outlook of nursing · peutic nursing plan and the nursing care and treatment plan, activities...

on the Practice of Nursing

OUTLOO

K

2010 EDITION

on the Practice of Nursing

2010 EDITION

OUTL

OOK

Production and revisionPublications ServiceCustomer Service and Communications Department, OIIQ

Co-ordinationSylvie Couture, Head, Publications ServiceClaire Demers, Assistant to the Head, Publications Service

Graphic designMario Paquette

Photographs© Comstock Images© Stockbyte

English translationTerry Knowles

ProofreadingClaire Demers

DistributionOrdre des infirmières et infirmiers du QuébecPublications Sales4200, boulevard Dorchester OuestWestmount (Québec) H3Z 1V4Téléphone : 514 935-2501 ou 1 800 363-6048Télécopieur : 514 [email protected]

Legal depositBibliothèque et Archives nationales du Québec, 2010Library and Archives Canada, 2010ISBN 978-2-89229-499-6 (print)ISBN 978-2-89229-500-9 (PDF)ISBN 2-89229-203-4 (1st edition, 1996)

© Ordre des infirmières et infirmiers du Québec, 2010All rights reserved

Note – In accordance with OIIQ editorial policy, the feminine pronounis used without prejudice, simply to make for easier reading.

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AuthorHélène Lévesque-Barbès

Co-ordinationMonique Chagnon / Judith Leprohon

Quality of Professional Practice Department, OIIQ

ContributorsMonique Nadeau, clinical nurseOIIQ team of Counsellors-Investigators

Nurses from 30 health care facilities (RSTCCs, RLTCCs, CLSCs) and teaching institutions (CEGEPs and universities) also participated.

Special thanks are extended to the clients who, during our focus group activities, agreed to share their expectations regarding health care delivery by nurses.

Suzanne AucoinClémence DallaireMarie De SerresLise DonahueAndrée DuplantieClaudette FoucaultMaryse GodinCéline GouletLucie HalleuxMarie HénaultPierrette Lange-Sondack

Louise-M. LessardMartine MayrandPatricia O’ConnorColombe PelletierSuzanne PlourdeFrance RoyDiane SaulnierDanielle St-LouisCéline ThibaultNicole Tremblay

2007 UpdateScientific Department

In collaboration withProfessional Development and support DepartmentExternal Affairs DepartmentNursing Practice Supervision Office

ConsultationHélène Lévesque-Barbès

2010 UpdateScientific Department

In collaboration withFrance Laflamme, Nurse ConsultantProfessional Development and Support Department

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Table of Contents

Introduction 5

Foundations of the Nursing Profession 7

Beliefs and Assumptions 8

Person 8

Health 9

Environment 9

Nursing 10

Goal of Nursing Practice 11

Descriptive Statements 11

1. Nurse-Client Partnership 12

2. Health Promotion 13

3. Prevention of Illness, Accidents, Social Problems and Suicide 14

4. Therapeutic Process 16

5. Functional Rehabilitation 19

6. Quality of Life 20

7. Professional Commitment 21

Application of Descriptive Statements with Regard to Public Protection 22

Essential Criteria 22

Conclusion 23

Nurses Act, s. 36, 36.1 24

Professional Code, s. 39.4 24

Glossary 25

References 27

In 1996, the Board of Directors of the Ordre des infirmières et infirmiers du Québec (OIIQ) adopted a document entitled Outlook on the Practice of Nursing. This outlook was defined based on clients’and significant others’ expectations and with the help of nurses from various areas of activity, geographical regions of Quebec, health care settings and fields of practice.

This outlook on nursing practice is based on professional practice, orientations in the health care system and emerging trends in evaluation. Furthermore, both the health care policy in Quebec –focussed on client outcomes – and the primary health care approach emphasize partnership withclients and their participation in care. Given that both these orientations affect nurses, they haveguided the preparation of this document.

Major amendments were made to the Nurses Act (R.S.Q., c. I-8) as a result of the entry into force in 2003 of the Act to amend the Professional Code and other legislative provisions as regards thehealth sector (S.Q. 2002, c. 33). The field of practice of the profession was brought up to date, 14 professional activities (R.S.Q., c. I-8, s. 36) were reserved to nurses and a provision stipulatingthat nurses who are so qualified can engage in five activities reserved to doctors (s. 36.1) has beenadded to the Act. In 2009, the adoption of the Act to amend the Professional Code and other legislative provisions in the field of mental health and human relations led to other changes to the Nurses Act, including the addition of three new activities reserved to nurses.

This new edition of Outlook on the Practice of Nursing has been updated to reflect these new legislative provisions.

This document begins by outlining the beliefs and assumptions on which the practice of nursing isbased. These beliefs and assumptions colour one’s perception of the person (family, group or community), health, the environment and nursing care, which in turn orients professional practice.This section is followed by the foundations of professional practice for the coming years, which aresummarized in the section “Goal of Nursing Practice.” Then, the descriptive statements relating toprofessional practice define the partnership with the client, the main functions of nurses (health promotion, prevention of illness, accidents, social problems and suicide, the therapeutic process,functional rehabilitation), quality of life and professional commitment. These descriptive statementsdefine the nature of nursing practice. They allow nurses to fully perform their roles and help themclarify this role to their clients, colleagues in other disciplines, the general public and the various lev-els of government. An application of these descriptive statements with a view to protecting the publicis presented at the end of the document as a series of essential criteria pertaining to the client, the nurse and the organization.

