世卫组织总干事陈冯富珍博士在国际护士会的主旨讲话（中英对照）

Ladies and gentlemen,

女士们、先生们，

The nursing profession is acutely aware of what these trends mean for health care, the costs, and the added demands on the daily practice of your work. The level of awareness is readily apparent in the agenda for this event.

护理行业已经敏锐地注意到这些趋势对于卫生保健、相关费用以及对你们日程工作的更多要求意味着什么。这种认识也明显反映在本次大会的议程上。

The nursing profession, that so-called “sleeping giant”, is actually wide awake and ready to race ahead in clearly defined strategic directions. You are waiting for the starting gun.

护理行业这个所谓的“沉睡的巨人”其实早已醒来，并准备好朝着明确界定的战略方向全力奔跑。你们正在等待发令枪响。

Even more so, you are waiting for someone to let up on the reins that hold you back, the constraints that keep you from performing with the full set of competencies for which you were educated, trained, and licensed.

甚至，你们正在等待有人来放松束缚着你们的缰绳，使你们摆脱限制，从而发挥出你们通过教育、培训获得并因而拥有从业资格的全部能力。

Some constraints have historical roots, often in legislation. As far back as 1986, experts convened by WHO concluded that national and subnational regulations often prevent nurses from exercising their full knowledge and skills.

一些限制有其历史渊源，往往存在于立法中。早在1986年，世卫组织召集的专家就得出结论：国家和地方法规常使护士无法运用他们的全部知识和技能。

The report set out a strategy for strengthening the contribution of nurses to primary health care based on a reorientation of legislation.

该报告阐述了通过调整立法加强护士对初级卫生保健的贡献的战略。

The impact of that strategy has been disappointing. Much more recently the US Institute of Medicine’s 2010 report on “The future of nursing: leading change, advancing health” reached much the same conclusion.

该战略的影响令人失望。美国医学研究所2010年报告《护理的未来：引领变革、推动健康》得出了基本一样的结论。

Again, that report argued that nurses should be able to practice to the full extent of their education and training.

报告再次指出，应该让护士充分实践他们所受到的教育和培训。

The conclusion is similar to the one made 24 years ago: regulatory and institutional obstacles, including limits on nurses’ scope of practice, should be removed so that health systems can reap the full benefit of their training, skills, and knowledge.

其结论与24年前的结论类似：应消除监管和体制障碍，包括对护士执业范围的限制，使卫生系统能够充分利用他们的培训、技能和知识。

Other constraints are attitudinal, often entrenched in the views and policies of national medical associations. As bluntly stated by the IOM report, physicians are unwilling to embrace policy that expands the supply and roles of nurses.

其它限制则是态度上的，根深蒂固地存在于国家医学协会的观点和政策中。正如美国医学研究所报告所直率指出的那样，医生不愿意接受扩大护士供应和职能的政策。

My own view is this. Given the enormous complexity of health challenges faced as the world transitions to the post-2015 era, no one, including WHO, dares to ignore the full contribution that the nursing profession can make.

我个人的看法是这样的：随着全世界进入2015年以后阶段，鉴于卫生挑战极为复杂，没有人，包括世卫组织，敢忽视护理专业人员所能做出的全部贡献。

If for no other reason, we cannot afford to ignore you.

即使没有其它原因，我们也负担不起忽视你们的后果。

A recent study conducted in the US found that the majority of clinicians have no idea about the costs of the interventions they order or the procedures they perform. In contrast, nurses are trained to work in a context of cost constraints, especially when their job involves procurement of medicines and hospital supplies.

美国最近一项研究发现，大部分临床医生对于自己所要求采取的干预措施或是开展的医学程序的费用一无所知。与此相反，护士接受的培训就包括在费用受限情况下开展工作，特别是在其工作涉及采购药品和医院物资的情况下。

Nurses need to have a much more active role in the policy process, especially in decisions that influence the financing of health services.

护士需要在决策进程中发挥更为积极的作用，特别是对影响卫生服务供资的决定。

For NCDs, we cannot afford to miss opportunities for prevention, for early diagnosis, for counselling aimed at behavioural change, or for community-based approaches that improve health literacy.

