STANDARDSOF NURSING PRACTICE
Japanese Nursing Association
Revision 2021

Introduction
In 1995, the Japanese Nursing Association (JNA) formulated the JNA Standards of Nursing
Practice*1 ("the Standards") to delineate the required levels of nursing practice*2 common to all
nursing professionals specified in the Act on Public Health Nurses, Midwives and Nurses, as wellas the responsibilities of nursing professionals. In 2006, the Standards were revised in response tothe requirements of the changing times. At this time, the JNA indicated a policy for a review of theStandards in accordance with changes in the environment surrounding nursing.
Against this backdrop, the JNA established a special committee for the review of the Standards
from 2014 to 2016 and started with a review of desirable nursing standards.
In Japan, society is becoming super-aged with a declining birth rate. Needs for medical and longterm care are not only increasing, but also becoming more diversified and complicated owing to
the advancement of medical care and changes in people's awareness. Various policies and systems
pertaining to the treatment and care settings are rapidly shifting from a conventional hospital-based
approach to community-based approach. For the providers of healthcare and welfare services, theviewpoint of support focused on persons living in the local community has become indispensable.
Owing to these changes, nurses have recently been playing increased roles, while the fields andsettings for their activities have become diversified. Expectations of nurses are great, asprofessionals who respond to the increasing advancement of medical care, prevent illness andpromote health for the extension of people's healthy life expectancy, sustain care beyond theborders of facilities and communities, and support each person to live a life that suits themthroughout their lifetime.
Because nursing practice*2 is in the midst of substantial changes, the importance of guidelines
common to all nurses has increased.
Therefore, the JNA has decided that the Standards should indicate the core part of nursing
practice*2 common to all nurses, including public health nurses, midwives, nurses, and assistantnurses, regardless of their workplace, age, or career. From this standpoint, the JNA formulated theStandards of Nursing Practice*1 (Revision 2016). The JNA reviewed and revised the Standards as
the JNA Standards of Nursing Practice*1 (Revision 2021), in line with the JNA Code of Ethics for
Nurses revised in March 2021.
As the settings of nursing practice*2 have become diversified, the necessity for clarifying the core
part of practice*2 has increased. It is important to delineate the required levels of nursing practice*2
in the Standards in order to guarantee the quality of nursing.
The term "nursing practice (gyomu) 1" refers to what and how a service should be rendered and ledby the providers of nursing care, while "nursing practice(jissen)" signifies the approach by allnurses to persons who are being cared for, and comprises the main part of nursing
practice(gyomu).

1The term "nursing practice" is expressed differently in Japanese, where it is translated as"gyomu*1" or "jissen*2".

1 Standards of Nursing Practice*2
1-1

Responsibilities for nursing practice*2
1-1-1

All nursing practice*2 activities are based on the JNA Code of Ethics for
Nurses ("the Code").

Nurses are persons who are authorized to practice*2 nursing by license and who practice*2 nursing in order tofulfill their social responsibilities referring to the Code as their action guidelines.

1-1-2

Nurses act from the standpoint of respecting human life and dignity.

Nurses are professionals who respect human life, human dignity, and human rights. Nurses must fulfill thisresponsibility as professionals no matter what reason they may have. Nurses raise questions when they identify
an act of others that may compromise human life or dignity.

1-1-3

Nurses provide safe, secure, and reliable nursing care.

In nursing practice*2, nurses place the first priority on the safety and security of persons who need nursing careand support them to maximize their abilities based on their professional knowledge. Nurses also endeavor toimprove the quality of their nursing practice*2 and continuously improve their professional skills to maintainsocial trust.

1-2

Activities for nursing practice*2
1-2-1

Nurses support persons who need nursing care in physical, mental, social,and spiritual aspects.

Nurses comprehensively understand individuals, their families, groups and local communities that need nursing
care in physical, mental, social, and spiritual aspects, and support each person to live a life that suits themthroughout their lifetime.

1-2-2

Nurses support decision-making by persons who need nursing care.

All persons have the right to know their health condition and treatment and to make decisions based onadequate information. Nurses respect the decision-making right of persons who need nursing care and support
them to make choices that best match them.

1-2-3

Nurses support persons who need nursing care to better adapt to changes.