Before reading this document, it is helpful to review some definitions. First of all, the anticipatedclient outcomes provide indications that can help evaluate the effects of the care given to a client or a category of clients. The elements of practice refer to the nursing care and treatment provided forthe client, and the organizational elements are external factors that contribute to the quality of professional nursing practice.

This outlook can be used as a guide by OIIQ members and can serve as a reference for nurses who work in diverse sectors such as clinical practice, education, administration or research. Thedescriptive statements and the essential criteria should be considered as a starting point. They willsurely be fine-tuned over time and as professional practice evolves. The OIIQ Board of Directorshopes this Outlook will be used as a guide by Quebec nurses for the continuous improvement of theservices offered to the public.

Introduction

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Foundations of the Nursing Profession

All the beliefs and values related to a way of perceiving the person, the health, the environment and the nursing, which guide the practice of the nursing profession.

Environment

All the components in a person’s surroundings with which that person inter-acts (family, group or community). Theenvironment includes the followingdimensions: physical (living environment,care setting), psychosocial (natural ororganized network that offers support orimposes constraints), political and eco-nomic (laws and regulations, popularmovements such as support groups or con-sumers’ associations), spiritual (values,beliefs), cultural (ethnic origin, feministmovement), and organizational (caredelivery structure).

Nursing

Dynamic process intended to maintain, restoreor improve the health, well-being and qualityof life of a person (family, group or communi-ty), prevent illness, accidents, social problemsand suicide and promote rehabilitation. Thisprocess encompasses the assessment andmonitoring of the person’s physical and mentalstate of health, the determination of the thera-peutic nursing plan and the nursing care andtreatment plan, activities related to nursingand medical care and treatment, and to infor-mation, professional advice, teaching, referraland client support. These activities are carriedout within a partnership with the client andwith due respect for the client’s capacities.

Person

Indivisible, unique and evolving entitywho acts in accordance with his/herchoices, values and beliefs and to thebest of his/her abilities. Persons interre-late with other persons, the family, groupor community, as well as with their envi-ronment.

Health

Dynamic and continuous process in whicha person (family, group or community)aspires to a state of equilibrium that fos-ters well-being and quality of life.

This process involves adaptation to multi-ple environmental factors, a learningprocess and commitment on the part ofthe person and society.

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Beliefs and Assumptions

Following are the beliefs that colour one’s perceptions of the person (family, group or community), health, the environment and nursing:

• People aspire toward health, well-being and a good quality of life.• People, in co-operation with those close to them, are active partners in health care.• Environment has an influence on clients’ health, well-being and quality of life.• Professional commitment is first an individual one, and the various activities resulting from this commitment help define one’s professional identity.

• Nursing care demands scientific knowledge, continuous updating of this knowledge, capacity to make clinical judgments and the mastery of complex technical skills throughexperience.

• Nursing care is as much an art as a science, and is experienced as a unique and creative work.

• Nurses are responsible to clients for the care they give them and must therefore be heldaccountable for the quality of the care they provide.

• As partners in the health care delivery system, nurses make a unique contribution within the multidisciplinary team.

Person (Family, Group or Community)

• The person1 is an indivisible, unique and evolving entity.• The person has beliefs as well as social, political, cultural and spiritual values.• The person has a health history and is capable of making choices according to individualcapacities; these may vary with time and may be dependent upon environmental condi-tions.

• People learn from their experiences and can generally recognize their resources andlimitations with regard to health.

• People have rights and responsibilities with regard to health, and contribute, accordingto their capacities, to the care they receive. People can express their expectations aspart of their partnership with the nurse.

• People interrelate with other people, within their families, their natural support networksand their communities.

1. The definitions applying to the “person” are generally understood as also applying to the family, group and community.

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Health

• Health is a dynamic and continuous process; it is a subjective experience.• Health is a value toward which every person aspires, even though health may be more fragileat certain stages of a person’s life and even though the person may suffer from a disabilityduring specific phases of an illness.

• Health is a person’s capacity to perform tasks related to the fulfillment of his/her role usingindividual resources and those of friends and family, in a manner that is satisfactory to theperson and his/her significant others2.

• Health goes beyond healthy living habits: it includes aspiring to a greater degree of well-being and a better quality of life. It presupposes a commitment on the part of the person andsociety.

• Health can have various meanings according to each person’s perception.• Several environmental factors can influence health. These factors require the person to adaptto preserve his/her well-being and quality of life, as well as to evolve toward self-actualiza-tion.

• Health is learning experience based on past and newly acquired knowledge.

Environment

• The environment is the framework surrounding a person’s life. It has several dimensions: psychological, social, spiritual, political, cultural, economic and organizational.

• The environment is made up of all the components of the person’s surroundings with which theperson interacts and that influence his/her health, well-being and quality of life.

