European Festival of Psychiatric Nursing, Malta Mgr. TOMAS PETR BLANKA NOVOTNÁ Psychiatric Nursing in Czech Republic

Who are we? Tomas Petr (MSc, BSc, RN) - BSc General Nursing - MSc Management in Health Care - Currently Manager of Psychiatric Intensive Care Unit, Central Military Hospital, Prague Blanka Novotná (RMN)MN) - Registered mental health nurse - Currently manager of nursing care, Psychiatric Hospital Prague

Overview Introduction Health care system in Czech Republic General information about mental health Structure and organisation of services Nurses training, registration, professional bodies Specific issues, challenges

Czech Republic Population: approx. 10 mil. Nationality: 95% Czech 5% Slovak, Polish, German, Vietnamese, Ukrainian Official language: Czech Capital: Prague

Prague

Health care system in The Czech Republic - main features - Social health insurance system - Compulsory contribution – 13,5 % from salary (4,5% employee, 9% employer) - State – contribution for unemploeyd people, children, retired people, women on maternity leave - 9 insurance companies - Since – regulatory fees (a doctor´s appointment – 30 CZK, 1 day at hospital – 60 CZK, prescribtion of drugs – 30 CZK = 1,2 EU etc.) - Expenditure on health services – 7,3 % of GDP

Percent of GDP spent on health care (OECD, 2004) UK7,7 France9,7 Germany10,9 Sweden9,2 Czech Republic7,3 Spain7,6

Lack of nurses (deficit of 1000 nurses in the system) Re-defining competences of nurses (higher education, but the same competences) Low salaries Changes in education nurses completed study started working in hospitals carried on with study on higher level - rest of them dissapeared Main challenges in nursing in Czech Republic

Mental health care Cinderella between medical disciplines Lack of interest from politicians and public Retaining stigma of psychiatry (media, movies etc.) Insufficient funding (mental health – only 3,5 % from health care budget)

% of health care budget Zdroj: MHEEN, 2004 Expenditure on mental health care 3.5% from health care budget

STIGMA OF PSYCHIATRY representative sample of 1248 respondents, – the best, 5 – the worst SOCIAL PRESTIGE

Choosing a job ??? Nurse? Teacher? IT?

Jobs with the highest prestige Jobs with the lowest prestige Physicians – 88 Scientists – 82 University teachers – 77 Nurses – 72 Secretary - 41 Member of Parliament - 34 Priest - 40 Cleaner - 30 CVVM 9/2008 Prestige of nursing job 99 – the highest prestige, 0 – the lowest prestige

On the way to becoming a psychiatric nurse step 1 age of 18 finished secondary education A.3 years study on nursing school  general nurse B. 3 years on university (bachelor degree)  general nurse

step 2 On the way to becoming a psychiatric nurse step 2 general nurse diploma general nurse diploma 12 months of field experience 12 months of field experience 3 years postgradual study 3 years postgradual study 640 hours - 50% theory, 50% practice  psychiatric nurse Less then 30% of nurses working at psychiatric hospitals have got specialization at psychiatric nursing.

Where to work, if you are psychiatric nurse? Asylum-like hospitals (20, beds) Psychiatric wards (32, beds) Ambulatory care providers (1 295 providers) Community care

Asylum-like hospitals 20 68,8% of hospitalisations happens within asylums average length of hospital stay – 79,4 days 2,5% of clients longer then 1 year number of nurses

Psychiatric wards 32 average length of hospital stay – 20,9 days number of nurses - 700

Ambulatory care providers number of them is growing up (in 2005 – 24,4% more then in 2000) private, paid by insurance companies number of nurses – not known

Community care poor network mainly concentrated in big cities problems with funding number of nurses - 6

Structure of services - main issues - Most of the care happens within hospitals Lack of community services Long hospitalization Frequent rehospitalization High cost of care/low effectiveness Poor conditions within inpatients settings

Psychiatric nurse What your job will be like? - 12 hours shifts - 1 nurse – group of 20 clients - Increase of paperwork - A lot of stress - Average salary – 1000 EU/month

Compulsory since 2004 Registration term lasts 6 years Condition for renewing: - 40 credits - clinical practise - CRB - good state of health Registration of nurses

Professional bodies CNNA – Czech National Nurses Association - Member of ICN, PCN, WENR - Divided into 69 sections members - Membership is voluntary

CNNA Psychiatric section 700 members full member of Horatio Main activity: Organizing conferences, congresses, workshops Working on clinical guidelines Participating in clinical research Publishing study materials Horatio congress in Prague

Conditions within psychiatric hospitals - contrasts -

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