1、0,2 Professional Guides to Action in Nurse-client Relationship,1,Basic Concepts 1.American Nurses Associations Definition of Professional Nursing Practice 2.Professional Licensure 3.Nurse Practice Acts 4.Professional Standards of Care,OUTLINE,1.美国护理学会对护理执业的定义 2.护理执业执照 3.护理开业条例 *4.护理执业标准,2,OUTLINE,5.
2、Legal StandardsConfidentialityInformed ConsentProtecting Client Rights 6.Ethical Code for Nurses,*5.护理法规 6.护理职业道德,3,ApplicationsNursing ProcessNursing Process and Professional RelationsAssessmentDiagnosisPlanning and Outcome IdentificationImplementationEvaluationCritical Pathways Summary,OUTLINE,4,O
3、BJECTIVES,1.Discuss the implications of nurse practice acts in the nurse-client relationship 2.Identify professional standards of care 3.Discuss implications of the code of ethics with interpretive statements for the nurse-client relationship 4.Describe the nursing process as a frame-work for profes
4、sional nursing practice and the nurse-client relationship 5.Discuss critical pathways as a method of communication,5,If a mans actions are not guided by thoughtful considerations, then they are guided by inconsiderate impulse, unbalanced appetite, caprice or the Circumstances of the moment . John De
5、wey (1933),如果一个人的行为不被深思熟虑的思想所指导,那么他们就受轻率的冲动，不平衡的欲望, 反复无常或片刻的环境所左右。 约翰 Dewey(1933),6,Professional Nursing Practice,American Nurses Association(ANA) ,s definition of professional nursing practice. The practice of professional nursing means the performance for compensation of professional services requ
6、iring substantial specialized knowledge of the biological, physical, behavioral, psychological, and sociological,sciences and of nursing theory as a basis for assessment, diagnosis, planning, intervention, and evaluation in the promotion and maintenance of health; the case finding and management of
7、illness, injury, or infirmity; the restoration of optimum function; and the achievement of a dignified death.,7,Professional Nursing Practice,2.Occupational English Test(OET)OET是澳大利亚职业英语考试（Occupational English Test）的英文缩写，所有希望赴澳大利亚工作的海外护士首先需要面对OET专业语言考试。由于考试题型与雅思颇为相象，因此OET被称为医疗领域的“雅思”。,8,Professional
8、 Nursing Practice,3. Commission on Graduates of Foreign Nursing Schools(CGFNS)CGFNS是Commission on Graduates of Foreign Nursing Schools(外国护校毕业生委员会)的缩写, CGFNS考试测试外籍护士的护理知识水平和英语能力，作为来美国从事护士行业的资格和条件之一。,9,Nurse Professional Licensure,The registered nurses professional license ensures that each individual
9、 nurse has successfully completed nursing program requirements and can demonstrate the knowledge, skills, and competencies to function as a health provider of safe, effective nursing care. All persons practicing nursing are required by law to have a current license in the state in which they practic
10、e and to update their licensure yearly. This license requires anyone practicing nursing to comply with all state laws governing practice. ,10,Nurse Practice Acts,1.Nurse Practice Acts are the single most important statutory laws governing the provision of professional nursing care through the nurse-
11、client relationship. 2.Because the Nurse Practice Act so directly affects professional nursing functions, nurses should pay close attention to legislation and state statutory definitions of nursing practicing in their practice.,11,3.Violations of the Nurse Practice Act are serious, and professional
12、nurses can lose their licensure to practice or have it suspended for a period of time. 4.Each state develops and executes its own Nurse Practice Act. If a nurse moves to another state, he has to apply for licensure in that state.,Nurse Practice Acts,12,Nurse Practice Acts,中华人民共和国护士法执业条例 1.未经护士执业注册者不
13、得从事护士工作。护理专业在校生或毕业生进行专业实习，以及按本办法第十八条规定进行临床实践的，必须按照卫生部的有关规定在护士的指导下进行。2.护理人员只能在护士的指导下从事临床生活护理工作。3.护士在执业中应当正确执行医嘱，观察病人的身心状态，对病人进行科学的护理。遇紧急情况应及时通知医生并配合抢救，医生不在场时，护士应当采取力所能及的急救措施。,13,4.护士有承担预防保健工作、宣传防病治病知识、进行康复指导、开展健康教育、提供卫生咨询的义务。 5.护士执业必须遵守职业道德和医疗护理工作的规章制度及技术规范。 6.护士在执业中得悉就医者的隐私，不得泄露，但法律另有规定的除外。,Nurse Pr
