The professional title of a nurse or a nurse may be used by a person who obtained the right to practice the profession, granted by the district nursing chambers and Nursing Workplaces. The right to practice the profession is vested in any person who has received a diploma or certificate of completion of a Europe nursing school or abroad, provided that the education conditions meet the minimum educational requirements specified in the provisions of European Union law.
- Code of Professional Ethics for Nurses and Midwives
- Nursing Workplaces, in the scope of public
- Professional functions of a nurse
- Direct professional functions of a nurse
- Fundamentals of Nursing Volume 1. Theoretical assumptions, Ciechanowicz
- Nursing Workplaces Process:
- Advantages and disadvantages of nursing care organization methods
- Individual care method
- Advantages of the primary Nursing Workplaces method
- Disadvantages of primary nursing method
- Family must obtain the direct consent
- Doctors are responsible
- Related Topic
To obtain the right to practice a profession, you must also have full legal capacity, a medical condition that allows you to practice the profession, and an impeccable ethical attitude. The practice of Nursing Workplaces is governed by the following laws and regulations
Code of Professional Ethics for Nurses and Midwives
- Labor Code
- Act on the self-government of nurses and midwives of 15 July 2011 (Journal of Laws 11.174.1038)
- Regulation of the Minister of Health of November 7, 2007. on the type and scope of preventive, diagnostic, therapeutic and rehabilitation services provided by a nurse or midwife independently without a medical order. (Dz.U.07.210.1540)
- Mental Health Protection Act of 19 August 1994, as amended.
- Ordinance of the Minister of Health of December 20, 2012 on standards of medical treatment in the field of anesthesiology and intensive care for entities conducting medical activity. (Dz.U.13.15)
- Ordinance of the Minister of Health on the method of establishing minimum standards of employment for nurses and midwives in non-business healthcare entities of December 28, 2012 (Journal of Laws December 15, 45)
- Regulation of the Minister of Health on the types and scope of medical documentation and the method of its processing of December 21, 2010 (Journal of Laws of 2010 No. 252 item 1697)
- Act on patients ‘rights and the Ombudsman for Patients’ Rights of November 6, 2008 (Journal of Laws 2009 No. 52 item 417)
Nursing Workplaces, in the scope of public
A nurse can perform his profession in addition to the hospital, outpatient clinics also by teaching the profession, conducting scientific research in the field of nursing, managing a Nursing Workplaces team, in prison service, in a nursery, performing functions in the nursing self-government, in Nursing Workplaces, in the scope of public.
Ministration Activities include health surveillance. The legislator has specified exactly what the practice of being a nurse and midwife is.
“Practicing the profession of a nurse consists of providing health services, in particular:
1) Identifying the patient’s health conditions and needs;
2) Identifying patient care problems;
3) Planning and providing patient care;
4) Independent provision of preventive, diagnostic, therapeutic and rehabilitation services as well as medical rescue operations in a specified scope;
5) Carrying out medical orders in the process of diagnosis, treatment and rehabilitation;
6) Deciding on the type and scope of care and Nursing Workplaces benefits;
7) Health education and health promotion.
Professional functions of a nurse
The professional functions of a nurse can be divided into direct, implemented for the ward and indirect, implemented for the development of the profession. Intermediate functions include: scientific and research function, education function (own and for environmental) and management function. Direct professional functions, carried out for the benefit of the mentee, are an outline of the possible duties of a nurse working in a hospital and present the tasks for which the nurse was prepared during her education.
Direct professional functions of a nurse
- assistance in carrying out vital functions that guarantee comfort,
- organizing and participating in terminal care. Educational function shaping the sense of responsibility for one’s own health
- Preparation for self-care,
- Preparing relatives to care for the sick,
- Preparation for health-promoting activities. Health promotion function implementation of health promotion programs,
- Creating conditions for strengthening health,
- Preparation to increase control over one’s own health. Preventive function recognition, planning and implementation of preventive actions,
- Planning and implementing actions to prevent or reduce the risk of complications as a result of the treatment used,
- Assessment of the tasks performed for the prevention of health. Therapeutic function cooperation with the therapeutic team in the diagnosis process,
- Performing treatments covered by the therapy plan,
- Performing tasks and procedures as part of providing pre-medical first aid. Rehabilitation function helping in acquiring new skills or practicing functions necessary to cope with a new situation,
- Cooperation with the patient’s family in the field of improvement,
- Help in preparing the environment for hosting a disabled person.