In the provision of healthcare and welfare services, nurses support persons who need nursing care to understandthe specifics and purpose of the services and to take a proactive role in the services with peace of mind. Nurses
also provide support in the adjustment of lifestyle and the living environment in response to changes in healthlevels.

1-2-4

Nurses perform medical interventions under the instructions of theattending physician, monitor the response, and take appropriate measures
based on the response.

Nurses perform medical interventions under the instructions of the attending physician pursuant to Article 37 of
the Act on Public Health Nurses, Midwives and Nurses. Nurses raise questions when an activity does notrespect human life, human dignity, or human rights. Nurses determine the following points based on theirrespective licenses.
1. Rationale and ethics of medical interventions
2. Appropriate protocol for the persons who are being cared for
3. Observation of response to medical interventions and appropriate measures

1-2-5

Nurses take effective measures in emergency situations.

An emergency situation signifies a situation where lives are extremely threatened, including times of disaster.
In such an emergency, nurses promptly ascertain the situation, arrange for necessary human resources, and takeeffective first-aid measures.

1-3

Methods for nursing practice*2
1-3-1

Nurses explain the purpose and methods for nursing practice*2, andpractice*2 nursing based on agreement.

Nurses explain the purpose and methods for their nursing practice*2. In this process, nurses adequately respect
the understanding and intentions of the persons who need nursing care, and endeavor to obtain their agreement.

1-3-2

Nurses make necessary decisions in nursing practice*2 based onprofessional knowledge.

Nurses make necessary decisions in nursing practice*2 based on professional knowledge and their respective
licenses. Nurses refer to scientific evidence for making more appropriate decisions. Nurses also endeavor toacquire multidisciplinary knowledge in related fields and learn the latest findings and skills.

1-3-3

Nurses continuously monitor persons who need nursing care, assess theircondition, and take appropriate measures.

Nurses continuously monitor the individuals, their families, groups and local communities that need nursing
care, and comprehensively identify and assess their health condition and living environment, in order to clarify
support to be provided and formulate, implement, and evaluate the relevant plans. This course of process istaken to rapidly and flexibly adapt to changes in their health condition and living environment. The process isreviewed as appropriate to provide support for improving their condition, and various resources are utilized
when necessary.

1-3-4

For collaboration in team care, nurses understand their respective roles andabilities and those of team members.

To collaboratively provide necessary healthcare and welfare services as a team, nurses understand therespective roles of professionals and non-professional staff engaged in the provision of services and exercise
their expertise as nursing professionals.

1-3-5

Nurses keep a record of the course of process of nursing practice*2.

The record of the course of process of nursing practice*2 indicates the professional thoughts and activities ofnurses. To guarantee the continuity and consistency of nursing practice*2 and to enable evaluation and qualityimprovements, the record should be kept in an objective manner that facilitates information sharing in all kindsof nursing settings. The record evidences the nursing practice*2 that has been implemented. The record of thespecifics of nursing practice*2 is handled while protecting personal information and confidentiality. Reasonabledecisions should be made regarding sharing with others.

2 Standards of the Organization of Nursing Practice*22-1

Nursing practice*2 is implemented by an organization with a philosophy.

To provide continuous and consistent nursing care, an organized group of nursing professionals is required. An
organization that implements nursing practice*2 must clarify its basic philosophy for management, values, andsocial benefits. Its philosophy must not contradict with the Code of Ethics for Nurses of the JNA or of theInternational Council of Nurses (ICN), or with the philosophy of the institution or facility to which theorganization belongs.

2-2The organization and management of nursing practice*2 are undertaken by themanagers of nursing professionals.

The organization and management for providing continuous and consistent nursing care are undertaken by themanagers of nursing professionals (hereinafter referred to as "nurse managers") who are capable of determining
optimal nursing care, are familiarized in nursing practice*2, and have the knowledge and skills of nursing
management.

2-3

Nurse managers establish an environment for providing high-quality nursingcare.

Nurse managers maintain a nursing structure for providing high-quality nursing care. Nurse managers alsoestablish an environment that enables nurses and nursing aides to fully exercise their abilities and continue
working and provide compensation that matches their responsibilities.

2-4

Nurse managers manage resources required for nursing practice*2.

For the organization that provides nursing care to attain its purpose, nurse managers are responsible foracquiring necessary human resources, supplies, funds, information, and other resources, and for effectively
utilizing these resources based on time management.