• The environment is a set of conditions within which the nurse and the client interact.• In various ways, the environment can be a source of support for the person and contribute tohis/her growth. If the environment is healthy, safe and stimulating, it promotes the person’shealth, well-being and quality of life.

• The environment can be harmful if it contains cumulative risk factors affecting health, well-being and quality of life; it can be threatening and constraining.

2. The OIIQ uses the term “significant other” in a broad sense, to designate any important person in the client’s life.

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Nursing

• Nursing contributes in a specific manner to the maintenance, restoration and improve-ment of a person’s health, well-being and quality of life.

• Nursing takes into account the person’s health history: to elicit this history, the nurseestablishes a relationship with the client in which each partner can express his/herexpectations.

• Nursing helps people assume their health-related responsibilities and mobilize theirresources to maintain, restore or improve their health. Nursing also takes into accountthe environments in which clients evolve.

• Nursing helps people acquire adaptation mechanisms that will enable them to prevent orto overcome health problems and crisis situations.

• Nursing helps compensate for a person’s deficits and guides the person as he/she adaptsto a new health situation.

• Nursing helps the person learn how to increase his/her repertoire of personal resourceswith a view to assuming individual health care responsibilities and acquiring self-careskills.

• Nursing is stamped with humanism: the nurse promotes the rights of persons in her careand helps them in situations where their rights are violated

• Nursing takes place in an interdisciplinary setting; it is offered in concert with servicesrendered by other health care professionals and community resources, with a view toensuring a continuum of care and services.

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Goal of Nursing Practice

Nursing practice aims to enable people (person, family, group or community)to take charge of their health, according to their capacities and to the resourcesavailable in their environment, regardless of their stage of life and regardlessof the phase of their illness. Nursing practice also has the purpose of enablingpersons to ensure their own well-being and to maintain a good quality of life.

Descriptive Statements

Seven categories of statements describe the various aspects from which the practice ofnursing can be considered:

1 Nurse-client partnership;

2 Health promotion;

3 Prevention of illness, accidents, social problems and suicide;

4 Therapeutic process;

5 Functional rehabilitation;

6 Quality of life;

7 Professional commitment

The underlying principle of each descriptive statement is defined in terms of the foundations on which it rests. The statements describe anticipated client outcomes, elements of practice and organizational elements. Their presentation reflects the processthat has been used for their development, starting from the expectations of clients and of their significant others.

These seven categories use the terms listed in the glossary on page 25.

PRINCIPLE

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Nurse-Client Partnership

All clients are responsible for their own health. When clientsexpress a need or expectation, the nurse, taking into accounttheir capacities, encourages them to mobilize their personalresources and those available in their environment. The nurse-client alliance is established through a relationship character-ized by mutual respect and shared objectives.

ANTICIPATED CLIENT OUTCOMES

ELEMENTS OF PRACTICE ORGANIZATIONAL ELEMENTS

Clients state that they are consid-ered as unique persons and aspartners in nursing care activities.Family members accompany theclients, if the clients wish it andwhen they feel the need. Theclients state that they havereceived sufficient information ontheir health situation to makeinformed decisions.

Clients participate in the planningof their care and treatment to thebest of their abilities and makechoices. They notice continuityand follow-up in the care andtreatment activities. They areaware of certain resources withinthe health care setting that areavailable to them.

The nurse recognizes the unique-ness of clients as persons. Sheestablishes a partnership withclients and helps the family par-ticipate in the care. This partner-ship is reflected in the nurse’sapproach, notably by her atten-tiveness and the way in which sheresponds to the needs and expec-tations expressed by the client.

The nurse uses a nursing processto plan care and treatment activi-ties with clients based on theirneeds and expectations. Thisplanning includes measures toensure the continuity and follow-up of nursing and medical careand treatment and is intended tohelp clients use their personalresources and those available intheir environment.

The concepts of person, health,environment and nursing care arestated in writing.

Family participation is encour-aged. The family is invited toaccompany the client.

The means to take account of theclient’s needs and expectationsand ensure follow-up on care andtreatment (policies, documenta-tion system for nursing care, etc.)are implemented.

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PRINCIPLE

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Health Promotion

All clients aspire to health and well-being. The nurse helpsclients apply the choices they make while respecting theircapacities, which may vary over time. The clients’ choices aredependent upon their expectations, personal resources and theresources in their environment.



Clients adopt healthy living habitsand make good use of their per-sonal resources and those in theirenvironment. They make choicesthat enable them to maintain orimprove their health and well-being.

Clients participate in activitiesthat improve the quality of theirenvironment and that help themadapt to any environmental con-straints.

Clients pass on to others theinformation they receive.

The nurse helps clients use andbroaden their personal repertoireof resources to maintain orimprove their health and well-being. She facilitates theexchange of health-relatedknowledge and helps clients makechoices. The nurse acknowledgesthe health-related behavioursthat clients have acquired andtakes into account the way theylearn.

The nurse identifies, in co-opera-tion with clients, the ways inwhich they can foster a healthy,safe and stimulating environment.