Fundamentals of Nursing Volume 1. Theoretical assumptions, Ciechanowicz
Although the basic professional functions of a nurse are the same for all employed nurses, the duties of a sectoral nurse vary depending on the specialty of the department in which she works. The qualifications of nurses working in the same wards may also be different. The Minister of Health specified in the regulation on the type and scope of preventive, diagnostic, therapeutic and rehabilitation services provided by a nurse or midwife independently without a medical order, what are the specific rights of nurses and midwives. They differ depending on the education received.
At present, nurses are trained in three years of bachelor’s studies and two years of complementary master’s studies. There are several forms of postgraduate education for nurses and midwives.
You can complete specialized courses, specialization courses (called specializations), and refresher courses. Specialization and specialist courses give nurses additional qualifications in a given scope.
Selected qualifications obtained through postgraduate education, useful in the work of a nurse working in a clinical hospital are presented. The table presents the qualifications that a nurse can obtain depending on the type of education undertaken.
These are specialization courses (so-called specialization), qualification courses and specialist courses. Refresher courses are not shown in the table because they do not give additional qualifications to nurses. Specialization and specialist courses give nurses additional qualifications in a given scope. Selected qualifications obtained through postgraduate education, useful in the work of a nurse working in a clinical hospital are presented.
The table presents the qualifications that a nurse can obtain depending on the type of education undertaken. These are specialization courses (so-called specialization), qualification courses and specialist courses. Refresher courses are not shown in the table because they do not give additional qualifications to nurses. useful in the work of a nurse working in a clinical hospital are presented.
Table 2 Selected rights of sectoral nurse obtained through postgraduate education
|Type of education||Permissions|
|A specialist in the field of nursing||Physical examination,|
- referring to diagnostic tests or collecting materials for diagnostic tests,
- referral for research or collection of materials for bacteriological research (urine, feces, sputum, swabs from the nose, throat and genitals and other secretions),
- oxygen therapy. Specialist wound treatment selection of methods and treatment of burns, wounds, pressure sores (up to and including III) and fistulas,
- removing seams,
- assessment of the degree and surface of burns Specialist course cardiopulmonary resuscitation intravenous administration of drugs and intravenous drip transfusions as part of the management of cardiopulmonary resuscitation according to current standards of emergency management,
- defibrillation Specialist course of dialysis therapy intravenous drip transfusion of fluids, intravenous drug administration (Heparinum, Natrium Chloratum 0.9%, Glucosum 5%, Natrium Chloratum 10%, Calcium 10%) and dose modification, during dialysis, according to treatment plan established for a given patient and standards in force in a given healthcare institution,
- preparation of patients (and their families) treated with the methods of: Continuous Ambulatory Peritoneal Dialysis (CADO), Automatic Peritoneal Dialysis (ADO) and hemodialysis as well as hyperalimentation for participation in the conducted treatment,
- assessment of the degree of overhydration of a dialysis patient Specialist course in palliative care ad hoc modification of the therapeutic dose of analgesics and drugs used to alleviate other nagging symptoms (shortness of breath, nausea, vomiting, anxiety, delirium) in patients receiving palliative care,
- intravenous, epidural and subcutaneous administration of medications to alleviate bothersome symptoms in palliative care patients, including modern techniques (use of patient-controlled analgesia PCA, continuous administration of drugs and fluids subcutaneously using the “Buterfly” kit and infusors)
- assessment and monitoring of pain and other symptoms in chronic patients under palliative care and assessment of physical fitness of the patient,
- assessment of the quality of life of the patient under palliative care Specialization course in anaesthesiology and intensive care endotracheal intubation in emergency situations,
- assessment of the patient’s level of anesthesia and relaxometry Qualification course in anesthesiology and intensive care measurements of the concentration of gases involved in the breathing process (gasometry, capnometry),
- assessment of the patient’s state of consciousness using appropriate assessment methods (diagrams, classifications) Specialist course ECG recording and interpretation ECG performance Specialized vaccination course protective vaccination under vaccination calendar and commissioned by relevant health care organizational units and issuing related certificates
Additional nurses’ entitlements can be a way for employers to reduce labor costs. A highly qualified nurse can take over part of the doctor’s professional duties. Hiring a nurse to replace a doctor can significantly reduce hospital costs. On the other hand, some of the nurse’s current duties may be fulfill by medical caregivers.