14、actice Acts,14,7.遇有自然灾害、传染病流行、突发重大伤亡事故及其他严重威胁人群生命健康的紧急情况，护士必须服从卫生行政部门的调遣，参加医疗救护和预防保健工作。 8.护士依法履行职责的权利受法律保护，任何单位和个人不得侵犯。,Nurse Practice Acts,15,Box 2-1.Professional Standards Guiding the Nurse-Client Relationship Standards of Care .AssessmentThe nurse collects client health data. .DiagnosisThe nurse
15、analyzed the assessment data in determining diagnoses. .Outcome IdentificationThe nurse identifies expected outcomes individualized to the client.,Professional Standards of Care,16,.PlanningThe nurse develops a plan of care that prescribes interventions to attain expected outcomes. .ImplementationTh
16、e nurse implements the interventions identified in the plan of care. .EvaluationThe nurse evaluates the clients progress toward attainment of outcomes,Professional Standards of Care,17,Box 2-1. Standards of Professional Performance,.Quality of CareThe nurse systematically evaluates the quality and e
17、ffectiveness of nursing practice.Performance AppraisalThe nurse evaluates his/her own nursing practice in relation to professional practice standards and relevant statutes and regulations. .EducationThe nurse acquires and maintains current knowledge in nursing practice.,18,.Collegiality The nurse co
18、ntributes to the professional development of peers, colleagues, and others. .EthicsThe nurses decisions and actions on behalf of clients are determined in an ethical manner. .CollaborationThe nurse collaborates with the client, significant others, and health care providers in providing client care.,
19、Box 2-1. Standards of Professional Performance,19,.ResearchThe nurse uses research findings in practice. .Resource UtilizationThe nurse considers factors related to safety, effectiveness, and cost in planning and delivering client care.,Box 2-1. Standards of Professional Performance,20,Legal Standar
20、ds,In the nurse-client relationship, the nurse is responsible for maintaining the professional conduct of the relationship. Any form of conduct that could compromise the client ,s health or welfare is considered unprofessional. Examples of unprofessional conduct in the nurseclient relationship inclu
21、de: *Verbally or physically abusing a client *Assuming nursing responsibility for actions without having sufficient preparation *Delegating care to unlicensed personnel that could result in client injury *Following a doctor,s order that would result in client harm *Failing to report or document chan
22、ges in client health status *Falsifying records,21,Legal Standards,Confidentiality 1.The nurse is bound legally to respect the client ,s privacy. 2.The nurse has a legal responsibility to ensure against invasion of privacy related to the following: 1)Releasing information about the client to unautho
23、rized parties 2)Unwanted visitations in the hospital,22,3)Discussing client problems in the public places or with people not directly involved in the client,s care 4)Taking pictures of the client without consent or using the photographs without the client,s permission 5)Performing procedures such as
24、 acquired immunodeficiency testing without the client,s permission 6)Publishing data about a client in any way that makes the client identifiable without the client,s permission,Legal Standards,23,Legal Standards,Protecting Client Right 1.有享受医疗的权利 享受平等医疗权； 享受安全有效的诊治； 有权要求清洁、安静的医疗环境，有权知道经管护士的姓名； 有权了解
25、有关诊断、治疗、处置及病情预后等确切内容和结果； 有权决定自己的手术及各种特殊诊治手段。,24,2.有拒绝治疗的权利 3.有要求保密的权利 4.有参与评估的权利 5.有监督维护自己医疗权利实现的权利,Legal Standards,25,Legal Standards,护士伦理学国际法国际护士协会在1953年7月召开的诡计护士会议上通过了此项法规。随后，于1956年6月，在德国法兰克福大议会予以修订并被采纳。国际法中提出：护士护理病人，担负着建立有助于健康的、物理的、社会的和精神的环境，并着重用教授示范的方法预防疾病，促进健康。 1.护士的基本职责：保护生命，减轻痛苦，增进健康。 2.护士必须