2-5

Nurse managers evaluate nursing practice*2 and endeavor to guarantee thequality of practice*2.

In accordance with the purpose of the organization that provides nursing care, nurse managers establish astructure and system to evaluate nursing practice*2, and continuously endeavor to guarantee and improve thequality of practice*2.

2-6

Nurse managers provide an educational environment for the improvement ofnursing practice*2.

Nurse managers maintain the practical abilities of nursing professionals, and support their respective
development and occupational maturity while enhancing the power of the group to provide nursing care andachieving an educational environment for contributing to individuals, their families, groups, local communities
that need nursing care.

[Notes concerning assistant nurses]
While the JNA Standards of Nursing Practice*1 include all nurses in its scope, it must be noted that there aredifferences between nurses and assistant nurses regarding their statutory definitions, hours and content ofeducation, and basic concept of education.
○ Definitions of nurses and assistant nurses (Act on Public Health Nurses, Midwives and Nurses)- Nurse:"a person who has acquired a nursing license from the Minister of Health, Labour andWelfare to provide medical treatment or assist in medical care for injured and ill persons or
puerperal women, as a profession" (Article 5)- Assistant nurse: "a person who has acquired a nursing assistant license from the prefectural governor topractice*1 nursing that is set forth in the preceding Article under the direction of aphysician, dentist, or nurse, as a profession" (Article 6)○ Basic concepts for the education of nurses and assistant nurses (based on the Tutorial Guidelines for
the Management of Nursing Schools*)- Nurse:"To develop basic abilities to make necessary clinical decisions in nursing practice*2 basedon scientific rationale," etc.
- Assistant nurse: "To develop abilities to safely assist nursing and medical care, considering the comfort ofpersons who are being cared for, under the direction of a physician, dentist, or nurse," etc.
* Based on a partial revision in 2020

Based on these differences, a different required level applies to assistant nurses in the following part of "1-3Methods for nursing practice*2."- Instead of "1-3-3 Nurses continuously monitor persons who need nursing care, assess their condition, and takeappropriate measures," assistant nurses provide support to persons who need nursing care under the directionof nurses, based on the plans formulated by nurses.

Reference: extract from the JNA Code of Ethics for Nurses (Japanese Nursing Association,2021)
CODE
1. Nurses respect human life, human dignity, and human rights.
2. Nurses provide equitable nursing to persons who are in their care.
3. Nurses establish a relationship of trust with persons who are being cared for and provide nursing based on thatrelationship.
4. Nurses respect people's rights and support them to make choices that match their intentions and values.
5. Nurses respect the confidentiality of persons who are being cared for and properly handle personal information.
6. If a risk or harm arises for persons who are being cared for, nurses protect them and ensure their safety.
7. Nurses accurately understand their responsibilities and abilities and are responsible for their nursing practice asindividuals.
8. Nurses always endeavor to develop, maintain, and improve their abilities through continuous learning as part of theirindividual responsibilities.
9. Nurses achieve better healthcare and welfare services in collaboration with other professionals.
10. To provide nursing care of higher quality, nurses set a behavioral standard for practice and behave to act with thestandards.
11. Through research and practice, nurses endeavor to create and develop professional knowledge and skills andcontribute to the development of nursing science.
12. To practice nursing of higher quality, nurses endeavor to improve their own well-being.
13. Nurses always endeavor to maintain integrity and enhance social trust of all nurses.
14. To protect people's lives and health, nurses share responsibilities with society based on the idea of social justiceconcerning various issues.
15. Nurses belong to professional organizations, participate in activities to enhance the quality of nursing, and contributeto the achievement of a better society.
16. In collaboration with various disaster relief providers, nurses make all possible efforts to protect the lives, health, andlivelihood of all people affected by disasters.
For the full text of JNA Code of Ethics for Nurses, visit:

URL：https://www.nurse.or.jp/assets/pdf/nursing/code_of_ethics.pdf

October 2021
Published by: Japanese Nursing Association (JNA)
5-8-2 Jingumae, Shibuya-ku, Tokyo 150-0001
Tel: +81 3 5778 8831
URL: https://www.nurse.or.jp
Contact:
Nursing Practice and Healthcare Safety
Division, Department of Nursing
Development, JNA
Tel: +81 3 5778 8548
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