美国医院“护士规培”内容你了解吗？
2016/2/23 护士学习笔记
时下最热议的话题莫属卫计委最新出台的护士规培试行办法，那么美国医院的护士规培又是怎么样的呢，ISPN带你一起走入美国新入职护士培训的内容。
里面有中文了，大家可以参考一下，其实，我们一直都在模仿美国!
美国护士规培(一)
US News & World Report全美癌症类专科医院排名第一的德克萨斯大学MD安德森癌症中心(University of Texas MD Anderson Cancer Center)对于不同学位毕业的新入职护士均有不同的入职须知或入职培训手册，这里就从本科阶段毕业新入职护士的手册中取出一段，让我们一起了解一下有关该院护理工作所秉持原则的相关内容。
Nursing Professional Practice Model
护理专业执业模式
MD Anderson’s Nursing Professional Practice Model (PPM) is a patient care delivery system comprising a set of key elements set within a unifying framework.
MD安德森护理专业执业模式(PPM)是一套患者护理供应系统，它由一系列关键因素构成，这些因素统一于统一框架内。
It emphasizes who does what, where and when, and how work is organized.
该模式强调个人工作内容、工作环境、工作时间以及工作如何安排
It outlines how nurses practice, collaborate, communicate and grow professionally.
该模式为护士具体工作、合作、沟通以及专业化个人成长勾勒轮廓
It focuses on how patient care is organized to so the work of nursing is facilitated and quality patient outcomes are achieved.
该模式关注如何安排对患者的护理，以便促进护理工作，并获得高质量的患者预后
It is a structure and process by which patient care responsibilities are assigned and work is coordinated among members of the nursing staff.
该模式也是一个结构和进程，藉此分别分配委派不同的患者护理责任，以及护理工作人员团队成员通过该模式进行工作协调
Quality-Caring Model
高质量护理模式
At the center of MD Anderson’s PPM is the Quality-Caring Model, a nursing theory developed by Joanne Duffy, Ph.D., that informs and guides the practice of professional nursing. Caring professional practice requires:
MD安德森专业执业末世的核心即为高质量护理模式，该模式由乔安娜·达菲博士创造(Joanne Duffy, Ph.D.)。该模式为护理专业工作提供建议和指导。护理专业执业要求：
Knowledge of the caring factors and relationships between self, patients and caregivers, health care team and community
自己、患者与护理人员、医疗卫生团队与社区公众之间的关系和护理因素方面的相关知识
Skills: Behaviors and competencies
技能：行为与能力
Intentions: Attitudes and beliefs that lead to choices
动机：态度和信念产生不同的选择
Time: Primary focus on relationships; the integration of being and doing.
时间：优先考虑各种关系因素；将本质和行动合为一体
The overall role of the nurse in this model is to engage in caring relationships that lead to feeling cared for. The caring relationships include caring for self, caring for patients and caregivers, and caring for community. Feeling cared for assists patients and caregivers to improved short and long term outcomes including those that are nurse-sensitive. The relationships described and the parties involved in those relationships are found in the center of the PPM.
在该模式中，护士的总体角色是参与到护理的整个关系脉络中，而该关系脉络直接影响接受护理后产生的情感。护理的关系包括自我关怀、对患者和护理人员的关怀，以及对社区公众的关怀。接受护理后产生的情感帮助患者和护理人员促进短期和长期的预后，这其中还包括对于护士有直接影响的方面。在这些关系中包括的部分以及描述的各种关系，在专业执业模式中都可以找到。
Colors of the hands
不同颜色的手的意义
Professional values (gray hand): Shared beliefs about the attributes of professional nursing practice. Autonomy, accountability and excellence in practice are the professional practice values of nurses at MD Anderson.
职业价值观(灰色手)：护理专业执业特质的共有信仰。执业中的自治、责任和杰出都是MD安德森护士的专业执业价值观。
Patient care delivery system (green hand): Patient care is delivered in all settings in accordance with principles of the Quality Caring Model and relationship-centered caring.
