The National Institute of Childhood Diseases (hereinafter “NÚDCH”) was established by the Ministry of Health of the Slovak Republic in 1991. The basic task of the NÚDCH is to perform tasks related to the protection, maintenance, and restoration of the health of patients from birth to the age of 18 years + 364 days by providing healthcare.
The NÚDCH has inpatient and outpatient departments, as well as shared treatment and examination components. In addition to the inpatient section of the hospital, which has a capacity of over 420 beds, healthcare is also offered in specialized outpatient clinics. The shared examination and treatment components are organized into the Department of Radiodiagnostics, the Department of Laboratory Medicine, and the Department of Physiotherapy and Rehabilitation.
NÚDCH is also the teaching base of several faculties of the Comenius University in Bratislava, the Slovak Medical University in Bratislava and other schools – it offers undergraduate and postgraduate education.
In the Slovak Republic, the education of nurses is regulated by national legislation and offers several pathways to acquire professional competence. Aspiring nurses can qualify through higher professional education at secondary medical schools or by obtaining bachelor’s or master’s degrees in nursing at accredited universities. Following initial qualification, they can further specialize or gain certification through a system of continuing professional education. This structured framework ensures diverse opportunities to enter the nursing profession and to advance within it. More detailed information can be found in this compact summary.
Lifelong training: Uniting skills, knowledge, and empathy
Training at NÚDCH is carried out in cooperation with universities, always based on a specific professional task. It should be noted that the nature of the work and the procedures and technologies used require specific skills that are not always solely medical in nature, but also professional technical knowledge and, of course, a certain human approach (psychological skills), especially since the facility’s patients are children and adolescents, explains Ing. Gruberová. The services provided by the hospital require a wide range of professions and a constant openness to continuing education. Depending on the employee’s work in a particular department and their willingness to develop professionally, conditions are created that enable continuous training. On the other hand, as a provider of training positions, NÚDCH is in contact with interns from postgraduate medical schools (students and graduates) and universities (bachelor’s, master’s, and doctoral students). Preparing for the profession and completing the associated internship is one important element, with efforts focused on creating conditions that also appeal to potential future employees. Equally significant is the enhancement of qualifications, which supports staff in their professional development, as compensation is tied to both the level of continuing education pursued and the successful completion of training courses.
NÚDCH – training healthcare professionals at every level
Ing. Gruberová explains that nursing education and training is a never-ending process, and that working in the healthcare and nursing field is not a job for which a single qualification is sufficient. Due to technological, medical, and pharmaceutical advances, and taking into account the types and progression of diseases, doctors, nurses, and other medical professionals cannot do without ongoing training. Of course, at the beginning, it is always important that each trainee has the necessary qualifications and either acquires them at a secondary medical school or, as required by Slovak law, holds at least a bachelor’s degree qualifying them for independent medical work (e.g., as an independent nurse). This nursing training, for example, is conducted in cooperation with the Slovak Medical University and lasts 6 semesters (3 academic years). It is a demanding program, not only because of its content, but also because of the nurse’s involvement in the work process (working day and night shifts, working on holidays, etc.). After completing the bachelor’s degree, the training process is not complete; only its intensity changes, also with regard to the individual needs of the nurses.
NÚDCH is committed to helping interns and employees achieve the highest level of education while simultaneously leaving room for improvement. Ing. Gruberová explains that conditions have been created that enable trainees to complete secondary education (including the final secondary school leaving examination), obtain a bachelor’s degree (1st degree – e.g., in nursing), a master’s/medical degree (combined 1st and 2nd degree, e.g., general practice), and a doctoral degree (3rd degree – e.g., in pediatrics). As a training center for the whole of Slovakia, this important institution contributes to all levels of education. NÚDCH also promotes supplementary (continuing) education, encouraging participation in various training courses geared to practical requirements.
Slovak healthcare facing low recognition, high workload, and staff shortages
Based on Ing. Gruberová’s experience as a primary contact with interns, employees, and job seekers, she knows that preferences and expectations have changed between generations, that working in healthcare is not financially attractive for everyone, and that job opportunities (in this field) abroad pose a major threat to institutions in Slovakia. NÚDCH’s advantage over other hospital facilities is its treatment of children and adolescents. For many applicants, contact with children is a primary motivator.
The form and method of training must be adapted to the students, and the generation of young people preparing for their careers in healthcare works intensively with information technology. These trainees therefore prefer modern (interactive) forms of training to traditional techniques. In certain areas, digitalization in training is advantageous and promising, but we must not forget the skills that can only be developed in a practical way.
