the nursing profession showed that they mostly perceive nursing as an opportunity to serve humanity; some noted that they perceive the nursing profession as a caring profession. [16]

In Zambia, a study was conducted to find out the image of the nursing profession students to further strengthen the positive image of nursing and retention of the profession at a high level. Students' perceptions helped to evaluate the nursing activity to identify the strengths and weaknesses of the educational program; in addition, it affects the future career of nurses. The results showed that 70% of students have a positive perception of their profession and 30% have a negative perception of the image of nursing. There are many dangerous diseases such as Ebola, HIV / AIDS, etc. in the world we live now, and nurses have saved many lives. Throughout the world, mainly in developing countries, there is a shortage of nurses and questions about nurses related to their image. Moreover, with the help of studies of students' perception, evident reasons were found for why enrollees do not choose the nursing profession. Furthermore, all students do not proceed to work in this field even if they choose nursing and graduate from nursing school. This problem is not only the problem of one country but all countries. [17]

The lack of nurses is a common problem throughout the world and this international shortage will continue until radical measures are taken. The perception of nursing students can both facilitate and prevent the possibility of becoming a professional nurse, making it important that institutions provide a well- informed, cutting-edge experience and a positive nursing recruitment strategy. The educators may be more aware of the potential differences in student ideals, expectations, and the reality of nursing practice if they understand their perception before, during, and after the educational program. Further research is needed to determine whether the perceptions occupied by this first cohort of Bahrain nursing students represent other general care students in this field. To improve nursing retention, there is a need to raise awareness and understanding of health policies, members of the profession barriers, and how these barriers affect both male and female student nurses in the profession. Nursing educators should strive to work more closely with universities to portray positive perceptions for students who are potential candidates for nursing education. [18]

In addition, most students misunderstand the direction of the nursing profession and this leads to wrong decisions that have an impact on their careers. The status of nurses has an important role to ensure that there is no shortage of personnel in health care. The opinion of high school students plays a very important role since they constitute a part of our society. This will help the successful recruitment of nurses in the future and can be one of the beneficial factors that will prevent the lack of nurses in health care. [19]

The state of nursing with the introduction of applied baccalaureate in Kazakhstan

The Ministry of Health of the Republic of Kazakhstan strives to transfer the system of nursing to the European model. As it was said earlier, a pilot project was started in 2014 with the Universities of Applied Sciences of Finland. The first graduates of applied baccalaureate in nursing completed their studies in 2018. In future, the graduates will increase in large amounts as the number of educational institutions providing this education will increase every year. The goal is to develop a new generation of nurses to conduct independent receptions and solve the problems that were previously solved by doctors with knowledge of specific chronic diseases. [20]

In comparison to traditional theory - based education with only eight weeks of practice, the novel applied bachelor program in nursing is focused on “practice-oriented learning”. The curriculum consists of 50% of clinical practice and from the theoretical studies 20% is independent work. Many nursing subjects are held in clinical bases and simulation centers. [21] Clinical practice plays a large role in the development of a professional attitude and helps graduate students achieve clinical competence. [20]

Interactive and active teaching methods develop critical thinking and the ability to work independently, and in addition, improve communication skills. Furthermore, the new approach and education programme motivates to continue learning. [21]

In addition, world practice shows that applied bachelor's in nursing will have high theoretical and deep practical knowledge and will be ready for practical work at the end. For Kazakhstan, there is a great need for nurses who will care for patients on their own and will strive for a high status of nurses. Sometimes nurses have problems such as disrespect from patients and colleagues in Kazakhstan. Applied nurses will help solve these problems and improve the state of public health. Furthermore, applied baccalaureates are important for the employer since they will help solve the shortage of personnel and prospects in the organization. A graduate of applied bachelor's in nursing will have all the competencies required in modern health care and may continue to a master's degree and do research in the future, so they have the opportunity for career growth. Applied baccalaureate is a new approach for Kazakhstan to prepare nurses. This new approach will increase the prestige of nurses and help transform nursing into an independent profession in Kazakhstan. [22]

Conclusion. The introduction of applied bachelor's in nursing in Kazakhstan has become a new approach to the education of nurses. The theory and practice of foreign countries have shown that different specialists of health care are trained to improve the entire health care system. In this review, it was discussed how the nursing profession and practice, the values, and the public image are perceived by graduates of the bachelor's in nursing in foreign countries as well as the state of nursing in Kazakhstan today.

Applied bachelor graduates of nursing will become the bridge between clinical practice and science. Nurses are trained by nurses all over the world and they are engaged in nursing science. The training of these specialists will help Kazakhstan's healthcare system to reach the world level. These specialists will raise the status of nurses and help the nursing profession to become independent.

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