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2 2 Professional Guides to Action in Professional Guides to Action in Nurse-client RelationshipNurse-client Relationship 1 Basic ConceptsBasic Concepts 1.American 1.American Nurses Nurses Associations Associations Definition Definition of of Professional Nursing PracticeProfessional Nursing Practice 2.Professional Licensure2.Professional Licensure 3.Nurse Practice Acts 3.Nurse Practice Acts 4.Professional Standards of Care4.Professional Standards of Care OUTLINE OUTLINE 1. 1.美国护理学会对护理执业的定义美国护理学会对护理执业的定义 2. 2.护理执业执照护理执业执照 3. 3.护理开业条例护理开业条例 * *4. 4.护理执业标准护理执业标准 2 OUTLINEOUTLINE 5.Legal Standards5.Legal Standards Confidentiality Confidentiality Informed Consent Informed Consent Protecting Client Rights Protecting Client Rights 6.Ethical Code for Nurses6.Ethical Code for Nurses * *5. 5.护理法规护理法规 6. 6.护理职业道德护理职业道德 3 ApplicationsApplications Nursing Process Nursing Process Nursing Process and Professional Relations Nursing Process and Professional Relations Assessment Assessment Diagnosis Diagnosis Planning and Outcome Identification Planning and Outcome Identification Implementation Implementation Evaluation Evaluation Critical Pathways Critical Pathways Summary Summary OUTLINEOUTLINE 4 OBJECTIVESOBJECTIVES 1.Discuss the implications of 1.Discuss the implications of nurse practice actsnurse practice acts in in the nurse-client relationshipthe nurse-client relationship 2.Identify2.Identify professional standards of care professional standards of care 3.Discuss 3.Discuss implications implications of of the the code code of of ethicsethics with with interpretive interpretive statements statements for for the the nurse-client nurse-client relationshiprelationship 4.Describe 4.Describe the nursing processthe nursing process as a frame-work as a frame-work forfor professional nursing practice and the nurse-client professional nursing practice and the nurse-client relationshiprelationship 5.Discuss 5.Discuss critical critical pathwayspathways as as a a method method of of communicationcommunication 5 If a mans actions are not guided by thoughtful If a mans actions are not guided by thoughtful considerations, then they are guided by inconsiderate considerations, then they are guided by inconsiderate impulse, unbalanced appetite, caprice or the impulse, unbalanced appetite, caprice or the Circumstances of the moment .Circumstances of the moment . John Dewey (1933)John Dewey (1933) 如果一个人的行为不被深思熟虑的思想所指导如果一个人的行为不被深思熟虑的思想所指导, ,那么他们就受那么他们就受 轻率的冲动，不平衡的欲望轻率的冲动，不平衡的欲望, , 反复无常或片刻的环境所左右。反复无常或片刻的环境所左右。 约翰约翰 Dewey(1933) Dewey(1933) 6 Professional Nursing PracticeProfessional Nursing Practice 1. 1. American Nurses Association(ANA) American Nurses Association(ANA) , , s definition of s definition of professional nursing fessional nursing practice. 2. 2. The practice of professional nursing means the The practice of professional nursing means the performance for compensation of professional performance for compensation of professional services requiring substantial specialized services requiring substantial specialized knowledge of the knowledge of the biological, physical, behavioral, biological, physical, behavioral, psychological, and sociological,sciences and of psychological, and sociological,sciences and of nursing theorynursing theory as a basis for assessment, diagnosis, as a basis for assessment, diagnosis, planning, intervention, and evaluation in the planning, intervention, and evaluation in the promotion and maintenance of health; the case promotion and maintenance of health; the case finding and management of finding and management of illness, injury, or illness, injury, or infirmity; the restoration of optimum function; infirmity; the restoration of optimum function; and the achievement of a dignified deathand the achievement of a dignified death. . 3. 3. 7 Professional Nursing PracticeProfessional Nursing Practice 2.Occupational English Test(OET)2.Occupational English Test(OET) OETOET是澳大利亚职业英语考试（是澳大利亚职业英语考试（Occupational Occupational English TestEnglish Test）的英文缩写，所有希望赴澳大利亚的英文缩写，所有希望赴澳大利亚 工作的海外护士首先需要面对工作的海外护士首先需要面对OETOET专业语言考试。专业语言考试。 由于考试题型与雅思颇为相象，因此由于考试题型与雅思颇为相象，因此OETOET被称为医被称为医 疗领域的疗领域的“ “雅思雅思” ”。 