26、始终坚持高标准的护理工作和职业作风。,26,3.护士对工作不仅要有充分的准备，而且必须保持高水平的知识和技能。 4.尊重病人的宗教和信仰。 5.护士应对信托给他们的个人情况保守秘密。 6.护士不仅要认识到职责，而且要认识到职业功能限制。若无医嘱，不予推荐或给予医疗处理，护士在紧急的情况下可给予医疗处理，但应将这些行动尽快地报告给医生。 7.护士有理智地、忠实地执行医嘱的义务，并应拒绝参与非道德的行为,Legal Standards,27,Legal Standards,8.护士受到 保健小组中的医生和其他成员的信任，对同事中的不适当的和不道德的行为应该向主管当局揭发。 9.护士接受正当的薪金和
27、接受，例如契约中实际的或包含的供应补贴。 10.护士不允许将他们的名字用于商品广告中或作其他形式的自我广告。 11.护士与其他事业的成员和同行合作并维持和睦的关系。,28,12.护士坚持个人道德标准，因为者反映了对职业的信誉。 13.在个人行为方面，护士不应有意识地轻视在她所居住和工作的居民中所做的行为方式。 14.护士应参与其他卫生行业所分担的责任，以促进满足公共卫生需要的努力，无论是地区的、州的、国家的和国际的。,Legal Standards,29,Ethical Code for Nurse,Ethical principles are guides to actions in the
28、 nurse-client relationship and should be a basic consideration in a nurses choice of words and actions.,30,Ethical Code for Nurse,Box24 American Nurses Association Code Nurses 1.The nurse provides services with respect for human dignity and the uniqueness of the client unrestricted by considerations
29、 of social or economic status, personal attributes, or the nature of health problems. 2.The nurse safeguards the client ,s right to privacy by judiciously protecting information of a confidential nature.,31,3.The nurse acts to safeguard the client and the public when health care and safety are affec
30、ted by the incompetent, unethical, or illegal practice of any person. 4.The nurse assumes responsibility and accountability for individual nursing judgments and actions. 5.The nurse maintains competence in nursing.,Ethical Code for Nurse,32,6.The nurse exercises informed and uses individual competen
31、ce and qualifications as criteria in seeking consultation, accepting responsibilities, and delegating nursing activities to others. 7.The nurse participates in activities that contribute to the ongoing development of the profession,s body of knowledge. 8. The nurse participates in the profession ,s
32、efforts to implement and improve standards of nursing.,Ethical Code for Nurse,33,9.The nurse participates in the profession ,s efforts to establish and maintain conditions of employment conducive to high-quality nursing care. 10. The nurse participates in the profession,s efforts to protect the publ
33、ic form misinformation and misrepresentation and to maintain the integrity of nursing. 11.The nurse collaborates with members of the health professions and other citizens in promoting community and national efforts to meet the health needs of the public.,Ethical Code for Nurse,34,护理职业道德,护理职业道德，是在一般社
34、会道德基础上，根据护理专业的性质、任务，以及护理岗位对人类健康所承担的社会义务和责任，对护理工作者提出的护理职业道德标准和护士行为规范。是护士用于指导自己言行，调整护士与病人，护士与集体，护士与社会之间关系；判断自己和他人在医疗、护理、预防保健、护理管理、护理科研等实践过程中行为是非、善恶、荣辱和褒贬的标准。护理职业道德是护理社会价值和护士理想价值的具体体现，它与护士的职业劳动紧密结合。,35,36,Critical Pathways,1.Current changes in the health care delivery system with an emphasis on maximiz
35、ing resource use and multidisciplinary accountability have fostered the developed of new, broader clinical management tools that extend beyond the nursing process. 2.Critical pathways function as interdisciplinary health care guidelines. They begin with a desired client outcome, based on clinical di
36、agnosis rather than with individualized client needs.,37,3.A critical pathway document is a comprehensive client-centered plan of care that: *Define desired client outcomes and goals*Directs collaborative practice*Provides for coordination and continuity of care involving client families.*Focuses on
37、 reducing resource requirements.,Critical Pathways,38,Critical Pathways,4.Criteria for the development of a critical pathway include high volume, high cost, or difficulty in treatment resources needed to achieve designated outcomes within specified time frames and lessen documentation by using a che
