什么是人际关系和人际沟通课件

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Chapter6RoleRelationshipPatterns1 whatkindsofoutlinearethemostimportantinthechapter?RoleRelationshipPatterns2 BasicConceptsDefinitionsRelatedTermsPersonalInterpretationsofRoleSocietalInterpretationsRoleEffectsofAlterationinRolePerformanceonOthersOUTLINEp.108RoleRelationshipPatterns3 ApplicationsProfessionalNurseRoleTypesofProfessionalRolesRoleSocializationRoleStressSelf-awarenessintheProfessionalRoleOUTLINEp.108RoleRelationshipPatterns4 ClientRolePatient'sBillofRightsRolePerformanceasaNursingDiagnosisSupportiveInterventionsDevelopingNewSolutionsSummaryOUTLINEp.108RoleRelationshipPatterns5 Whataretheobjectivesoflearningorstudyinginourlesson?RoleRelationshipPatterns6 Attheendofthechapter,thestudentwillbeableto1.Defineroleandroleperformance2.Describethefourcomponentsofprofessionalrolesocialization3.Discusstheprofessionalrolesofthenurse4.DiscussthecharacteristicsofthesickroleObjectivesp.108RoleRelationshipPatterns7 RoleRelationshipPatternsObjectiveOne:Defineroleandroleperformance8 Whatisrole?Aroleisdefinedasasetofexpectedbehavioralstandardsestablishedbythesocietyorcommunitytowhichapersonbelongs(Creasia,1991).Definitionsp.109-110RoleRelationshipPatterns9 Whatisrolerelationship?Rolerelationshipsinfluencecommunicationcontentandprocess.Consideryourown"role”asanursingstudentandhowitinfluencescommunicationcontentandprocess.Definitionsp.109-110RoleRelationshipPatterns10 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.310RoleRelationshipPatterns11 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.303p.310RoleRelationshipPatterns12 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。”RoleRelationshipPatterns13 Whatisroleperformance?Roleperformancereferstoaperson'scapacitytofunctioninaccordwithsocialexpectationsofaparticularrole.Perceptionsofbehavioralstandardsforroleperformancedifferfrombasedoncultural,gender,institutional,andfamilyexpectations;Peoplestillexpectdifferentrolebehaviorsfrommenandwomendespitetremendousadvancesinequalopportunity.Definitionsp.109-110RoleRelationshipPatterns14 Roletransitiondescribeschangesinroleexpectationsthatoccurasdevelopmentallifecrisesorwhenunexpectedlifeeventssuchasillnessorinjuryalterrolefunction.Forexample,newmotherexperiencesasignificantroletransitionwiththebirthofherfirstchild,asdoesayoungathletestruckdowninaballgamewithaspinalcordinjury.Whatisroletransition?Definitionsp.109-110RoleRelationshipPatterns15 Whatisposition?Positionrepresentsastandardizeddescriptionofaroleandassociatedexpectationsthatmakesitunderstandabletoothersinthecommunityorgroup.Socialpositionrelatestothestatusandidentitythepersonholdsinthecommunity.Theconceptofpositionsometimesplaysaroleinhowhelpingprofessionalsrespondtoclients:theysometimestreatclientsinhighpositionsdifferentlythanthosewithnomoneyorlowsocialstatus.Definitionsp.109-110RoleRelationshipPatterns16 Whereasitisimportantforthenursetorecognizedifferencesinpositionasrelevantfactorsinsupportingclientintegrityandself-esteem,nursesneedtoviewallclientsasveryimportantpersons,treatingthemallwiththesamerespectandgivingthemallqualitycareregardlessofposition.Definitionsp.109-110Whatisposition?RoleRelationshipPatterns17 