患者护理供应系统(绿色手)：在各种情境内提供的患者护理，都要依据高质量护理模式和从关系出发的护理这两个原则进行。
o In the inpatient setting, Primary Team Nursing (PTN) is the patient care delivery system. PTN is a group practice culture of nursing care delivery in which nursing practice groups are delineated by inpatient unit geography, with each practice group focused on a discrete cohort of patients. Each group includes a masters-prepared clinical nurse leader, and each group is collectively accountable and responsible for outcomes of care delivered to patients in the group practice.
o 在住院情境下，初级团队护理(PTN)即为患者护理供应系统。初级团队护理是提供护理的一种团队协作文化。在该护理中，护理工作小组从地理结构上、由住院病房进行划分定义，每一个工作小组的工作重心都是各自独立的一个患者群体。每一个工作小组都包括一位准硕士级别的临床护士长，且在小组工作中，每一组对其向患者所提供护理产生的预后都负有集体责任。
o In the ambulatory care setting (multidisciplinary care centers and regional care centers), care is delivered by interdisciplinary teams.
o 在非卧床护理情境下(多学科护理中心和区域性护理中心)，则由跨学科组成的团队提供护理。
o PTN principles, applicable in all patient care settings, include: safe and effective care; synergy of patient needs and nursing expertise; nursing team satisfaction and vitality; team-based professional practice development; interdisciplinary and inter-professional collaboration; continuity of care providers; and care coordination.
o初级团队护理原则，适用于所有的患者护理情境，包括安全有效的护理、患者需求和护理专业技能的共同增益效果、护理团队满意度和活力、以团队为中心的专业执业发展、跨学科和学科内的合作、护理提供者的持续性护理、以及护理工作协调。
Professional recognition (red hand): The formal acknowledgement of an individual’s education, clinical expertise and professional status, it ensures nursing expertise is visible, valued and understood, and that professional autonomy is maintained. In addition, it values and rewards clinical practice, provides a structure for ongoing education, encourages the achievement of specialty certification, and supports nurse retention. Examples include: CNAP; NCAP; certification pay; TAP; Rising Stars; Daisy Awards; Nursing Excellence Awards; and the Arceneaux Award.
专业认可(红色手)：这是一种对个人受教育程度、临床专业技能和职业地位的正式确认，它保证了护理专业技能的可视化、受尊重和被理解，藉此个人的专业自治也能维系下去。此外，这种认可尊重临床执业并对其奖励，从而促个人持续学习框架的产生，鼓励个人去获得更多专业认证，今儿促进了护士的留院率。这样的案例包括思科网络技术学院项目(CNAP)、新车评估测试项目(NCAP)、认证奖励、团队实践项目(TAP)、后起之秀奖、黛西奖、护理杰出荣誉奖、以及阿西诺奖。
Professional partnerships (blue hand): An internal or external collaboration in all partners merge their collective knowledge, expertise and perspectives to improve patient outcomes which cannot be reached when individual professionals act on their own. Internal professional partnerships include nurses, physicians, other professionals and volunteers. External partners include NCI, professional nursing organizations, nursing schools, affiliate sites and global partners.
专业合作(蓝色手)：在所有参与者中的内部或外部的协同合作，他们融合了集体的知识、专长、观点，从而提升了患者预后，而这样的预后由专业个体单独进行是无法达成的。内部的专业合作包括护士、医师以及其他专业人员和志愿者。外部的合作伙伴包括美国国家癌症研究所(NCI)、专业护理机构、护理院校、附属组织和全球合作伙伴。
Shared governance (purple hand): A decision-making body is accountable for the process,
implementation, communication, coordination and outcome of decisions affecting clinical practice. The shared governance body at MD Anderson is a multi-disciplinary team of representatives from across the institution charged with the task of defining, implementing and maintaining institutional standards for clinical practice that are consistent with national, state and local standards of practice.