The nurse trains multiplyingagents and chooses with clientsthe most relevant educationalstrategies.

Health promotion programmes areavailable.

Initiatives taken by nurses todevelop new health educationstrategies for clients are supported.

Implementation of environmentenhancement initiatives proposedby nurses is facilitated.

Training activities for nurses are planned.

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Prevention of Illness, Accidents, Social Problems and Suicide

All clients face risks related to their state of health, living habits, lifetransitions or to the environment. The nurse helps clients identifypotential problems related to these risks and helps clients adapt toactual problems so as to maintain their health and well-being.



PRINCIPLE

Clients indicate the risk factorsfor their health and recognizetheir personal limitations. Theyidentify living habits and factorslikely to trigger infection, illness,accidents, crisis situations or vio-lence. They apply preventivemeasures.

Clients are aware of the diagnos-tic measures they are undergoingfor screening purposes. Theyknow the vaccine administered.

The nurse develops and applies, in co-operation with clients andother health professionals, pro-grammes to prevent infections,illness, accidents, crisis situationsor violence. She assesses risks forclients and, when she detects arisk situation, determines theappropriate preventive measuresand screening, monitoring andfollow-up procedures, in the ther-apeutic nursing plan.

The nurse decides whether thereis a need for restraint or isolationmeasures to protect the client,after evaluating the other possi-ble solutions and consulting themembers of the interdisciplinaryteam as necessary. She deter-mines the clinical monitoringparameters in the client’s thera-peutic nursing plan.

The nurse initiates diagnostic procedures for screening purposesand performs vaccinations as partof public health-related activities.

Programmes to prevent infection,illness, accidents, social problemsand suicide are available.

Nursing programmes for screen-ing and responding to risk or crisis situations or violence areimplemented in keeping withclient needs and environmentalrisks.

All written information on theapplication of prevention andnursing programmes is availableto nurses (e.g. Quebec immuniza-tion protocol, the institution’sprotocol regarding restraintmeasures).

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Prevention of Illness, Accidents, Social Problems and Suicide (continued)



Clients are aware of their personalresources and the resources intheir environment to which theycan turn in a stress, crisis or tran-sition situation. They satisfactori-ly perform tasks related to theirsocial roles.

The nurse helps clients becomeaware of their personal resources,informs them of the resourcesoffered in their environment andhelps them deal with their specificsituation. She pays particularattention to clients who are vulnerable or at risk.

In co-operation with other healthprofessionals, the nurse engagesin activities intended to correctpractices and policies that maylead to health and social prob-lems.

Written information is madeavailable to clients.

Nurses are offered training on theprevention of illness, accidents,social problems and suicide.

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PRINCIPLE

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Clients describe their health situ-ation in their own words andexpress their feelings about it.

Clients state that they are reas-sured and comforted in the healthcare setting.

Clients are aware of and co-oper-ate in the nursing care and treat-ment they are receiving.

Clients demonstrate that theyhave acquired the knowledge andskills required by their health situation (self-testing, livinghabits, self-care, etc.)

The nurse assesses clients’ physical and mental state ofhealth and determines the therapeutic nursing plan and thenursing care and treatment plan.She exhibits clinical skills andmakes the appropriate decisionsbased on clients’ situations. Sheensures a therapeutic presence foreach client and reassures them asrequired. The nurse informsclients of their state of health andof the care and treatment they willreceive.

The nurse provides nursing careand treatment, using the neces-sary invasive techniques. Shedetermines the treatment plan forwounds and alterations of the skinand teguments and provides therequired care and treatment.

The nurse co-ordinates care andtreatment activities for her groupof clients, taking each client’s priorities into account. She makessure that clients receive the careand treatment stipulated for themin the nursing care and treatmentplan, in accordance with the nursing therapeutic plan.

The nurse teaches clients whatthey need to know and supportsthem as they learn.

The delivery system and theorganization of nursing care allowfor safe, efficient and effectivedelivery of care and treatment toclients through the optimal use ofprofessional skills to attain theanticipated client outcomes.

Nurses are provided with rulesgoverning nursing care, nursingprotocols, nursing care methods,policies or regulations concerningnursing care, as well as referencedocuments.

A nursing care evaluation systemis in place. This evaluation coversboth the quality of nursing careand the quantity of nursing carerequired.

Teaching programmes tailoredspecifically to the needs of various groups of clients areintroduced, and a system toassess these programmes is put in place.

Therapeutic Process

All clients who learn the diagnosis of their health problem need to becared for, treated, informed, reassured and comforted. The nurseassesses their physical and mental state of health and, with theclients, determines the nursing care and treatment required to main-tain, restore or improve their health or to help them die with dignity.She encourages clients to take part, to the best of their abilities, in thecare and treatment stipulated in the nursing care and treatment plan,of which she ensures the realization. She provides clients with theassistance they require and, throughout the therapeutic process,takes into account their reactions.

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4 Therapeutic Process (continued)



Clients who learn that they sufferfrom a condition with a bleakprognosis, that they are in theterminal stage of an illness or thatdeath is imminent have the oppor-tunity to express their emotions,feelings and desires. Family mem-bers who are experiencing a losshave the same opportunity.