The profession was include in the classification of professions and specialties for the needs of the labor market Regulation of the Minister of Labor and Social Policy of 27 April 2010 on the classification of professions and specialties for the needs of the labor market and the scope of its application.
Nursing Workplaces Process:
The universal method of a nurse’s work, which is derive from a scientific approach to problem solving, is the nursing process, i.e. the gold standard of nursing. The nursing process is a rational behavior of the nurse base on scientific premises, focuse on the patient and his environment. The nursing process is individualize nursing, which means rational, base on scientific theoretical foundations, general principles of conduct and ethical principles of action.
The concept of the nursing process appear on American soil in the 1950s. The precursors were Hildegard Peplau, Lydia Hall and Dorothy Johnson, and their publications significant for Nursing Workplaces. The working method including the nursing process increases the quality of care. It is perceive as modern, holistic and individual care. There are various divisions of the stages of the nursing process in the literature.
- Recognition (Collection and analysis of patient and environmental data).
- Planning (Establishing an individual nursing plan to solve recognized problems of the patient and his environment).
- Implementation of the plan (active participation of the patient and the environment in the implementation of the plan is required).
- Assessment of actions taken (consists of two stages analysis of care results and formulation of assessment)
The nursing process is a multi-stage operation, but in practice it is an endless series of dynamic activities closely related to each other. They are also characterized by logicality and time sequence. The nursing process is also very universal and can be used in various health conditions. A nurse with a therapeutic team and a man (patient) whom she serves sets goals, priorities and methods of Nursing Workplaces. The nursing process can be used to solve individual needs of the patient. Is a specific method of work aimed at improving the quality of care? It leads to optimal, active and creative human functioning in conditions of health and illness or disability.
Advantages and disadvantages of nursing care organization methods
There are many different nursing models in the theory of nursing. A dozen or so of them have been created since the time of Florence Nightingale the creator of the theoretical foundations of nursing. Depending on the place of providing care, the most popular are:
- Dorothy Orem model theory of self-care deficit and needs
- Florence Nightingale model environmental theory
- Virginia Henderson model theory of needs
- Hildegarde Peplau model theory of cooperation
- Model of Colisty Roy system theory.
For the science of management and organization, theoretical foundations are very important as a cognitive value. However, from the point of view of work organization and management practice, it is necessary to combine individual models and create a work method suitable for a given place. The method in management sciences is referred to as “consciously used, ordered and tested in terms of its effectiveness.”
This chapter describes four methods of organizing nursing work that differ in how nursing care is implemented. Those are:
- Individual care method,
- Task method,
- Teamwork method,
- Teading nurse” method
- Primary nursing.
Individual care method
Individual care method is the nurse’s sole responsibility for all care for a patient or group of patients. It is used in community care, in intensive care and postoperative departments as well as in other hospital departments.
The advantages of this method include simplicity in its use. No division planning required. This method of work provides conditions for comprehensive and holistic care. This method requires from the nurse specialist clinical and humanistic knowledge, instrumental and interpersonal skills as well as in the field of mental support, patient education and efficient documentation of performed activities.