RoleRelationshipPatternsObjectiveTwo:Describethefourcomponentsofprofessionalrolesocialization18 Unlikeotherformsofeducation,thenursingstudentmustsimultaneously(同时地)adjusttolearningnewmaterialwhilestartingonthejobtraininginwhichthestakes(风险)arehigh.Cohenidentifiedfourgoalsofprofessionalsocialization(seeBox6-4).Whichisthefourcomponentsofprofessionalrolesocialization?ProfessionalNurseRolep.114-115RoleRelationshipPatterns19 Box6-4.StepsintheSocializationProcessLearnthetechnologyoftheprofession:thefacts,skills,andtheory.Internalize(使内在化)theprofessionalcultureFindapersonallyandprofessionallyacceptableversionoftherole.Integratethisprofessionalroleintoalltheotherliferoles.RoleRelationshipPatterns20 Box6-4.StepsintheSocializationProcess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。把职业角色整合到所有其它生活角色中。RoleRelationshipPatterns21 ExerciseLookingatMyDevelopmentasaProfessionalNursePurpose:Tohelpyoufocusonyourself-developmentasaprofessionalnurseRoleRelationshipPatterns22 ExerciseLookingatMyDevelopmentasaProfessionalNurseProcedure:Writethestoryofhowyouchosetobecomeanurseinaone-totwo-pageessay(maybedoneasahomeworkassignment).Therearenorightorwronganswers;thisissimplyyourstory.Youmayusethefollowingasguidesindevelopingyourstory.RoleRelationshipPatterns23 ExerciseLookingatMyDevelopmentasaProfessionalNurseProcedure:Whatareyourreasonsforchoosingnursingasaprofession?Whatfactorsinfluencedyourdecision;people,circumstances,orsituations?Describeyourvisionofyourselfasanurse.Whatfearsdoyouhaveaboutyourabilitytofunctionasaprofessionalnurse?Howdoyouthinkbeinganursewillaffectyourpersonallife?RoleRelationshipPatterns24 Inwhatwaysisyourstorysimilartoordifferentfromthoseofyourclassmates?Asyouwroteyourstory,wereyousurprisedbyanyofthedataorfeelings?RoleRelationshipPatternsDiscussion:25 Studentscandiscusssomeoftherealisticdifficultiesencounteredasnursingstudentsbothprofessionallyandpersonallyandwaystohandlethem.Explorethroughdiscussionthefollowing:ThepracticesnursingstudentswillneedtofollowtoachievetheirvisionThetypesofsupportsnursesneedtofostertheirongoingprofessionaldevelopmentRoleRelationshipPatternsDiscussion:26 RoleRelationshipPatternsObjectiveThree:Discusstheprofessionalrolesofthenurse27 WhicharethereProfessionalNursingRolesP.1161.Caregiver:a.Providescompleteorpartialcompensatorycareforclientswhocannotprovidetheseself-carefunctionsforthemselvesb.Implementssupportive/educativeactionstopromoteoptimumhealthReinforcesthenatural,developmental,andhealingprocesseswithinapersontoenhancewell-being,comfort,function,andpersonalgrowthProfessionalNurseRoleRoleRelationshipPatterns28 2.Teacher:a.Provideshealthteachingtoindividualclientsandfamiliesb.Developsandimplementspatienteducationprogramstopromote/maintainhealthfulpracticesandcompliancewithtreatmentrecommendationsc.Guidesindividualsintheirhumanjourneytowardwholenessandwell-beingthroughpsychoeducationWhichareProfessionalNursingRolesP.116RoleRelationshipPatterns29 3.Clientadvocate:a.Protectsclient'srighttoself-determinationb.Motivatesindividualsandfamiliestobecomeinformedactiveparticipantsintheirhealthcarec.MediatesbetweenclientandothersinthehealthcareenvironmentActsasclient'sagentincoordinatingeffectivehealthcareservicesWhichareProfessionalNursingRolesP.116RoleRelationshipPatterns30 