Patricia Benner以她的新手到专家护理技能发展模式而闻名，她将护理定义为“由护理和责任的道德艺术和伦理指导的护理实践，在护士和患者之间的关系中展开。4本纳还确定了护理实践的7个领域（表1），虽然更适合现代急性和危重病护理实践，但仍需要一些发展和完善。
美国护士协会5将护理定义为护理艺术和科学的整合，重点是“保护，促进和优化健康和人类功能;预防疾病和伤害;促进健康，并通过同情心的存在减轻痛苦”。他们进一步指出，护理是“诊断和治疗人类的反应和宣传，在照顾个人，家庭，团体，社区和人口，承认全人类的联系”。
Blueprint的文章1然而，提供了一个全面的定义，实际工作，急性和危重病护理护士每天做的。
“护士与个别病人和家庭建立关怀关系，以促进他们的健康，康复和愈合。护士-患者/家庭关系支持患者和家庭的弹性，并限制或减少患者和家庭愈合的障碍。虽然护理对患者护理的初始方法是标准化的，但独特的患者和家庭差异和偏好要求护士进行个性化护理，并提供基于精确的干预措施，这些干预措施依赖于位于患者疾病轨迹内的单个护士的临床判断。为了做到这一点，护士来了解他们的病人和家庭的反应，同时照顾他们。了解病人和家属包括他们是谁，他们的价值，以及他们希望从护士那里得到什么。...专家护士谁“知道”在他们的专科病人所需的护理，一贯提供重要的人口特定的临床结果。”
这项工作是通过9个领域的急性和危重病护理实践（表1).这些领域具体阐明了急性和重症监护护士的真实工作，并提供了一个框架，测量策略，具体量化护士的工作，使护理被认为是一个收入来源，而不是运营成本。
英文
What do nurses do? It is a perplexing question. We do so much, but because what we do is often hard to verbalize, and even worse, hard to quantify, it sometimes seems that we do so little. When asked about one’s profession, a nurse will often demurely respond that “I am just a nurse.” While the hero status of the COVID pandemic was, in most cases, welcome, the reality is that we are so much more than heroes in capes. We are professionals with a profound scope of work, and subsequently, an even more profound impact on patient outcomes. This impact, what nurses do, is the foundation of the healthcare system. Without nurses, there is no healthcare system. So why do we have such a hard time describing what it is that we do?
I have been very honored to be a contributing author to what we hope will be a landmark publication in the nursing profession:Call to Action: Blueprint for Change in Acute and Critical Care Nursing.1In this article, the author team specifically aims to call attention to the work of acute and critical care nurses, the nurses at the bedside that are the engine of the healthcare system. Our goal was to clearly elucidate what we do, and more importantly, address how our work is measured, so that we, as acute and critical care nurses, can be recognized for our value to the healthcare system.
The first step to the measurement of any concept is to theoretically define that concept. Definitions of nursing have evolved over time, and have been primarily designed to define all nursing care in all settings. Florence Nightingale defined nursing as “the act of utilizing the environment of the patient to assist him in his recovery.”2She goes on to note five environmental factors that were essential to a nurturing healing environment: fresh air, pure water, efficient drainage, cleanliness or sanitation, and light/direct sunlight. While we still struggle to still address many of these environmental components on a global scale, this definition of nursing is of very little significance to the work of acute and critical care nursing today.
Virginia Henderson, an early nurse theorist, defined nursing as the unique function of assisting the “individual, sick or well, in performance of those activities contributing to health or its recovery (or peaceful death) that he/she would perform unaided if he/she had the necessary strength, will or knowledge. And to do this is such a way as to help him/her gain independence as rapidly as possible.”3Henderson goes on to name 14 components of basic nursing care (Table 1), the majority of which are applicable to acute and critical care nursing, and still current today.
Table 1
Henderson’s 14 Components of Basic Nursing Care
Benner’s Domains of Nursing Practice
Curley, et al’s 9 Domains of Acute and Critical Care Practice - What Nurses Do
Breath normally
The helping role
Create safe healing environments
Eat and drink adequately
The teaching-coaching function
Build caring relationships with patients and families
Eliminate body waste
The diagnostic and patient-monitoring function
Assess and manage patient symptoms
Move and maintain desirable postures
Effective management of rapidly changing situations
Administer physical, therapeutic, preventative, and end-of-life care
Sleep and rest
Administering and monitoring therapeutic interventions and regimens
Provide surveillance, vigilant of patient risks, and are ready to intervene
Select suitable clothes, dress and undress
Monitoring and ensuring the quality of health care practices
Teach patients and families what they need to know to actively participate in their own care and decision-making and manage their own care after hospital discharge
Maintain body temperature within normal range by adjusting clothing and modifying the environment
Organizational and work-role competencies
Collaborate with, and coordinate care within the interprofessional team
Keep the body clean and well-groomed and protects the integument
Advocate for the patient and family ensuring that their needs and preferences are known and respected within the interprofessional care team
Avoid changes in the environment and avoid injuring others
Navigate patient transitions in care across and out of the healthcare system
Communicate with others expressing emotions, needs, fears, or opinions
Worship according to one’s faith
Work in such a way that there is a sense of accomplishment
Play or participate in various forms of recreation
Learn, discover, or satisfy the curiosity that leads to normal development and health and use of available health facilities
Patricia Benner, most well known for her Novice to Expert model of nursing skill development, defines nursing as a “caring practice guided by the moral art and ethics of care and responsibility that unfolds in relationships between nurses and patients.”4 Benner also identifies 7 domains of nursing practice (Table 1), that while more appropriate to modern-day acute and critical care nursing practice, are still in need of some development and refinement.
The American Nurses Association5 defines nursing as the integration of the art and science of care that focuses on the "protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of health, and alleviation of suffering through compassionate presence.” They go further to state that nursing is the “diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity.”
The Blueprint article,1 however, provides a comprehensive definition of the actual work that acute and critical care nurses do on a daily basis.
“Nurses engage in caring relationships with individual patients and families to facilitate their health, recovery, and healing. Nurse-patient/family relationships bolster the resiliency of patients and families and limit or diminish barriers to patient and family healing. While nursing’s initial approach to a patient’s care is standardized, unique patient and family differences and preferences require nurses to individualize care and provide precision-based interventions that rely on an individual nurse’s clinical judgment situated within a patient’s illness trajectory. To accomplish this, nurses come to know their patients and the family’s responses while caring for them. Knowing patients and families includes who they are as individuals, what they value, and what they wish to receive from their nurses. ………Expert nurses who “know” the care required of patients in their subspecialty, consistently deliver on important population-specific clinical outcomes.”
“Nurses engage in caring relationships with individual patients and families to facilitate their health, recovery, and healing. Nurse-patient/family relationships bolster the resiliency of patients and families and limit or diminish barriers to patient and family healing. While nursing’s initial approach to a patient’s care is standardized, unique patient and family differences and preferences require nurses to individualize care and provide precision-based interventions that rely on an individual nurse’s clinical judgment situated within a patient’s illness trajectory. To accomplish this, nurses come to know their patients and the family’s responses while caring for them. Knowing patients and families includes who they are as individuals, what they value, and what they wish to receive from their nurses. ………Expert nurses who “know” the care required of patients in their subspecialty, consistently deliver on important population-specific clinical outcomes.”
This work is accomplished through 9 domains of acute and critical care practice (Table 1). These domains specifically elucidate the true work of acute and critical care nurses, and provide a framework for a measurement strategy to specifically quantify the work of nurses, allowing for nursing to be recognized as a revenue generator, and not an operational cost.
来源：Nursing Reaearch 护理研究前沿
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