It excludes fragmentation of patient care. This method allows the nurse to provide direct care and enables practice and a leading role within his duties, functions and permissions it fulfills. In addition, responsibility for the work process, independence in deciding how to carry it out, a sense of competence and knowledge, and knowledge of the results in better performance and greater satisfaction with the work performed by the nurse.
In the patient’s medical records kept by nursing it should be noted which of the nurses on duty provides direct patient care. During the Nursing Workplaces report, the nurse who carries out individual patient care transfers the call directly to the nurse who will take care of the patient during the next call.
A nurse taking over duty should also check the status of nursing records while taking over the duty. Another advantage of this method is that it facilitates the employee evaluation process and the measurement of nursing care results. By assessing Nursing Workplaces results, it is easier to evaluate individual employees.
The disadvantage of the method may be its failure to adapt to the complexity of patients’ needs (competence diversity). In this method, qualified personnel can also be involved in relatively simple tasks or restrict the patient’s access to specialist care.
Task method work involves the division of work by task key. In the classic edition, one nurse permanently performs specific tasks or a group of tasks personally assigned to her. The division of tasks between nurses takes place according to their qualifications, experience, but also position in the team.
This method is usually used simultaneously with another method of work, e.g. team work method, the “leading nurse” method. Then one of the nurses is delegated to perform specific tasks or groups of tasks.
In practice, this is usually an additional “full-time” in the ward and the person working in this method of work is in the ward every day, excluding weekends, holidays and vacation time. During her absence, her duties must be taken over by nurses on duty, every day in a shift system.
The most common group of tasks performed by nurses in the task-based work method are: performing procedures and medical orders (the so-called “surgical nurse”), performing, changing dressings and preparing patients for surgical procedures (so-called “dressing nurse”) or distributing medicines (so-called ” drug “). This method is very effective and has a positive economic aspect.
The nurse who works in this way, through repetition of the same activities every day, achieves great proficiency and perfectionism in her activities. In her selective activities there is continuity of patient care in the ward. The division of labor and responsibility for the tasks entrusted is also very clearly presented. This method also allows the use of low qualified personnel,
The disadvantage of the above-mentioned method is the fragmentation of patient care. It lacks a holistic, holistic approach to the patient and a person who could coordinate care for the sick. Important needs of the patient may be omitted there is no person who would meet these needs.
The nurse feels responsible for doing her job and not for looking after the patient. Fragmentary care of patients can also cause problems in cooperation and communication in the Nursing Workplaces team. By narrowing the nurse’s competences, there is also a greater risk of fatigue and rapid burnout.
Teamwork method is to provide care for a selected group of patients by a group forming a formal team. This team usually has its coordinator (leader), who must have high qualifications, experience and be an authority for his team. He must also have an appropriate level of professional independence to be able to make important decisions on behalf of the entire team. The leader must apply the principles of democratization of team coordination.
The team provides all care for the patient, which reduces fragmentation of care for patients compared to task-based work methods. In such a team, staff may have different qualifications and different experiences. In a small group, low qualified staff feel safe and can often ask other nurses for advice.
The method of teamwork can be used in any hospital ward and is convenient for staff to use. It has high efficiency provided that there is good communication in the team. Nursing Workplaces staff provides professional satisfaction and creates conditions for a good atmosphere in the team. It is a method often used in both conservative and surgical wards.
The disadvantage of the team method is the high risk of its misuse, such as poor work coordination, excessive workload, and the leader is not an authority. This method is also time consuming in terms of communication. Poor communication and conflicts in the team can lead to negative consequences for the sick and the work of the ward.
The “leading nurse” method is based on the assumption of entrusting one-man responsibility for providing nursing care for a selected nurse. This method is a modification of the individual (classical) approach to hospital care conditions and the present day. The attending nurse is responsible for the results and not just the delivery of care.
Responsible for providing comprehensive patient care, even if he does not personally perform all activities with the patient because of the fulfillment of other duties in his workplace. In this method, the responsibility for the results of care is legible, it excludes collective responsibility. It also facilitates the assessment of the employee and the results of his work. This method also requires high professional qualifications and constant supplementation of knowledge by Nursing Workplaces staff.