4.Manager:a.Coordinatesstaffandproductivityb.DelegatesdifferentiatedtaskstoappropriatepersonnelFacilitatescommunicationwithinandamongdepartmentsServesoncommitteestoimproveandmaintainqualityofcaree.MakesdecisionsanddirectsrelevantchangestoensurequalitycareWhichareProfessionalNursingRolesP.116RoleRelationshipPatterns31 5.Evaluator:a.Setsqualityassurance/carestandardsReviewsrecordsandmonitorscompliancewithstandardsc.MakesrecommendationsforimprovementWhichareProfessionalNursingRolesP.116RoleRelationshipPatterns32 6.Researcher:Developsandimplementresearch/grantproposalstobroadenunderstandingofimportantissuesinclinicalpracticeandvalidatenursingtheoriesasabasisforeffectivenursingpracticeWhichareProfessionalNursingRolesP.116RoleRelationshipPatterns33 7.Consultant:Providesspecializedknowledge/advicetoothersonhealthcareissuesb.Evaluatesprograms,curricula,andcomplexclinicaldatac.ServesasexpertwitnessinlegalcasesWhichareProfessionalNursingRolesP.116RoleRelationshipPatterns34 8.CaseManager:a.Administerscareforacaseloadofclientsb.Coordinatescost-effectivecareoptionsMonitorsclientprogresstowardexpectedbehavioraloutcomesCollaborateswithotherprofessionalstoensurequalitycareacrosshealthcaresettingsWhichareProfessionalNursingRolesP.116RoleRelationshipPatterns35 RoleRelationshipPatternsObjectiveFour:Discussthecharacteristicsofthesickrole36 Fromtheclientperspective,lossoforchangesinnormalroles,rolerelationships,androleperformanceareimportantdimensions(尺度/元)oftheemotionalpainclient’sexperienceinhealthcaresituations.Howwellpeopleareabletoperformtheirroleswithinthefamilyandsocietyinfluencestheirreputationwithinthecommunityandtheirsenseofself-esteem.Whenillnessorinjuryaffectsroleperformance,italsoimpactsrolerelationshipswithothersandself-esteem.HowtounderstandClientrole,rolerelationships,performanceandtransition?p.119RoleRelationshipPatterns37 Thenursemaybetheonlypersonwhohastheexpertiseandwillingnesstofacilitatediscussionsoftheimplicationsofrolechangesstemmingfrom(源于)alteredhealthstatusfortheclientinanobjective,compassionatemanner.p.119HowtounderstandClientrole,rolerelationships,performanceandtransition?RoleRelationshipPatterns38 Talkingaboutthemeaningofrolechangeisjustasimportantastalkingabouthowtochangeadressingorwhataphysicalsymptommeans.Lossofrole,changesinroleexpectationsandperformance,rolerelationshipsandroletransitionscanoccurasaresultofage,illness,lossofjoborsignificantperson,injury,andmentaldisordersHowtounderstandClientrole,rolerelationships,performanceandtransition?p.119RoleRelationshipPatterns39 Mostpeopledonotassumethesickrolevoluntarily.Illnessortrauma(外伤)canchangeanindividual’ssocialrolefromoneofindependentself-sufficiencytooneofvulnerability(脆弱性)andvaryingdegreesofdependencyonothers,apersonalrolefromoneofindependencetodependence.Whenclientsenterahealthcaresituation,theyencounteraninterpersonalenvironmentthatencouragesthedevelopmentoffeelingsofanonymity(无名)andhelplessness.HowtounderstandClientrole,rolerelationships,performanceandtransition?p.119RoleRelationshipPatterns40 