1、1,Role Relationship Patterns,2,what kinds of outline are the most important in the chapter?,RoleRelationshipPatterns,3,Basic ConceptsDefinitionsRelated TermsPersonal Interpretations of RoleSocietal Interpretations RoleEffects of Alteration in Role Performance on Others,OUTLINE,p.108,RoleRelationship
2、Patterns,4,ApplicationsProfessional Nurse RoleTypes of Professional RolesRole SocializationRole StressSelf-awareness in the Professional Role,OUTLINE,p.108,RoleRelationshipPatterns,5,Client RolePatients Bill of Rights Role Performance as a Nursing DiagnosisSupportive InterventionsDeveloping New Solu
3、tions Summary,OUTLINE,p.108,RoleRelationshipPatterns,6,What are the objectives of learning or studying in our lesson?,RoleRelationshipPatterns,7,At the end of the chapter, the student will be able to 1. Define role and role performance2. Describe the four components of professional role socializatio
4、n3. Discuss the professional roles of the nurse4. Discuss the characteristics of the sick role,Objectives,p.108,RoleRelationshipPatterns,8,RoleRelationshipPatterns,Objective One:Define role and role performance,9,What is role?,A role is defined as a set of expected behavioral standards established b
5、y the society or community to which a person belongs (Creasia, 1991).,Definitions,p.109-110,RoleRelationshipPatterns,10,What is role relationship?,Role relationships influence communication content and process. Consider your own “role” as a nursing student and how it influences communication content
6、 and process.,Definitions,p.109-110,RoleRelationshipPatterns,11,什么是人际关系和人际沟通？,人际关系人际关系是人们通过交流与相互作用而形成的比较稳定的心理关系，反映着个体或群体满足其社会需要的心理状态，其发展变化取决于双方社会需要的满足程度。人际关系外延很广，包括朋友关系、夫妻关系、师生关系、同学关系、同事关系等。内涵是个体之间的心理上的关系，表现为亲近或疏远、敌对或友好等心理上的距离。,p.310,RoleRelationshipPatterns,12,什么是人际关系和人际沟通？,人际沟通人际沟通是指人际间的信息交流。可以是面对
7、面的，也可以是非面对面的，可以是语言的，也可以是非语言的，旨在传达思想、交换意见、表达感情和需要等。它包括关系沟通与内容沟通，即每个沟通都包含着一定的内容和确定一定的关系。内容是指沟通中所传信息的实质含义，关系是指沟通各方在沟通中所处的地位和联系方式。,p.303 p.310,RoleRelationshipPatterns,13,你能举例说明人际关系沟通和内容沟通之间的联系吗？,护士：“昨晚我给xx（患者）的药为什么没吃？,护患关系 内容沟通效果,很熟悉 成功 一般 有心理距离但可能成功 紧张 很难有效，患者家属可能说“我怎么知道？没吃药到底是谁的责任。”,RoleRelationshipP
8、atterns,14,What is role performance?,Role performance refers to a persons capacity to function in accord with social expectations of a particular role. Perceptions of behavioral standards for role performance differ from based on cultural, gender, institutional, and family expectations; People still
9、 expect different role behaviors from men and women despite tremendous advances in equal opportunity.,Definitions,p.109-110,RoleRelationshipPatterns,15,Role transition describes changes in role expectations that occur as developmental life crises or when unexpected life events such as illness or inj
10、ury alter role function. For example, new mother experiences a significant role transition with the birth of her first child, as does a young athlete struck down in a ball game with a spinal cord injury.,What is role transition?,Definitions,p.109-110,RoleRelationshipPatterns,16,What is position?,Pos