8 Professional Nursing PracticeProfessional Nursing Practice 3. Commission on Graduates of Foreign Nursing 3. Commission on Graduates of Foreign Nursing Schools(CGFNS)Schools(CGFNS) CGFNS CGFNS是是Commission on Graduates of Foreign Commission on Graduates of Foreign Nursing Schools(Nursing Schools(外国护校毕业生委员会外国护校毕业生委员会) )的缩写的缩写, , CGFNSCGFNS考试测试外籍护士的护理知识水平和英语能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。力，作为来美国从事护士行业的资格和条件之一。 9 Nurse Professional LicensureNurse Professional Licensure qq The registered nurses professional license The registered nurses professional license ensures that each individual nurse has ensures that each individual nurse has successfully successfully completed nursing program requirements and can completed nursing program requirements and can demonstrate the knowledge, skills, and competenciesdemonstrate the knowledge, skills, and competencies to function as a health provider of safe, effective to function as a health provider of safe, effective nursing care. nursing care. qq All persons practicing nursing are required by All persons practicing nursing are required by law to have a current license in the state in which they law to have a current license in the state in which they practice and practice and to update their licensure yearlyto update their licensure yearly. This . This license requires anyone practicing nursing to comply license requires anyone practicing nursing to comply with all state laws governing practice. with all state laws governing practice. 10 Nurse Practice ActsNurse Practice Acts 1.Nurse Practice Acts are the single most important 1.Nurse Practice Acts are the single most important statutory statutory laws governing the provision of professional laws governing the provision of professional nursing care through the nurse-client relationship.nursing care through the nurse-client relationship. 2.Because the Nurse Practice Act so directly affects 2.Because the Nurse Practice Act so directly affects professional nursing functions, nurses should pay professional nursing functions, nurses should pay close attention to legislation and state statutory close attention to legislation and state statutory definitions of nursing practicing in their practice.definitions of nursing practicing in their practice. 11 3. 3.ViolationsViolations of the Nurse Practice Act are serious, and of the Nurse Practice Act are serious, and professional nurses can lose their licensure to practice professional nurses can lose their licensure to practice or have it suspended for a period of time.or have it suspended for a period of time. 4.Each state develops and 4.Each state develops and executesexecutes its own Nurse its own Nurse Practice Act. If a nurse moves to another state, he has Practice Act. If a nurse moves to another state, he has to apply for licensure in that state.to apply for licensure in that state. Nurse Practice ActsNurse Practice Acts 12 Nurse Practice ActsNurse Practice Acts 中华人民共和国护士法中华人民共和国护士法执业条例执业条例 1. 1.未经护士执业注册者不得从事护士工作。护理专未经护士执业注册者不得从事护士工作。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。关规定在护士的指导下进行。 2. 2.护理人员只能在护士的指导下从事临床生活护理护理人员只能在护士的指导下从事临床生活护理 工作。工作。 3. 3.护士在执业中应当正确执行医嘱，观察病人的身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。采取力所能及的急救措施。 13 4. 4.护士有承担预防保健工作、宣传防病治病知识、进行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。康复指导、开展健康教育、提供卫生咨询的义务。 5. 5.护士执业必须遵守职业道德和医疗护理工作的规章制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。度及技术规范。 6. 6.护士在执业中得悉就医者的隐私，不得泄露，但法律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。另有规定的除外。 Nurse Practice ActsNurse Practice Acts 14 7. 7.遇有自然灾害、传染病流行、突发重大伤亡事故及遇有自然灾害、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从卫生行政部门的调遣，参加医疗救护和预防保健工 作。作。 8. 8.护士依法履行职责的权利受法律保护，任何单位和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。个人不得侵犯。 Nurse Practice ActsNurse Practice Acts 15 Box 2-1.Professional Standards Guiding the Nurse-Box 2-1.Professional Standards Guiding the Nurse- Client RelationshipClient Relationship Standards of CareStandards of Care .Assessment.Assessment The nurse collects client health data. The nurse collects client health data. .Diagnosis.Diagnosis The The nurse nurse analyzed analyzed the the assessment assessment data data in in determining diagnoses.determining diagnoses. .Outcome Identification.Outcome Identification The The nurse nurse identifies identifies expected expected outcomes outcomes individualized to the client.individualized to the client. Professional Standards of CareProfessional Standards of Care 16 .Planning.Planning The The nurse nurse develops develops a a plan plan of of care care that that