面对非传染性疾病，我们负担不起失去预防、早期诊断、提供咨询以促进行为变化或是以社区为基础提高健康意识机会的后果。

As I speak, many health systems are at a critical juncture in planning their health workforces. For several reasons, the supply of primary health care physicians is dwindling, precisely at a time when the need for primary care has never been greater.

目前，许多卫生系统都处于规划卫生人力的关键时刻。由于种种原因，初级卫生保健医生的供应正在萎缩，而初级保健需求却比历史上任何时候都多。

In countries facing a shortage of primary care physicians, one way to fill the gap is to permit nurses with advanced degrees to practice without a doctor’s oversight, order and interpret diagnostic tests, prescribe medicines, and administer treatment. Yet this obvious solution still faces opposition from the medical profession.

在缺乏初级保健医生的国家，填补空白的一个办法是允许具有高级学位的护士在没有医生监督的情况下执业，包括开化验单和解读化验结果、开药以及管理治疗。但是，这一明显的解决方案仍面临来自医生的反对意见。

Physicians who continue to believe that expanding the scope of nursing practice will have an adverse effect on the quality of patient care have not looked at the evidence. Mounting evidence shows that this opposition is more about competition than competence.

仍然认为扩大护士执业范围对患者护理质量有不良影响的医生是没有研究证据。越来越多证据表明，这种反对意见更多是出于竞争而不是能力考虑。

Nor can we afford to ignore other lines of evidence. Hospitals with a higher ratio of nurses to patient have lower mortality rates.

我们也负担不起忽视其它证据的后果。护士与患者比例更高的医院死亡率更低。

Studies underscore the quality of care provided by nurses, including preventing medical errors and medication mistakes, reducing or eliminating infections, shortening hospital stays, and easing the transition of patients from hospital to home.

多项研究显示，护士可以提供高质量护理，包括防止医疗和用药错误、减少或消除感染、缩短住院时间、使患者从医院到家里的过渡更为容易。

Nurses using new technologies to care for patients, including the elderly, in their homes have been shown to reduce the number of hospital readmissions and visits to emergency wards. All of this cuts costs, of course, but it also improves the quality of life for patients.

有证据显示，护士使用新技术在患者（包括老年人）家里提供护理有助于减少重新住院和进入急诊病房的次数。所有这些当然都会降低费用，但也会提高患者的生活质量。

What is needed is a less rigid dichotomy between the autonomy of nurses and doctors, and more collaborative teamwork.

需要减少护士和医生之间僵化的二分法，并进行更多团队合作。

This emphasis is thought to be one reason for the effectiveness of the WHO Surgical Safety Checklist, which gives all members of the team, and most especially nurses, an equal voice in decisions about surgical care.

强调这一点被认为是世卫组织手术安全检查表有实效的原因之一。该检查表使所有团队成员，特别是护士，在有关手术护理的决定中有平等发言权。

Studies conducted in eight countries showed that use of this simple 19-item checklist reduced the rate of deaths and surgical complications by more than one third.

在八个国家进行的研究表明，这一简单的包含19项内容的检查表使死亡和手术并发症率降低了三分之一还多。

Other studies have noted an increased likelihood of staff speaking up when a problem is noticed. In fact, WHO recommends that a nurse be put in charge of running the checklist.

其它研究还注意到，工作人员更愿意在注意到问题时把问题提出来。事实上，世卫组织建议由护士负责根据检查表核对各项内容。

Ladies and gentlemen,

女士们、先生们，

The nursing profession can transform the way health services are organized and how health care is delivered.

护理专业可以改变卫生服务的组织和提供方式。

The sleeping giant is wide awake. With health challenged by so many first-time events, the starting gun has sounded.

沉睡的巨人早已醒来。面对如此之多“第一次”事件带来的挑战，发令枪已经打响。

You know where the health of this world needs you to run, and you are fully competent to move in those directions.

你们知道这个世界的卫生事业需要你们往哪个方向奔跑，而且你们也完全有能力朝那个方向前进。

As I said, no one can afford to ignore your potential to change things for the better.

如我所言，没有人负担得起忽视你们改变形势使之朝好的方向发展的潜力所产生的后果。

More cost-effective and more care-effective services will be the result.

而你们的努力将带来更有成本效益、更见护理效果的服务。

Thank you.

谢谢大家。