11、ition represents a standardized description of a role and associated expectations that makes it understandable to others in the community or group. Social position relates to the status and identity the person holds in the community. The concept of position sometimes plays a role in how helping prof
12、essionals respond to clients: they sometimes treat clients in high positions differently than those with no money or low social status.,Definitions,p.109-110,RoleRelationshipPatterns,17,Whereas it is important for the nurse to recognize differences in position as relevant factors in supporting clien
13、t integrity and self-esteem, nurses need to view all clients as very important persons, treating them all with the same respect and giving them all quality care regardless of position.,Definitions,p.109-110,What is position?,RoleRelationshipPatterns,18,RoleRelationshipPatterns,Objective Two: Describ
14、e the four components of professional role socialization,19,首先，我们先抛弃任何病理性及并发症因素，我们从物理学角度来看高血压，根据流体力学的原理及压缩动力学原理，我把心脏和血管及毛细血管比喻成密封的压力循环系统，就是说人体是一台机器，心脏和血管就是润滑系统。中医认为高血压形成原理是：血管内皮组织代谢不稳定、交感和副交感神经系统混乱造成血压的升高。 1、从最常见的肥胖者高血压说起，太胖脂肪过多，对血管造成一定的挤压，当管道被挤压以后，动力源需要加大动力才可能使原来的循环达到流通，动力源动力加大，管道压力也会随之加大，就形成了高压。 2
15、、内部血液及其他疾病引起的血栓造成的，血液的新陈代谢，排出不够彻底，在管道内部形成污垢，对管道造成一定的堵塞，会使压力升高。 3、老年性管道硬化及疾病性硬化，管道打折硬化的话，会造成高压。 4、疾病性毛细血管堵塞和外伤性毛细血管堵塞，也是其中的因素之一。 5、机体病变性引起的，一部分高血糖患者，是因为消化系统太过亢奋，在肠胃方面有病变，在肠胃机体方面就会形成一定的血液循环堵塞，也会造成高压，这里只举一个例子。 6、心脏方面的先天及后天的缺失。 7、脑血管疾病引起的。 8、血液干涸造成的高压。 以上因素受季节变化影响，容易发病！ 血压调控机制多种因素都可以引起血压升高。心脏泵血能力加强（如心脏收
16、缩力增加等），使每秒钟泵出血液增加。另一种因素是大动脉失去了正常弹性，变得僵硬，当心脏泵出血液时，不能有效扩张，因此，每次心搏泵出的血流通过比正常狭小的空间，导致压力升高。这就是高血压多发生在动脉粥样硬化导致动脉壁增厚和变得僵硬的老年人的原因。由于神经和血液中激素的刺激，全身小动脉可暂时性收缩同样也引起血压的增高。可能导致血压升高的第三个因素是循环中液体容量增加。这常见于肾脏疾病时，肾脏不能充分从体内排出钠盐和水分，体内血容量增加，导致血压增高。 相反，如果心脏泵血能力受限、血管扩张或过多的体液丢失，都可导致血压下降。这些因素主要是通过肾脏功能和自主神经系统（神经系统中自动地调节身体许多功能的
17、部分）的变化来调控。 编辑本段临床表现1、头疼：部位多在后脑，并伴有恶心、呕吐等症状。若经常感到头痛，而且很剧烈，同时又恶心作呕，就可能是向恶性高血压转化的信号。 2、眩晕：女性患者出现较多，可能会在突然蹲下或起立时有所感觉。 3、耳鸣：双耳耳鸣，持续时间较长。 4、心悸气短：高血压会导致心肌肥厚、心脏扩大、心肌梗死、心功能不全。这些都是导致心悸气短的症状。 5、失眠：多为入睡困难、早醒、睡眠不踏实、易做噩梦、易惊醒。这与大脑皮质功能紊乱及自主神经功能失调有关。 6、肢体麻木：常见手指、脚趾麻木或皮肤如蚁行感，手指不灵活。身体其他部位也可能出现麻木，还可能感觉异常，甚至半身不遂。 物(特别是阿
18、司匹林和非甾体类消炎药，参见消化性溃疡的治疗部分)，克罗恩病或病毒感染所引起。幽门螺杆菌可能在此不发挥重要作用。 症状多为非特异性的，可包括恶心，呕吐和上腹部不适。内镜下显示在增厚的皱襞隆起边缘有点状糜烂，中央有白斑或凹陷。组织学变化多样。尚无某种方法具有广泛疗效或可治愈。 治疗多为对症治疗，药物包括制酸剂，H2拮抗剂和质子泵。 2慢性胃炎的癌变 对于胃溃疡发生癌变，人们比较容易理解，但对于有些类型的慢性胃炎也会发生癌变，许多人会感到不可思议然而，慢性萎缩性胃炎发生癌变却是事实 编辑本段现代中医史（df4肺炎88gdg青霉素d25f肝炎df6）轴心时代中、西医学的峰巅之作。雅斯贝而斯曾说：“如
19、果历史有一个轴心，那么我们就必须将这轴心作为一系列对全部人类都有意义的事件，发生于公元前800至200年间的这种精神历程似乎构成了这样一个轴心。,医学健康系列精品课件,本文档下载后可以修改编辑，欢迎下载收藏。,20,Unlike other forms of education, the nursing student must simultaneously(同时地)adjust to learning new material while starting on the job training in which the stakes(风险)are high.Cohen identified
20、 four goals of professional socialization (see Box 6-4). ,Which is the four components of professional role socialization ?,Professional Nurse Role,p.114-115,RoleRelationshipPatterns,21,Box 6-4.Steps in the Socialization Process Learn the technology of the profession: the facts, skills, and theory.