Atthehospitaldoor,theclientforsakes(放弃)recognizedsocialrolesinthefamily,worksituation,andcommunity,temporarilyorpermanently.Regardlessofhowcompetentthepersonmaybeinotherliferoles,whenillnessstrikes(打击),questionsaboutroleperformanceinevitablyarise.Oftenclientsmustlearnnewrolebehaviorsthatareunfamiliarandunsettlingtopreviouslyheldself-concepts.HowtounderstandthetransitionofClientrole,rolerelationships,androleperformance?RoleRelationshipPatternsp.11941 Adjustmenttoachangeinhealthcarestatusrequiresawholenewsetofcopingskillswithoutnecessarilyhavingthesamesocialsupports.Clientsclearlyneedthesupportofthenursetoincorporatetherapidlychangingmeaningoftheenvironmentalandpersonalchangesencounteredinillnessintoanotherwisebasicallyhealthyself-concept.HowtounderstandthetransitionofClientrole,rolerelationships,androleperformance?RoleRelationshipPatternsp.11942 Differencesinperspectivesplayamajorpartindeterminingwhichillnessesanddisordersarerecognizedaslegitimate(合理的),therolesclientsassumeintheirhealthcare,andwhobecomestheculturallyassignedexpert(在...中当专家)inpromoting,maintaining,andrestoringhealth.Forexample,someculturesbelievethatillnessispunishmentfromGodoranimbalanceofenergythatinterfereswiththebody'sfunctioning.Theseculturalunderstandingscanaffectrolerelationshipsinhealthcaresettings.HowtounderstandthetransitionofClientrole,rolerelationships,androleperformance?RoleRelationshipPatternsp.11943 ClientRoleClientsareexpectedtoactasparticipating,cooperativeagentsintheirrecoveryprocess.However,anAsianclientmayappearasapassiverecipientofhealthcare,strikinglydependentonfamilyandhealthcaregiverforallguidanceandcare.Withoutaclearunderstandingofthisculturallyacceptableexpressionofthesickrole,thenursemayrespondinappropriately.p.120RoleRelationshipPatterns44 WhatisaPatient'sBillofRights?p.1211.Thepatienthastherighttoconsiderateandrespectfulcare.ClientRoleRoleRelationshipPatterns45 WhatisaPatient'sBillofRights?p.1212.Thepatienthastherightto,andisencouragedtoobtainfromphysiciansandotherdirectcaregivers,relevant,current,andunderstandableinformationconcerningdiagnosis,treatment,andprognosis.Exceptinemergencieswhenthepatientlacksdecisionmakingcapacityandtheneedfortreatmentisurgent,thepatientisentitledtotheopportunitytodiscussandrequestinformationrelatedtothespecificproceduresandtreatments,risksinvolved,lengthofrecuperation,andmedicallyreasonablealternativesandtheiraccompanyingrisksandbenefits.ClientRoleRoleRelationshipPatterns46 WhatisaPatient'sBillofRights?ClientRole3.Patientshavetherighttoknowtheidentityofphysicians,nurses,andothersinvolvedintheircare,aswellasthestatusofthecaregivers(e.g.,whenthoseinvolvedarestudents,residents,orothertrainees.).p.121RoleRelationshipPatterns47 WhatisaPatient'sBillofRights?ClientRole4.Thepatienthastherighttomakedecisionsabouttheplanofcarebeforeandduringthecourseoftreatment,torefusearecommendedtreatmentorplanofcaretotheextentpermittedbylawandhospitalpolicy,andtobeinformedofthemedicalconsequencesofthisaction.p.121RoleRelationshipPatterns48 