The use of artificial intelligence and virtual reality represents a major challenge for NÚDCH. Therefore, it is valuable for NÚDCH to be able to gain experience and raise concerns within the framework of the VReduMED project.
Unfortunately, there is a natural problem across all age groups regarding continuing education: low motivation for further training and self-improvement. This is partly understandable, as the workload in healthcare is extremely high, also due to night shifts, and some nursing procedures (with regard to patient diagnoses) place enormous psychological strain. Nevertheless, according to Ms. Gruberová, efforts are made to motivate employees to continue their training wherever financially possible.
Analyses of the healthcare system in Slovakia, as well as in other countries, point to roughly the same problems and the lack of universal solutions. Compared to the past, many things are gradually improving, but the problem of social recognition for healthcare workers persists. Compared to other professions, financial compensation does not reflect the level, nature, and intensity of the work. Individual stakeholders have been calling for changes for decades, but these changes are progressing slowly.
With regard to age structure, the care sector faces challenges similar to those in other fields. Retirement is one of the negative factors that complicate the stabilization of medical personnel and their gradual replacement. When this is combined with the overwork of medical personnel—the chronic shortage is reflected in the workload of current employees—and the financial constraints imposed by the health care financing system, a combination of factors arises that also poses major challenges for the care sector.
Digitalization and VR/AR: enhancing everyday work but not replacing practice
From discussions with training participants, Ms. Gruberová gained the impression that using digital tools to visualize some theoretical processes is useful. However, developing the fine motor skills that are essential for nurses requires practice under real-life conditions—the sensitivity of some tasks is difficult to train in a virtual space. On the other hand, the applicability of VR/AR for practicing workflows to ensure that an action is not forgotten could be beneficial and represent a suitable addition to the training process, for example through a virtual tour of the facility or the simulation of a specific intervention or medical procedure.
One important aspect should not be overlooked: the appropriate technical equipment should be mobile and accessible to trainees during their free time. This would allow certain training activities to be shifted into the home environment. However, the technical solution must remain simple, requiring neither advanced technical skills nor complex equipment.
VR/AR as a tool for patient care and the well-being of staff
Based on the NÚDCH’s patient group, children and adolescents, special features must be taken into account: Working with a sick child is a unique situation in which fears of the environment, separation, and uncertainty about the procedure, treatment, etc. must be overcome. Ms. Gruberová believes that virtual reality can be helpful—if the patient’s diagnosis allows it—by allowing the nurse to virtually go through the process with the patient, thus helping the doctor prepare the patient for, for example, the medical procedure. On the other hand, the benefit of virtual reality from the patient’s perspective can lie in distraction, i.e. distraction from anxiety and its calming effect.
VR training for medical staff in stress management using virtual patients or scenarios could also be beneficial as it can reduce stress and anxiety in challenging situations.
The introduction of VR/AR at NÚDCH was closely linked to coordination with the appropriate infrastructure, i.e., the existing technical equipment. NÚDCH already has departments where VR/AR is partially used, where progress in this area is being evaluated, and VR is being used in practical training for trainees with some applications. Ms. Gruberová explains that it is challenging, and the doctors (lecturers) are doing their best.
VR/AR scenarios can be useful for practical preparation, acquiring new knowledge, and familiarizing yourself with workflows. Skill development depends on the type of skill, but Ms. Gruberová considers VR/AR a suitable training method for highlighting errors and deficiencies that may arise during a practical task.
VR applications should support multilingualism and provide feedback to trainees, allowing them to improve themselves or so that other participants in the group can also learn while watching. Regarding the length of VR scenarios, Ms. Gruberová believes it depends on many factors and therefore cannot be quantified. In her opinion, the ability to maintain attention and concentration for a long time must also be taken into account.
Ideally, the use of VR/AR in nursing education should generally increase motivation for the profession and interest in further training, because training, a course or a training program cannot comprehensively prepare a nurse for their profession.
And it wouldn’t hurt to use VR/AR not only in nurse training, but also as a stress-relieving tool for their recovery, says Gruberová. It’s important to remember that the motivation to pursue a nursing career is determined not only by one’s life situation and training, but also by a sense of mission and, in the case of pediatric patients, even maternal feelings.
Further information: Narodný ústav children chorôb (NÚDCH)
© National ústav children chorôb (NÚDCH)
Ing. Henrieta Gruberová and Mgr. Silvia Polák Valentinová in conversation with Prof. Ing. Peter Markovič, PhD.