Clients are aware of and co-oper-ate with the diagnostic measures,invasive examinations, diagnostictests and medical treatment theyare undergoing.

Clients know the desired effectsand side effects of drugs adminis-tered to them

The nurse knows the course of thedisease, recognizes mourning orloss reactions in clients, andaccompanies clients and theirfamilies. The nurse clarifies indi-vidual meanings of mourning orloss with clients and their fami-lies.

The nurse ensures that clients areaware of the diagnostic measures,invasive examinations and medical treatment they areundergoing.

The nurse initiates diagnosticmeasures and performs invasivediagnostic examinations or tests,according to a prescription.

The nurse provides and adjustsmedical treatment, includingmedications, according to individ-ual or collective prescriptions andany protocols in effect in thehealth care institution.

The nurse intervenes in emergencies, crises and situa-tions of violence, according to theclients’ needs and the policies ofthe health care institution.

The nurse makes sure that clientsknow the desired effects and sideeffects of medications adminis-tered to them.

The nurse evaluates the effects ofcare, treatment and medicationsthat clients receive and checkswith them about their reactions.She intervenes as the situationrequires, makes the relevant clinical decisions and adjusts thetherapeutic nursing plan as necessary.

Care is organized so as to permitclose support for people in theterminal stage of illness, forthose who are dealing with a loss,and for their family members.

Collective prescriptions, medicalprotocols, rules or policies relat-ing to medical care, medicaltreatment and drugs, as well asany appropriate reference materi-als, are made available to nurses.

General guidelines on emergen-cies, crisis situations and vio-lence, along with interventionmethods and required materials,are made available to nurses.

Drug-related teaching pro-grammes and documentation aremade available to nurses andclients.

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Clients co-operate in the variousclinical monitoring methods andexpress their feelings about them.

Clients see continuity in the careand services they receive.

Clients know why they arereferred for consultation toanother professional or directedtoward another resource in thehealth care setting.

The nurse monitors clients’ physical and mental condition inorder to track their progress andquickly detect any complication.She evaluates the effects of careand treatment administered, basedon relevant parameters, includingclinical monitoring data, andclients’ reactions. She intervenesas necessary, depending on problems and risks detected, andadjusts the therapeutic nursingplan as required.

Depending on her field of practice,she participates in pregnancy care,deliveries and postpartum care.

The nurse provides clinical follow-up for clients with complex healthproblems, by clinically assessingand monitoring their condition andadjusting the therapeutic nursingplan and, if applicable, medicaltreatment according to an individ-ual or collective prescription. Shetakes an interdisciplinary approachfor this purpose, in co-operationwith clients, and liaises with thedifferent departments, profession-als and health care institutionsconcerned.

The nurse records all the clinicalinformation necessary to monitorclients’ condition and ensure thecontinuity of care and treatment,including data relating to clinicalassessments, problems identified,the therapeutic nursing plan andits adjustments, interventions andoutcomes, as well as clients’ reac-tions. She ensures that clients’records are kept up to date.

Equipment and tools for docu-menting nursing care are madeavailable to nurses so as to ensurethe clinical monitoring requiredby clients’ condition, includingthe monitoring of relevant param-eters. On-the-job training activi-ties are implemented to simplifythe use of this equipment andthese tools.

Interdisciplinary consultingmechanisms are put in place.

Case management and follow-uptools such as clinical paths aremade available to nurses.

Reference documents are available to guide nurses’ chartingof their care activities.

Therapeutic Process (continued)

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Functional Rehabilitation

All clients who experience limitations subsequent to an ill-ness or accident can expand their self-care repertoire andenhance their well-being according to their capabilities. Thenurse accompanies clients in their efforts to recover a newequilibrium and to adapt to their environment.



Clients talk about their bodyimage and self-esteem. Afterrehabilitation, they describethemselves as they really are.They list ways they can changetheir environment according totheir needs.

Clients perform activities of dailyliving (ADL) and instrumentalactivities of daily living (IADL)despite the disabilities, deficien-cies or handicaps caused by theillness or accident. They makeplans to recover optimum func-tioning in a fixed period of timeand with a view to self-actualization.

The nurse helps clients to recoverthe equilibrium they seek and toadjust to their new self-image.

The nurse guides clients to helpthem or family members maximizetheir potential and recover theirautonomy. She teaches clientsmeans of ensuring their safetyand well-being, and strategiesthat will allow them to performactivities of daily living. Shefacilitates clients’ return to theirnatural environment or theirarrival in a protected setting. She cooperates with various professionals in designing aninterdisciplinary intervention plan.

Policies allow clients to partici-pate in their care, in accordancewith the adopted conception of nursing.

Care and teaching programmes in functional rehabilitation,adapted to the needs of variousclient groups, are made availableto nurses. Mechanisms are put inplace to promote interdisciplinar-ity and to encourage dialoguebetween resources within thehealth care settings and thehealth care delivery network.

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PRINCIPLE

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Quality of Life

All clients strive for an optimum quality of life and have theright to have their values respected. The nurse encouragesclients to use their personal resources and those of their environment to enhance their quality of life. She helpsclients to express their needs in this respect and to givemeaning to their health situation.