WhatisaPatient'sBillofRights?ClientRole5.Thepatienthastherighttohaveanadvancedirective(suchaslivingwill,healthcareproxy,ordurablepowerofattorneyoverhealthcare)concerningtreatmentordesignatingasurrogatedecisionmakerwiththeexpectationthatthehealthcareinstitutionwillhonortheintentofthatdirectivetotheextentpermittedbylawandhospitalpolicy.Healthcareinstitutionsmustadvisepatientsoftheirrighttomakeinformedmedicalchoices.p.121RoleRelationshipPatterns49 WhatisaPatient'sBillofRights?ClientRole6.Thepatienthastherighttoeveryconsiderationofprivacy.Casediscussion,consultation,examination,andtreatmentshouldbeconductedsoastoprotectthepatient'sprivacy.7.Thepatienthastherighttoexpectthatallcommunicationsandrecordspertainingtocarewillbetreatedasconfidentialbythehospital,exceptincasessuchassuspectedabuseandpublichealthhazards,whenreportingispermittedorrequiredbylaw.p.121RoleRelationshipPatterns50 WhatisaPatient'sBillofRights?ClientRole8.Thepatienthastherighttoreviewrecordspertainingtomedicalcareandtohavetheinformationexplainedorinterpretedasnecessary,exceptwhenrestrictedbylaw.9.Thepatienthastherighttoexpectthat,withinitscapacityandpolicies,ahospitalwillmakereasonableresponsetotherequestofapatientforappropriateandmedicallyindicatedcareandservices.Thehospitalmustprovideevaluation,service,andreferralasindicatedbytheurgencyofthecase.p.121RoleRelationshipPatterns51 WhatisaPatient'sBillofRights?ClientRole10.Thepatienthastherighttoaskandbeinformedoftheexistenceofbusinessrelationshipsamongthehospital,educationalinstitutions,andotherhealthcareprovidersorpayersthatmayinfluencethepatient'streatmentandcare.p.121RoleRelationshipPatterns52 WhatisaPatient'sBillofRights?ClientRole11.Thepatienthastherighttoconsentdeclinetoparticipateinproposedresearchstudiesorhumanexperimentationaffectingcareandtreatmentorrequiringdirectpatientsinvolvementandtohavethosestudiesfullyexplainedbeforeconsent.p.121RoleRelationshipPatterns53 WhatisaPatient'sBillofRights?ClientRole12.Thepatienthastherighttoexpectreasonablecontinuityofcarewhenappropriateandtobeinformedbyphysiciansandothercaregiversofavailableandrealisticpatientcareoptionswhenhospitalcareisnolongerappropriate.Thepatienthastherighttobeinformedofhospitalpoliciesandpracticesthatrelatetopatientcare,treatment,andresponsibilitiesandtobeinformedofavailableresourcesforresolvingconflicts.p.121RoleRelationshipPatterns54 licensurelegalconfidentialityidentificationinformedconsentethicalcodeconsiderationinconsiderateimpulseappetitecapriceparameterssequenceassumedisciplineprescribeappropriatemutuallyperformanceVocabularycompensationsubstantialfindingcounselingsupervisiondelegationexecutionregimenregisterednurseaccountableresponsiblecompetencystatuteterritorymonitorprioritizecoordinatepersonnelboardmandaterepresentativeviolationrevisearticulatebenchmarkoncologicalgerontologicalpsychiatrictenetrelevancetortbenchmarkjudgenegligencebreachdocumentfalsifywithholdprivilegedcommunicationcompromisemandatecommunicablestatutoryInadditiontoinanywayInformedConsentknowledgeable55 56 BasicConceptsAmericanNursesAssociation'sDefinitionofProfessionalNursingPracticeProfessionalLicensureNursePracticeActsProfessionalStandardsofCareLegalStandardsConfidentialityInformedConsentProtectingClientRightsOUTLINE57 