prescribes prescribes interventions to attain interventions to attain expected outcomes. expected outcomes. .Implementation.Implementation The The nurse nurse implements implements the the interventions interventions identified identified in in the plan of care.the plan of care. .Evaluation.Evaluation The The nurse nurse evaluates evaluates the the clients clients progress progress toward toward attainment of outcomesattainment of outcomes Professional Standards of CareProfessional Standards of Care 17 Box 2-1.Box 2-1. Standards of Professional Performance Standards of Professional Performance .Quality of Care.Quality of Care The The nurse nurse systematically systematically evaluates evaluates the the quality quality and effectiveness of nursing practiceand effectiveness of nursing practice .Performance Appraisal.Performance Appraisal The The nurse nurse evaluates evaluates his/her his/her own own nursing nursing practice in relation to professional practice in relation to professional practice practice standards standards and and relevant relevant statutes statutes and and regulations. regulations. .Education.Education The The nurse nurse acquires acquires and and maintains maintains current current knowledge in nursing practice.knowledge in nursing practice. 18 .Collegiality.Collegiality The The nurse nurse contributes contributes to to the the professional professional development development of peers, colleagues, and others.of peers, colleagues, and others. .Ethics.Ethics The The nurses nurses decisions decisions and and actions actions on on behalf behalf of of clients clients are determined in an ethical manner.are determined in an ethical manner. .Collaboration.Collaboration The The nurse nurse collaborates collaborates with with the the client, client, significant significant others, and health care others, and health care providers in providing client care. providers in providing client care. Box 2-1.Box 2-1. Standards of Professional Performance Standards of Professional Performance 19 .Research.Research The nurse uses research findings in practice. The nurse uses research findings in practice. .Resource Utilization.Resource Utilization The nurse considers factors related to safety, The nurse considers factors related to safety, effectiveness, and cost in planning effectiveness, and cost in planning and delivering client care. and delivering client care. Box 2-1.Box 2-1. Standards of Professional Performance Standards of Professional Performance 20 Legal Standards Legal Standards In the nurse-client relationship, the nurse is responsible for In the nurse-client relationship, the nurse is responsible for maintaining the professional conduct of the relationship. Any maintaining the professional conduct of the relationship. Any form of conduct that could form of conduct that could compromisecompromise the client the client , , s health or s health or welfare is considered unprofessional. Examples of unprofessional welfare is considered unprofessional. Examples of unprofessional conduct in the nurseclient relationship include:conduct in the nurseclient relationship include: *Verbally or physically abusing a client*Verbally or physically abusing a client *Assuming nursing responsibility for actions without having *Assuming nursing responsibility for actions without having sufficient preparationsufficient preparation * *DelegatingDelegating care to unlicensed personnel that could result in care to unlicensed personnel that could result in client injuryclient injury *Following a doctor*Following a doctor , , s order that would result in client harms order that would result in client harm *Failing to report or document changes in client health *Failing to report or document changes in client health statusstatus * *FalsifyingFalsifying records records 21 Legal StandardsLegal Standards ConfidentialityConfidentiality 1.The nurse is bound legally to respect the client 1.The nurse is bound legally to respect the client , , s privacy.s privacy. 