38、ck-off care plan sheet. 5.Critical pathways integrate the medical with corresponding nursing plans and predetermined standards of care. The pathway can include other health care services provided by physical therapy, nutritionists, occupational therapy, social work, and referrals to external health
39、care agencies.,39,6.In the hospital, critical pathway use days as time frames, and in home care, the time frames are developed around visits. The pathway focuses on critical clinical elements and events necessary to achieve predetermined treatment outcomes. 7.A critical pathway record is used at any
40、 give time as a composite guide to treatment and account of outcome achievement.,Critical Pathways,40,Critical Pathways,8.Critical pathways have implications for the nurse client relationship. The nurse frequently is in charge of coordinating the critical pathway and of explaining treatment expectat
41、ions and the client ,s role in the process of goal achievement. 9.Critical pathways should be client focused. The role of the client is active and centered on the treatment process. From the start of treatment, the client knows the anticipated short- and long-term outcomes and just what is expected
42、of him or her as a partner in the critical pathway to a successful outcomes.,41,10. The nursing process can still help the nurse organize nursing care within the critical pathway. Critical pathways spell out desired nursing interventions related to specific medical and nursing diagnosis. 11.Despite
43、the standardized format of critical pathways on paper, the nurse still individualizes nursing care to meet the unique needs of each client through the medium of the nurse-client relationship.,Critical Pathways,42,Critical Pathways,12.As in all other aspects of nursing practice, the nurse uses nursin
44、g theory to inform practice and integrates technical knowledge with creative applications of the nursing process to achieve mutually decided-on health care goals. 13.Often the nurse is accountable for ensuring continuity of care related to the critical pathway. Nurses will assume primary responsibil
45、ity for coordinating the care given by a number of health care team members as well as for evaluating the client ,s progress toward expected outcomes and documenting variances.,43,14.As documentation becomes increasingly computerized with client data entered at the time of service into an ongoing el
46、ectronic medical record, critical pathways become essential as a way of organizing and directing health care interventions.,Critical Pathways,44,Summary,1.Chapter 2 focuses on the nurse,s need to have a basic knowledge of the externally imposed legal and ethical variables that influence the nurse ,s
47、 choice of actions in the nurseclient relationship. 2.The chapter provides a brief overview of the nursing process as a framework for the actions taken in the relationship. 3.Knowledge of practice guidelines and ethical principles is necessary for implementing an effective nurse-client relationship.
48、,45,Summary,4.The nurse-client relationship is contained within the scope of nursing practice as defined by the Nurse Practice Acts. Standards of professional practice provide a measurement standard that should form the foundation of professional nursing. This means that the nurse is obligated to pr
49、ove a level of care that a reasonably prudent nurse would provide in a similar situation.,46,Summary,5.The ANA code of ethics provides a broad conceptual framework for identifying the moral dimensions of nursing practice and is an important guide to choices of actions in nurse-client relationship. 6.The nursing process serves as a clinical management framework, recognized by all nursing theorists as an organizing structure for clinical nursing practice. The nursing diagnosis is established at the end of the assessment phase and forms the basis for the remaining phases of the nursing process.,