OUTLINEEthicalCodeforNursesApplicationsNursingProcessNursingProcessandProfessionalRelationsAssessmentDiagnosisPlanningandOutcomeIdentificationImplementationEvaluationCriticalPathwaysSummary58 OBJECTIVES1.Defineprofessionalnursing2.Discusstheimplicationsofnursepracticeactsinthenurse-clientrelationship3.Identifyprofessionalstandardsofcare4.Discusslegalstandards5.Discussimplicationsofthecodeofethicswithinterpretivestatementsforthenurse-clientrelationship6.Describethenursingprocessasaframe-workforprofessionalnursingpracticeandthenurse-clientrelationship7.Discusscriticalpathwaysasamethodofcommunication59 Ifaman'sactionsarenotguidedbythoughtfulconsiderations,thentheyareguidedbyinconsiderateimpulse,unbalancedappetite,capriceortheCircumstancesofthemoment.JohnDewey(1933)如果一个人的行为不被深思熟虑的思想所指导,那么他们就受轻帅的冲动，不平衡的欲望,反复无常或片刻的环境所左右。约翰•Dewey(1933)60 ProfessionalLicensureTheregisterednurse’sprofessionallicenseensuresthateachindividualnursehassuccessfullycompletednursingprogramrequirementsandcandemonstratetheknowledge,skills,andcompetenciestofunctionasahealthproviderofsafe,effectivenursingcare.Allpersonspracticingnursingarerequiredbylawtohaveacurrentlicenseinthestateinwhichtheypracticeandtoupdatetheirlicensureyearly.Thislicenserequiresanyonepracticingnursingtocomplywithallstatelawsgoverningpractice.TheANAtestscorenursingknowledgebeforegrantinganurseaprofessionallicense.Nursinglicensurehelpsmaintainstandardsfornursing.Eachstatecurrentlyhastherighttodeterminewhodoesandwhodoesnotpracticeinthatstate.61 Box2-1.ProfessionalStandardsGuidingtheNurse-ClientRelationshipStandardsofCareⅠ.AssessmentThenursecollectsclienthealthdata.Ⅱ.DiagnosisThenurseanalyzedtheassessmentdataindeterminingdiagnoses.Ⅲ.OutcomeIdentificationThenurseidentifiesexpectedoutcomesindividualizedtotheclient.Ⅳ.PlanningThenursedevelopsaplanofcarethatprescribesinterventionstoattainexpectedoutcomes.Ⅴ.ImplementationThenurseimplementstheinterventionsidentifiedintheplanofcare.Ⅵ.EvaluationThenurseevaluatestheclient'sprogresstowardattainmentofoutcomes.62 护理程序的标准Ⅰ.评估护士收集患者的健康资料。Ⅱ.诊断护士分析评估资料作出诊断。Ⅲ.结果鉴定护士确定患者预期的个案结果Ⅳ.计划护士制定护理计划，以陈述要达到预期目标所采取的护理措施。Ⅴ.实施护士将制定的措施落实到护理计划中。Ⅵ.评价护士根据预期目标评价患者的转归。BOX2-1指导护患关系的专业标准63 Ⅰ.QualityofCareThenursesystematicallyevaluatesthequalityandeffectivenessofnursingpracticeⅡ.PerformanceAppraisalThenurseevaluateshis/herownnursingpracticeinrelationtoprofessionalpracticestandardsandrelevantstatutesandregulations.Ⅲ.EducationThenurseacquiresandmaintainscurrentknowledgeinnursingpractice.Ⅳ.CollegialityThenursecontributestotheprofessionaldevelopmentofpeers,colleagues,andothers.Ⅴ.EthicsThenurse’sdecisionsandactionsonbehalfofclientsaredeterminedinanethicalmanner.Ⅵ.CollaborationThenursecollaborateswiththeclient,significantothers,andhealthcareprovidersinprovidingclientcare.Ⅶ.ResearchThenurseusesresearchfindingsinpractice.Ⅷ.ResourceUtilizationThenurseconsidersfactorsrelatedtosafety,effectiveness,andcostinplanninganddeliveringclientcare.StandardsofProfessionalPerformance64 Ⅰ.护理质量护士系统地对护理实践的质量和效力进行评价。Ⅱ.业绩评价护士在专业操作标准以及有关法令法规方面评价自己的护理实践。Ⅲ.教育护士在护理实践中获得和提供现有的知识。Ⅳ.同事关系护士帮助同伴，同事和其他人的专业进步。Ⅴ.道德准则护士根据患者的利益，以符合道德的规范代表患者做出决定和行动。Ⅵ.合作护士在护理时应与患者、其他重要人员以及卫生保健人员合作。Ⅶ.研究在实践中护士应用研究结果。Ⅷ.资源利用护士在计划和护理方面考虑与安全，效率和费用相关的因素。专业素质的标准65