PRINCIPLE

Clients state that they appreciatethe care and treatment they havereceived and the fact that theirconception of quality of life hasbeen respected.

Clients indicate the resources,both personal and environmental,that will help them improve theirquality of life.

Clients state that they feel sup-ported and well cared for by nurs-es.

Clients explain their situation anddescribe the transformations theyare undergoing (evolving being).

Clients express their satisfactionthat their values and rights ashealth services users have beenrespected.

Clients who have made therequest know how to gain accessto their files.

Clients understand their rightsand responsibilities and feel sup-ported in any procedures theyundertake.

The nurse asks clients to specifythe main criteria that define theirquality of life, and takes thesefactors into account in her inter-ventions. She uses clients’ per-sonal resources and takes intoaccount the resources and con-straints of their environment. Sheencourages the maintenance ofnatural support networks.

The nurse ensures that her inter-ventions will enhance clients’well-being.

The nurse helps clients findmeaning in the situation they areexperiencing.

The nurse’s conduct is compatiblewith the legal, moral and ethicalimperatives of the nursing pro-fession.

If clients request it, the nurseinforms them of how to gainaccess to their files.

The nurse supports clients in thedefence of their rights and inter-cedes for them if necessary. Shereminds clients if their health-related responsibilities.

Control mechanisms are put inplace to promote clients’ quality oflife.

Evaluation tools are made avail-able to nurses to enable them todetermine client satisfaction withthe care and treatment received.

Courses on various values, cultures and religions are offeredto nurses.

A code of ethics defining conductthat will ensure respect for clientrights is made available to nurses,as are the Code of Ethics of Nursesand other legal documents relatedto the practice of nursing.

A description of how clients maygain access to their files is madeavailable to nurses.

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Professional CommitmentPRINCIPLE The nurse demonstrates that her professional practice is based

on sound scientific knowledge that she updates continuously.The nurse is committed to her profession and exhibits solidarity with other nurses. She builds her professional iden-tity through various nursing care and treatment activities. Sherecognizes the importance of interdisciplinarity and the needto co-operate with organizations within the community.

ELEMENTS OF PRACTICE

The nurse has a conception of the person, health, theenvironment and nursing; she pursues a goal in thepractice of her profession and is able to describe thatgoal as well as the other elements of her conception.

The nurse is familiar with and respects the Nurses Act,and the Code of Ethics of Nurses, as well as the otheracts and regulations governing her practice.

The nurse commits herself to continuous education andto updating her knowledge.

The nurse demonstrates in her practice that she:• uses new knowledge;• contributes to the development of new knowledge;

• helps renew care practices; and• participates in nursing research projects or conducts research in nursing.

The nurse asserts her professional identity by:• explaining her role to clients, the general publicand various health care professionals;

• sitting on various multidisciplinary committeesthat have repercussions on nursing; and

• sitting on committees where her presence isrequested (e.g., Council of Nurses).

The nurse exhibits leadership skills:• within her profession, by initiating innovativenursing care approaches;

• within the health system, by contributing, with aview to interdisciplinary co-operation, to improv-ing quality of care and services within the healthcare setting and the health care network; and

• within society, by explaining and demonstratingnursing’s contribution to health.

The nurse co-operates with members of the health careteam to ensure that clients constantly receive qualitycare.

In the practice of her profession, the nurse:• collaborates with educational institutions andfacilitates field work for students;

• helps to train nursing externs and candidates forthe profession of nursing;

• shares her expertise and makes constructive com-ments to her nursing colleagues; and

• is proud of her profession.The nurse is well informed about:• the functioning of the health care system;• the major problems affecting changes in healthand welfare policies;

• the social situations affecting the health system(e.g., shortage of resources, aging population);and

• the progress of the discipline of nursing.Together with members of the multidisciplinary teamand health care institution administrators, the nurseparticipates in promoting legislative and social meas-ures to improve health and social services (representa-tions to amend or adopt health policies, draft bills,regulations, etc.).

The nurse acts responsibly, by:• making sure that she has the necessary compe-tencies before intervening in a clinical situation;;

• using human, material and financial resourceswisely; and

• taking into account her own health-related rightsand obligations.

The nurse is responsible, at all times, for the care andtreatment she administers to clients.

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Application of Descriptive Statements withRegard to Public Protection

For purposes of professional inspection, the Board of Directors of the Ordre des infirmières et infir-miers du Québec has adopted essential criteria, defined on the basis of the application of thedescriptive statements, with a view to protecting the public. These essential criteria are used todevelop evaluation tools for use in professional inspection. Supervision of professional practice tar-gets the client, the nurse and the organization, while the nurse is the main focus of specific inquiriesinto professional competence.

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ESSENTIAL CRITERIA

THE CLIENT (ANTICIPATED OUTCOMES)Le client est exempt :

• d’infections, d’accidents, d’escarres, d’abus et de violence directement liés aux soins infirmiers ;• de douleurs contrôlables.