共同管理(紫色手)：决策体系对过程、实施、沟通、协调以及影响临床执业决定的结果负有责任。MD安德森的共同管理体系由多学科团队的代表组成，他们来自承担不同责任风险的内部机构，而风险产生于对机构内临床执业标准的定义、实施和维持过程中，始终与国家、州以及地区执业标准相一致。
Rings of support
维持圈
Caring factors (black ring)
护理因素(黑色圈)
Eight caring factors are identified in the Quality Caring Model. Each factor independently explains the concept of caring.
八个护理因素在高质量护理模式中分别定义。每个因素独立地诠释了护理的概念。
Mutual problem solving: Nursing behaviors that help patients and caregivers understand how to confront, learn and think about their health and illness. With this knowledge, patients can be better partners in decision-making regarding their care and treatment. This factor implies that nurses are informed, listen, continuously learning and engaged with patients.
共同解决问题：护理行为帮助患者和护理人员了解如何面对、学习和思考各自的健康和疾病。在这个知识的基础上，患者在自己接受护理和治疗的决策中可以成为更好的合作伙伴。该因素暗示了护士要知情、倾听、不断学习以及与病人接触。
Attentive reassurance: Availability and hopeful outlook. Patients learn that they can rely on the nurse and they feel a sense of security. Paying attention to the patient implies postponing action long enough to be authentically available to notice, actively listen, and focus. Acting this way requires conscious effort on the part of the nurse to concentrate fully on the patient at that moment.
悉心抚慰：有效性和有希望的前景。患者知道了自己能够依赖护士，他们就有了安全感。对患者多留意意味着足够长时间的延续了护理行为，从而能够真实有效地做到留意、积极地倾听以及关注。这样的工作方式要求在护士一方有足够的有意识的努力，进而在任何时刻能够全心全意关注患者。
Human respect: Honoring every person’s worth through unconditional acceptance, kind and careful handling of the human body, and recognition of rights and responsibilities. The simple act of calling a patient by his or her preferred name is a demonstration of respect.
人格尊重：通过无条件的接受、和蔼而细心的肢体接触、对权利和责任的掌握，尊重每个人的价值观。以病人倾向的方式呼唤他们，这样一个简单的举动就是尊重的最好展示。
Encouraging manner: Displaying caring through demeanor or attitude. Messages of support, positive thoughts and feelings, and openness to the feelings of others are what make patients feel cared.
鼓励的方式：通过行为或态度展现护理。表现支持的信息、积极的思想和情感、对他人感受的接受，都是能让病人感受到受到照料和护理的方式。
Appreciation of unique meanings: Knowing what is important to patients including distinctive
sociocultural connections associated with their experiences. Avoid assumptions concerning patients and families; instead, focus on those features that are important to them in the provision of care.
赏识不同的价值观：了解患者看重的事情中就包括了与其经历相关的、不同的社会文化关系。避免涉及患者及其家庭的臆断，取而代之应该在提供护理过程中，关注那些对患者而言很重要的突出方面。
Healing environment: A setting where care is taking place, where the focus is on holistic care in surroundings that maintain patient privacy, safety and control.
治疗环境：护理发生的情境中，在保护患者隐私、安全和受控的环境中，关注对人的全面护理。
Basic human needs: According to Maslow’s hierarchy of needs, all humans need physical well-being; safety; to feel a sense of love and belonging; esteem; and self-actualization. Caring for the physical body has traditionally been a time when nurses interact with patients through teaching, assessment and spending dedicated time with the patient.
人类基本需求：根据马斯洛的需求等级理论，所有人类都需要生理健康、安全，感受到爱与归属感、受尊重以及自我实现。对肉体的护理，在传统意义上就是护士与患者通过教导、评估和专心地为患者付出时间这一过程进行的阶段。
Affiliation needs: A sense of belonging and membership in families or other social contexts. The importance of families and other caregivers to the health and well-being of patients in the hospital is well recognized. Nurses need to appreciate and involve the family and caregivers as they care for patients.
归属的需要：即在家庭或其他社会背景中的归属感和成员意识。家庭以及其他护理人员对院内患者健康和福祉的重要性早已达成一致共识。护士需要尊重家庭和其他护理人员，并让他们参与到对患者的护理中，因为他们也起到对患者的照料作用。
来源：国际护士执业水平考试
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