In the reality of hospital work, it is impossible to provide Nursing Workplaces care to a patient by only one person. Other nurses must help with many activities, which require the presence of at least two nurses, such as: moving the patient, changing the patient’s position, sterile procedures as well as in times of no direct presence of the nurse in the ward (such as lunch break).
In such cases the leading nurse is informed about what has been done and about the results. The function of the attending nurse is similar to that of the attending physician. The implementation of this method often involves the functional division of the ward into sub-sections.
Primary nursing is “a series of nursing activities performed on the patient (family) by the same nurse who is responsible in both the nurse patient and nurse administration system for the results of their activities.
These Nursing Workplaces results are understood as the following components: health status, activity level, knowledge. This idea arose as a result of dissatisfaction with the nurse-patient relationship. The fact that the nurse was not in contact with the patient, not paying attention to the needs of the patient and the nurse, as well as the treatment concerned aroused dissatisfaction. Primary nursing is a method of care that meets four criteria:
Responsibility means that the nurse is responsible for caring for the patient lying in the hospital without interruption from admission to discharge, taking into account the individual needs of the patient (makes a nursing diagnosis), and together with the patient and his family sets care goals and assesses their effectiveness. Autonomy means that a nurse taking care of a patient independently makes decisions regarding the care of a sick person.
By coordinating it understood that the nurse coordinates the smooth flow of information between people exercising patient care. The nurse works with the doctor, the patient and his family, and does not work for a doctor or other member of the therapeutic team. The versatility criterion means that the nurse in this method provides holistic holistic patient care.
Advantages of the primary Nursing Workplaces method
- responsibility (the need to constantly improve your professional qualifications),
- The role of the ward nurse changes from supervising to advisory, supportive and mobilizing,
- continuity of patient care,
- Extension of tasks and competences in patient care,
- Better communication.
Disadvantages of primary nursing method
- overload of nurses,
- the need for additional staff to implement the method,
- Difficulties related to the new organization of the hospital’s work.
Organization of work in the intensive care unit on the example of a selected clinical hospital
The organization of work in the intensive care unit is significantly different from work in other hospital wards. The difference is due to the specificity of work and the amount of work required by patients in such wards.
The number of nursing staff on duty in the intensive care unit is by definition dependent on the level of hospital reference. In the Intensive Medical Therapy Ward of the Clinical Hospital, during nurses, the Nursing Workplaces staff is six nurses for six positions.
In this way, there is one nurse per patient in the ward. The ward, because it has a second reference level, in which, according to currently applicable regulations, there are 2.22 nurses per intensive care unit.
The classic individual nursing care method is also used in the ward. Each patient is assigned a specific nurse during his / her duty, who independently carries out Nursing Workplaces over the patient and is personally responsible for all procedures and medical orders, what a patient requires. She also assists the doctor during procedures such as: central puncture, incubation, extenuation, drainage removal.
He also provides the unconscious patient‘s family with information about the patient’s condition, risks and, if necessary, conducts family education and prepares them to take the patient back home.
In reality, however, it is difficult to organize and arrange the ward nurse’s work schedule so that there are always six nurses on duty. In practice, it is usually a four to five crew. For this reason, there must always be people who must be responsible for more than one patient. Nurses must also help each other in the care of patients during such activities as changing the patient’s position, toilet, changing bedding and sterile treatments.
Individual Nursing Workplaces care is also not possible when the patient is admitted to the ward and his condition is significantly worse. You need the help of at least a few other nurses and doctors. In a state of immediate threat to life, the entire therapeutic team takes care of the patient. Practically the entire on-duty therapeutic team is then involved in working with the patient.
Nurses in the ward keep numerous medical records. Every two hours, individual patient observation cards record the basic life parameters of patients (blood pressure, pulse, diuresis, body temperature). The patient’s skin condition, the risk of pressure sores and vascular access care are assessed daily in the documentation. Also, all care activities performed on the patient and medication given to the patient are also recorded with an accuracy of the hour.