Le client se dit renseigné, en confiance et en sécurité en ce qui a trait :• à son environnement ;• à sa situation de santé ;• à ses soins et ses traitements ;• à ses choix et ses décisions concernant sa santé.

THE NURSE (ELEMENTS OF PRACTICE)In the practice of her profession, the nurse assumes her responsibilities relating to all aspects ofher field of practice, in particular:

• assessing clients’ physical and mental state of health;• determining and adjusting the therapeutic nursing plan and ensuring that it is carried out;• administering nursing and medical care and treatment;

and to the activities reserved to nurses under section 36 of the Nurses Act.The nurse shows that she has the knowledge for her professional practice, in particular by makingthe appropriate clinical decisions.

In the practice of her profession, the nurse:• takes the necessary means to ensure continuity of care;• identifies and analyses risks to the safety of clients whether they are related to them or to the environment;

• takes the means to prevent harm to the client;• evaluates the results following nursing interventions.

The nurse assumes her role in interaction with the other team members.

ORGANIZATION (ORGANIZATIONAL ELEMENTS)Means are in place in the organization of nursing care to provide clients with safe care withrespect to:

• the number and the quality of human resources required;• the identification of dangerous situations and the corrective measures to be undertaken;• the work organization and the care delivery system.

The nurse, within the organization, takes the means to maintain client safety.

Conclusion

This document proposes a renewed vision of nursing practice, a vision that emerges from clients’expectations and rests on foundations recognized by nurses. The descriptive statements (and theessential criteria derived from them) are in accordance with this vision and are in keeping withthe present orientations of the professional system and the health and social services system.The OIIQ hopes that this outlook will be reflected in nurses’ daily practice and that it will help them to recognize themselves as partners with their clients. The OIIQ also hopes that this document will help to explain what quality practice is and will support nurses in their commitment to assuming the various aspects of their role.

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Nurses ActR.S.Q., c. I-8, s. 36, amended by S.Q. 2009, c. 28, s. 14*

1o assessing the physical and mental condition of asymptomatic person;

2o providing clinical monitoring of the condition of per-sons whose state of health is problematic, includingmonitoring and adjusting the therapeutic nursingplan;

3o initiating diagnostic and therapeutic measures,according to a prescription;

4o initiating diagnostic measures for the purposes of a screening operation under the Public Health Act(chapter S-2.2);

5o performing invasive examinations and diagnostictests, according to a prescription;

6o providing and adjusting medical treatment, according to a prescription;

7o determining the treatment plan for wounds andalterations of the skin and teguments and providingthe required care and treatment;

8o applying invasive techniques;9o participating in pregnancy care, deliveries and postpartum care;

10oproviding nursing follow-up for persons with complex health problems;

11o administering and adjusting prescribed medicationsor other prescribed substances;

12operforming vaccinations as part of a vaccinationoperation under the Public Health Act;

13omixing substances to complete the preparation of amedication, according to a prescription; and

14omaking decisions as to the use of restraint measures;

15odeciding to use isolation measures in accordancewith the Act respecting health services and socialservices and the Act respecting health services andsocial services for Cree Native persons;

16oassessing mental disorders, except mental retardation, if the nurse has the university degreeand clinical experience in psychiatric nursing carerequired under a regulation made in accordance with paragraph g of section 14;

17o assessing a child not yet admissible to preschooleducation who shows signs of developmental delay, in order to determine the adjustment and rehabilitation services required.

Professional CodeR.S.Q., c. C-26, s. 39.4, amended by S.Q. 2009, c. 28, s. 8*

39.4 The practice of the profession of the members of an order also includes disseminating information,promoting health and preventing suicide, illness, accidents and social problems among individuals and withinfamilies and communities to the extent that such activities are related to their professional activities.

36.1 Nurses may, if they are so authorized by regulations under subparagraph b of the first paragraph ofsection 19 of the Medical Act (chapter M-9) and under paragraph f of section 14 of this Act, engage in one or moreof the following activities referred to in the second paragraph of section 31 of the Medical Act:

1o prescribing diagnostic examinations;2o using diagnostic techniques that are invasive orentail risks of injury;

3o prescribing medications and other substances;

4o prescribing medical treatments; and5o using techniques or applying medical treatments thatare invasive or entail risks of injury.

* At the time of publication, activities 15, 16 and 17 of section 36 of the Nurses Act were not yet reserved to nurses. They will beonce section 14 of the Act to amend the Professional Code and other legislative provisions in the field of mental health andhuman relations (S.Q. 2009, c. 28) comes into force. The same applies for suicide prevention, which will be included in thecommon activities (section 39.4 of the Professional Code), once section 8 of that Act takes effect.

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36. The practice of nursing consists in assessing health, determining and carrying out the nursing careand treatment plan, providing nursing and medical care and treatment in order to maintain and restore the healthof a person in interaction with his environment and prevent illness, and providing palliative care.

The following activities in the practice of nursing are reserved to nurses:

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Anticipated client outcomesIndices that reveal the effects of nursing careprovided to individual clients or a category of clients. These indices include improvementof the clients’ health, well-being and quality oflife, and acquisition of new knowledge or self-care skills by clients. Satisfaction indices mayalso be considered as an anticipated outcome.