21、Internalize(使内在化)the professional culture Find a personally and professionally acceptable version of the role. Integrate this professional role into all the other life roles.,RoleRelationshipPatterns,22,Box 6-4.Steps in the Socialization Process 学会专业技能：专业法规、技术和理论。 与专业文化融为一体。 找到就个人和职业而言都可接受的角色类型。 把职业
22、角色整合到所有其它生活角色中。,RoleRelationshipPatterns,23,Exercise Looking at My Development as a Professional Nurse,Purpose: To help you focus on your self-development as a professional nurse,RoleRelationshipPatterns,24,Exercise Looking at My Development as a Professional Nurse,Procedure:Write the story of how y
23、ou chose to become a nurse in a one- to two-page essay (may be done as a homework assignment). There are no right or wrong answers; this is simply your story. You may use the following as guides in developing your story.,RoleRelationshipPatterns,25,Exercise Looking at My Development as a Professiona
24、l Nurse,Procedure: What are your reasons for choosing nursing as a profession? What factors influenced your decision; people, circumstances, or situations? Describe your vision of yourself as a nurse. What fears do you have about your ability to function as a professional nurse? How do you think bei
25、ng a nurse will affect your personal life?,RoleRelationshipPatterns,26,In what ways is your story similar to or different from those of your classmates? As you wrote your story, were you surprised by any of the data or feelings?,RoleRelationshipPatterns,Discussion:,27,Students can discuss some of th
26、e realistic difficulties encountered as nursing students both professionally and personally and ways to handle them. Explore through discussion the following: The practices nursing students will need to follow to achieve their vision The types of supports nurses need to foster their ongoing professi
27、onal development,RoleRelationshipPatterns,Discussion:,28,RoleRelationshipPatterns,Objective Three:Discuss the professional roles of the nurse,29,Which are there Professional Nursing Roles,P.116,1. Caregiver: a. Provides complete or partial compensatory care for clients who cannot provide these self-
28、care functions for themselves b. Implements supportive/educative actions to promote optimum health Reinforces the natural, developmental, and healing processes within a person to enhance well-being, comfort, function, and personal growth,Professional Nurse Role,RoleRelationshipPatterns,30,2. Teacher
29、: a. Provides health teaching to individual clients and families b. Develops and implements patient education programs to promote/maintain healthful practices and compliance with treatment recommendations c. Guides individuals in their human journey toward wholeness and well-being through psychoeduc
30、ation,Which are Professional Nursing Roles,P.116,RoleRelationshipPatterns,31,3. Client advocate: a. Protects clients right to self-determination b. Motivates individuals and families to become informed active participants in their health care c. Mediates between client and others in the health care
31、environment Acts as clients agent in coordinating effective health care services,Which are Professional Nursing Roles,P.116,RoleRelationshipPatterns,32,4. Manager: a. Coordinates staff and productivity b. Delegates differentiated tasks to appropriate personnel Facilitates communication within and am
32、ong departments Serves on committees to improve and maintain quality of care e. Makes decisions and directs relevant changes to ensure quality care,Which are Professional Nursing Roles,P.116,RoleRelationshipPatterns,33,5. Evaluator: a. Sets quality assurance/care standards Reviews records and monito
33、rs compliance with standards c. Makes recommendations for improvement,Which are Professional Nursing Roles,P.116,RoleRelationshipPatterns,34,6. Researcher:Develops and implement research/grant proposals to broaden understanding of important issues in clinical practice and validate nursing theories a
34、s a basis for effective nursing practice,Which are Professional Nursing Roles,P.116,RoleRelationshipPatterns,35,7. Consultant: Provides specialized knowledge/advice to others on health care issues b. Evaluates programs, curricula, and complex clinical data c. Serves as expert witness in legal cases,
35、Which are Professional Nursing Roles,P.116,RoleRelationshipPatterns,36,8. Case Manager: a. Administers care for a caseload of clients b. Coordinates cost-effective care options Monitors client progress toward expected behavioral outcomes Collaborates with other professionals to ensure quality care a