The medical records also always indicate which of the nurses provides individual patient care. She is also responsible for the correct completion of the patient’s medical records. Patient care and pressure ulcer prevention are systematically carried out.
The unconscious patient should and is treated as a person who feels and understands everything that is happening around him. It is unacceptable not to inform the patient about their activities. Both nurses and doctors are obliged to inform the patient about their activities. In this way, the patient’s right to privacy and dignity is also guaranteed when providing certain healthcare services.
Patients are provided with pastoral care. Families can visit the sick and be with them. However, their presence is limited because they need to obtain staff permission to enter the sick room. Families cannot stay in the sick room when Nursing Workplaces procedures are taking place in other patients as well as in other emergency situations such as: admitting a patient to the ward, resuscitation, 2 hours after the death of another patient.
Family must obtain the direct consent
In this case, the family must obtain the direct consent of the head physician. In a situation where the patient is unconscious, only the immediate family of the patient can enter the sick room. If the patient is conscious with his consent, he can also be visited by people from outside the family. The family may also be of limited assistance in patient care. This is due to the care of the staff for the well-being and health of the patient.
Patients in the intensive care unit are monitored around the clock, connected to a ventilator and other very numerous equipment. Lack of practice and knowledge in the field of care of an unconscious patient treated in intensive care makes it impossible to assist in patient care. Along with the improvement of the health of the family,
Compliance with patient rights in the workplace, which is the intensive care unit for adults, has a specific and different dimension than in other hospital wards. This is mainly due to the fact that the patient entering the intensive care unit is usually unconscious.
It is impossible to obtain informed consent for diagnostic and therapeutic activities from such a patient. Doctors and nurses, guided by their knowledge and patient’s well-being, must make certain decisions themselves. Obtaining consent from a patient’s family is not sufficient if they are not the legal guardian of the patient.
Waiting for the court decision is impossible, because therapeutic and diagnostic activities must be carries out immediately because patients are often taken in a state of immediate threat to life. In situation, when the admitted patient is unconscious, the doctor fills out the consent form for therapeutic and diagnostic actions for the unconscious patient.
The immediate family of the patient signs under the form confirming that they have been informed about the patient’s health and agree to his treatment. When the admitted patient is able to give consent for diagnostic and therapeutic activities, he is given consent for these activities. However, this is a very rare situation in the intensive care unit.
It happens, however, that the patient is able to give oral consent for treatment and diagnostic activities, but due to the severe condition, paralysis, immobilization he is unable to sign the consent. In this situation, witnesses (doctors and nurses),
Doctors are responsible
Doctors are responsible for issuing medical orders, commissioning diagnostic tests and conducting treatment. In cases of resuscitation, their task is to manage it and make a decision about its termination. Conscious patients are informed about their health by doctors. Nurses inform the patient only to the extent necessary for proper care.
Nurses also do not provide information on the state of health of patients’ families. This is the responsibility of doctors. Information about the state of health of the unconscious patient is provided only to the closest relatives of the patient. The nurse has the right to provide information on patient care and the patient’s condition.
Patients and their families have access to information about patients’ rights. At any time, both the patient and his family can learn about their rights. Patients are provided with the best possible care in accordance with the latest medical knowledge and the profile of the ward. Patients have access to pharmaceuticals and medical materials. Because of the inability of patients to provide self-care, nurses must provide comprehensive care and care for each patient.
The departmental nurse sets up the schedule of nurses’ work, sets up the plan of post-graduate and in-house training, and provides the department with necessary dressing materials, medicines and medical equipment. The hospital provides staff with the opportunity to improve their skills and qualifications.
Every two years, every nurse is entitle to a specialist or qualification course as part of postgraduate training. In addition, internal training is also conduct on care as well as the use of medical equipment. Many people from the nursing staff supplement their knowledge by participating in postgraduate courses, complementary undergraduate studies, the so-called “Bridging” and master’s studies.
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