ClientPerson (family, group or community) whosolicits nursing in order to be cared for, treated, informed, reassured and comforted,and to acquire the skills required to maintain or improve health, well-being or quality of life.

CommunityGrouping of persons with a common characteristic. Communities are generallydefined in terms of three characteristics: acommon geographical territory (neighbour-hood, school), a common feature (religiousbeliefs, age) or a common problem (pollutedwaterway). Most members of a community maynot know each other personally and may nothave direct contact with each other.

Elements of practiceInterventions related to the nurse’s field of practice, intended to maintain, restore or improve clients’ health, or to help them diewith dignity. These interventions include pro-fessional activities reserved to nurses undersection 36 of the Nurses Act and related activities, information, health promotion and prevention of disease, accidents and social problems.

FamilyTwo or more people linked emotionally whodefine themselves as a family unit (nuclearfamily, extended family, single-parent family,blended family). Each family is a social systemwith distinctive values, structural features andfunctions. This system evolves throughout thevarious stages of life.

Functional rehabilitationActivities designed to help clients recover asquickly as possible the functions lost as a resultof physical or mental illness, an accident or anaddiction problem.

GroupTwo or more people who communicate andidentify with each other and are interdependentbecause of one or more common interests.

Health historyEvents, facts, gestures or all information related to a person’s (family, group or commu-nity) health and associated with the person’spast or present situation.

Health problemDifficulty that a person (family, group or community) must diminish or resolve in orderto maintain or reach a state of equili-brium and evolve toward self-actualization.

Health promotionActivities designed to help clients maintain or improve their health, well-being and qualityof life.

InterdisciplinaritySituation in which services provided for a person, family, group or community are offeredby diverse healthcare professionals acting incollaboration. After jointly determining theircommon goals and objectives relating to theperson, family, group or community, these professionals decide on solutions and interven-tions, their priority, and how their respectiveroles and activities are to be shared in light of their specific disciplines.

Interdisciplinary intervention planPlan that includes the interventions plannedjointly by members of the multidisciplinaryteam, to meet clients’ care and support needsduring an episode of care.

Natural support network

Group of persons surrounding an individualand providing him/her with emotional, cognitive and material support. This networkcomprises significant others such as relatives, neighbours, friends, teachers,guardians, foster family members, etc.

Glossary

Nursing care and treatment planPlan that includes all the nursing care and treatment, prescribed medical care and treatment and other interventions whose implementation is planned andensured by the nurse.

Nursing processMethodical approach that can be appliedto nursing; it includes data collection andinterpretation, planning and implementingof interventions as well as the evaluation of the fulfillment of objectives (or anticipated outcomes).

Organizational elementsExternal factors that contribute to the qualityof the practice of nursing, in particularhuman and material resources, the healthcare facility’s nursing policies, rules governing nursing care and other supportmechanisms for nursing practice.

PartnershipAlliance between two or more persons whoshare a common objective, determined bymutual agreement. Clients and nurses arepartners with regard to maintenance andimprovement of clients’ health; even whenclients are going through a particular transi-tional stage of their life or experiencinghealth problems that make them vulnerable,they remain active partners.

Prevention of illness, accidents, socialproblems and suicideActivities intended to reduce current or poten-tial health risks (infections, accidents, suicide,crisis situations or violence, etc.). These risksmay be related to living habits, transitions inlife or to the environment.

Professional commitmentBehaviour of a nurse who is aware that shebelongs to a profession, to a service networkand to a society. The nurse must use her scientific knowledge and her art to serve herfellow citizens, the clients of the health network and her colleagues in nursing and in other disciplines.

Quality of lifeClients’ view of their health and well-being,i.e. as perceived and experienced by them.Interventions intended to maintain orimprove quality of life are evaluated basedon the degree of clients’ physical and psychological well-being, their degree ofautonomy, feeling of security and the extentto which they achieve self-actualization. Theassessment of the quality of life must takeinto account clients’ personal resources,those found in their natural support networkand those found in the environment.

Self-careA person’s (family, group or community)capacity to perform activities that best satisfy his/her health needs as well as those of family and friends.

Therapeutic nursing planRecorded in the client’s file, the therapeuticnursing plan is determined and adjusted bythe nurse on the basis of her clinical assess-ment. It provides an evolving clinical profileof the client’s priority problems and needs,and states the nursing directives issued forthe client’s clinical follow-up, particularly asregards clinical monitoring, care and treat-ment. The therapeutic nursing plan coversthe continuum of care and services and mayencompass more than one episode of care.

Therapeutic processNursing care and treatment activitiesintended to help clients deal with reactionsassociated with illness or diagnosis, alongwith activities designed to support them asthey restore their health or to help them die with dignity. These activities includediagnostic and therapeutic activities initiat-ed or performed by the nurse according to aprescription, as well as activities aimed athelping or encouraging clients to participatein the care and treatment required by theirstate of health.

Well-beingSubjective and multidimensional experienceas a result of harmony between a person’saspirations, health-promoting behavioursand environmental conditions.

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Glossary (continued)

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References (continued)

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