36、cross health care settings,Which are Professional Nursing Roles,P.116,RoleRelationshipPatterns,37,RoleRelationshipPatterns,Objective Four:Discuss the characteristics of the sick role,38,From the client perspective, loss of or changes in normal roles, role relationships, and role performance are impo
37、rtant dimensions(尺度/元)of the emotional pain clients experience in health care situations. How well people are able to perform their roles within the family and society influences their reputation within the community and their sense of self-esteem. When illness or injury affects role performance, it
38、 also impacts role relationships with others and self-esteem.,How to understand Client role , role relationships, performance and transition?,p.119,RoleRelationshipPatterns,39,The nurse may be the only person who has the expertise and willingness to facilitate discussions of the implications of role
39、 changes stemming from(源于)altered health status for the client in an objective, compassionate manner.,p.119,How to understand Client role , role relationships, performance and transition?,RoleRelationshipPatterns,40,Talking about the meaning of role change is just as important as talking about how t
40、o change a dressing or what a physical symptom means. Loss of role, changes in role expectations and performance, role relationships and role transitions can occur as a result of age, illness, loss of job or significant person, injury, and mental disorders,How to understand Client role , role relati
41、onships, performance and transition?,p.119,RoleRelationshipPatterns,41,Most people do not assume the sick role voluntarily. Illness or trauma(外伤)can change an individuals social role from one of independent self-sufficiency to one of vulnerability(脆弱性)and varying degrees of dependency on others, a p
42、ersonal role from one of independence to dependence. When clients enter a health care situation, they encounter an interpersonal environment that encourages the development of feelings of anonymity(无名) and helplessness. ,How to understand Client role , role relationships, performance and transition?
43、,p.119,RoleRelationshipPatterns,42,At the hospital door, the client forsakes(放弃)recognized social roles in the family, work situation, and community, temporarily or permanently. Regardless of how competent the person may be in other life roles, when illness strikes (打击), questions about role perform
44、ance inevitably arise. Often clients must learn new role behaviors that are unfamiliar and unsettling to previously held self-concepts.,How to understand the transition of Client role , role relationships, and role performance?,RoleRelationshipPatterns,p.119,43,Adjustment to a change in health care
45、status requires a whole new set of coping skills without necessarily having the same social supports. Clients clearly need the support of the nurse to incorporate the rapidly changing meaning of the environmental and personal changes encountered in illness into an otherwise basically healthy self-co
46、ncept.,How to understand the transition of Client role , role relationships, and role performance?,RoleRelationshipPatterns,p.119,44,Differences in perspectives play a major part in determining which illnesses and disorders are recognized as legitimate(合理的), the roles clients assume in their health
47、care, and who becomes the culturally assigned expert (在 .中当专家) in promoting, maintaining, and restoring health. For example, some cultures believe that illness is punishment from God or an imbalance of energy that interferes with the bodys functioning. These cultural understandings can affect role r
48、elationships in health care settings.,How to understand the transition of Client role , role relationships, and role performance?,RoleRelationshipPatterns,p.119,45,Client Role,Clients are expected to act as participating, cooperative agents in their recovery process. However, an Asian client may app
49、ear as a passive recipient of health care, strikingly dependent on family and health caregiver for all guidance and care. Without a clear understanding of this culturally acceptable expression of the sick role, the nurse may respond inappropriately.,p.120,RoleRelationshipPatterns,46,What is a Patients Bill of Rights ?,p.121,1. The patient has the right to considerate and respectful care.,Client Role,RoleRelationshipPatterns,