2.The nurse has a legal responsibility to ensure 2.The nurse has a legal responsibility to ensure against against invasioninvasion of privacy related to the of privacy related to the following:following: 1)Releasing information about the client to 1)Releasing information about the client to unauthorized partiesunauthorized parties 2)Unwanted visitations in the hospital2)Unwanted visitations in the hospital 22 3)Discussing client problems in the public places or 3)Discussing client problems in the public places or with people not directly involved in the clientwith people not directly involved in the client , , s cares care 4)Taking pictures of the client without consent or 4)Taking pictures of the client without consent or using the photographs without the clientusing the photographs without the client , , s permissions permission 5)Performing procedures such as acquired 5)Performing procedures such as acquired immunodeficiencyimmunodeficiency testing without the client testing without the client , , s s permissionpermission 6)Publishing data about a client in any way that 6)Publishing data about a client in any way that makes the client identifiable without the clientmakes the client identifiable without the client , , s s permissionpermission Legal Standards Legal Standards 23 Legal StandardsLegal Standards Protecting Client RightProtecting Client Right 1. 1.有享受医疗的权利有享受医疗的权利 享受平等医疗权；享受平等医疗权； 享受安全有效的诊治；享受安全有效的诊治； 有权要求清洁、安静的医疗环境，有权知道经管护有权要求清洁、安静的医疗环境，有权知道经管护 士的姓名；士的姓名； 有权了解有关诊断、治疗、处置及病情预后等确切有权了解有关诊断、治疗、处置及病情预后等确切 内容和结果；内容和结果； 有权决定自己的手术及各种特殊诊治手段。有权决定自己的手术及各种特殊诊治手段。 24 2. 2.有拒绝治疗的权利有拒绝治疗的权利 3. 3.有要求保密的权利有要求保密的权利 4. 4.有参与评估的权利有参与评估的权利 5. 5.有监督维护自己医疗权利实现的权利有监督维护自己医疗权利实现的权利 Legal StandardsLegal Standards 25 Legal StandardsLegal Standards 护士伦理学国际法护士伦理学国际法 国际护士协会在国际护士协会在19531953年年7 7月召开的诡计护士会议月召开的诡计护士会议 上通过了此项法规。随后，于上通过了此项法规。随后，于19561956年年6 6月，在德国月，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：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。法预防疾病，促进健康。 1. 1.护士的基本职责：保护生命，减轻痛苦，增进健护士的基本职责：保护生命，减轻痛苦，增进健 康。康。 2. 2.护士必须始终坚持高标准的护理工作和职业作风护士必须始终坚持高标准的护理工作和职业作风 。 26 3. 3.护士对工作不仅要有充分的准备，而且必须保持高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。水平的知识和技能。 4. 4.尊重病人的宗教和信仰。尊重病人的宗教和信仰。 5. 5.护士应对信托给他们的个人情况保守秘密。护士应对信托给他们的个人情况保守秘密。 6. 6.护士不仅要认识到职责，而且要认识到职业功能限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。报告给医生。 7. 7.护士有理智地、忠实地执行医嘱的义务，并应拒绝护士有理智地、忠实地执行医嘱的义务，并应拒绝 参与非道德的行为参与非道德的行为 Legal StandardsLegal Standards 27 Legal StandardsLegal Standards 8. 8.护士受到护士受到 保健小组中的医生和其他成员的信任，对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同事中的不适当的和不道德的行为应该向主管当局揭 发。发。 9. 9.护士接受正当的薪金和接受，例如契约中实际的或护士接受正当的薪金和接受，例如契约中实际的或 包含的供应补贴。包含的供应补贴。 10.10.护士不允许将他们的名字用于商品广告中或作其他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。形式的自我广告。 11.11.护士与其他事业的成员和同行合作并维持和睦的关护士与其他事业的成员和同行合作并维持和睦的关 系。系。 28 12.12.护士坚持个人道德标准，因为者反映了对职业的信护士坚持个人道德标准，因为者反映了对职业的信 誉。誉。 13.13.在个人行为方面，护士不应有意识地轻视在她所居在个人行为方面，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。住和工作的居民中所做的行为方式。 14.14.护士应参与其他卫生行业所分担的责任，以促进满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。和国际的。 Legal StandardsLegal Standards 29 Ethical Code for NurseEthical Code for Nurse Ethical principlesEthical principles are guides to are guides to actions in the nurse-client actions in the nurse-client relationship and should be a basic relationship and should be a basic consideration in a nurses choice of consideration in a nurses choice of words and actions.words and actions. 30 Ethical Code for NurseEthical Code for Nurse Box24 American Nurses Association Code NursesBox24 American Nurses Association Code Nurses 1.The nurse provides services with respect for human 1.The nurse provides services with respect for human dignity and the uniqueness of the client unrestricted by dignity and the uniqueness of the client unrestricted by considerations of social or economic status, personal considerations of social or economic status, personal attributes, or the nature of health problems.attributes, or the nature of health problems. 2.The nurse safeguards the client 2.The nurse safeguards the client , , s right to privacy by s right to privacy by judiciously protecting information of a confidential judiciously protecting information of a confidential nature.nature. 31 3.The nurse acts to safeguard the client and the public 3.The nurse acts to safeguard the client and the public when health care and safety are affected by the when health care and safety are affected by the incompetent, unethical, or illegal practice of any incompetent, unethical, or illegal practice of any person.person. 4.The nurse assumes responsibility and accountability 4.The nurse assumes responsibility and accountability for individual nursing judgments and actions.for individual nursing judgments and actions. 5.The nurse maintains competence in nursing.5.T