医学保健不明原因不孕症子宫内膜血管内皮因子（vegf）的表达expression_课件

精品PPT课件 浏览免费 下载后可以编辑修改。 /jn-lxh /lianer2012 / / http:/ / 1 Role Relationship Patterns Role Relationship Patterns 2 what kinds of what kinds of outlineoutline are are the most important the most important in the chapter?in the chapter? Role Relationship Patterns 3 Basic Concepts Definitions Related Terms Personal Interpretations of Role Societal Interpretations Role Effects of Alteration in Role Performance on Others OUTLINEOUTLINE p.108 Role Relationship Patterns 4 Applications Professional Nurse Role Types of Professional Roles Role Socialization Role Stress Self-awareness in the Professional Role OUTLINEOUTLINE p.108 Role Relationship Patterns 5 Client Role Patients Bill of Rights Role Performance as a Nursing Diagnosis Supportive Interventions Developing New Solutions Summary OUTLINEOUTLINE p.108 Role Relationship Patterns 6 What are the What are the objectivesobjectives of learning or of learning or studying in our lesson? studying in our lesson? Role Relationship Patterns 7 At the end of the chapter, the student will be able to 1. Define role and role performance q 2. Describe the four components of professional role socialization 3. Discuss the professional roles of the nurse 4. Discuss the characteristics of the sick role ObjectivesObjectives p.108 Role Relationship Patterns 8 Role Relationship Patterns Objective One: Define role and role performance 9 What is role? A role is defined as a set of expected behavioral standards established by the society or community to which a person belongs (Creasia, 1991). Definitions p.109-110 Role Relationship Patterns 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 and process. Definitions p.109-110 Role Relationship Patterns 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 Role Relationship Patterns 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 Role Relationship Patterns 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。” Role Relationship Patterns 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 expect different role behaviors from men and women despite tremendous advances in equal opportunity. Definitions p.109-110 Role Relationship Patterns 15 Role transition describes changes in role expectations that occur as developmental life crises or when unexpected life events such as illness or injury 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 Role Relationship Patterns 16 What is position? Position 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 professionals respond to clients: they sometimes treat clients in high positions differently than those with no money or low social status. Definitions p.109-110 Role Relationship Patterns 17 Whereas it is important for the nurse to recognize differences in position as relevant factors in supporting client 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? Role Relationship Patterns 18 Role Relationship Patterns Objective Two: Describe the four components of professional role socialization 19 1、冠心病:长期的高血压可促进动脉粥样硬化的形成和发展。冠状动脉粥样硬化会阻塞或使血管腔变狭窄，或因冠状动脉功能性改变而导致心肌缺血缺氧、坏死而引起冠心病。冠状动脉粥样硬化性心脏病是动脉粥样硬化导致器官病变的最常见类型，也是严重危害人类健康的常见病。 2、脑血管病:包含脑出血、脑血栓、脑梗塞、短暂性脑缺血发作。脑血管意外又称中风，其病势凶猛，且致死率极高，即使不致死，大多数也会致残，是急性脑血管病中最凶猛的一种。高血压患者血压越高，中风的发生率也就越高。高血压患者的脑动脉如果硬化到一定程度时，再加上一时的激动或过度的兴奋，如愤怒、突然事故的发生、剧烈运动等，会使血压急骤升高，脑血管破裂出血，血液便溢入血管周围的脑组织，此时，病人会立即昏迷，倾倒在地，所以俗称中风。 3、高血压心脏病:高血压患者的心脏改变主要是左心室肥厚和扩大，心肌细胞肥大和间质纤维化。高血压导致心脏肥厚和扩大，称为高血压心脏病。高血压心脏病是高血压长期得不到控制的一个必然趋势，最后或者可能会因心脏肥大、心律失常、心力衰竭而影响生命安全。 4、高血压脑病:主要发生在重症高血压患者中。由于过高的血压超过了脑血流的自动调节范围，脑组织因血流灌注过多而引起脑水肿。临床上以脑病的症状和体征为特点，表现为弥漫性严重头痛、呕吐、意识障碍、精神错乱，严重的甚至会昏迷和抽搐。 5、慢性肾功能衰竭:高血压对肾脏的损害是一个严重的并发症，其中高血压合并肾功能衰竭约占10%。高血压与肾脏损害可以相互影响，形成恶性循环。一方面，高血压引起肾脏损伤；另一方面，肾脏损伤会加重高血压病。一般到高血压的中、后期，肾小动脉发生硬化，肾血流量减少，肾浓缩小便的能力降低，此时会出现多尿和夜尿增多现象。急骤发展的高血压可引起广泛的肾小动脉弥慢性病变，导致恶性肾小动脉硬化，从而迅速发展成为尿毒症。 6、高血压危象:高血压危象在高血压早期和晚期均可发生，紧张、疲劳、寒冷、突然停服降压药等诱因会导致小动脉发生强烈痉挛，导致血压急剧上升。高血压危象发生时，会出现头痛、烦躁、眩晕、恶心、呕吐、心悸、气急以及视力模糊等严重的症状。 编辑本段诊断鉴别 诊断依据 高血压的诊断主要根据诊所测量的血压值，采用经核准的水银柱或电子血压计，测量安静休息坐位时上臂肱动脉部位血压。必要时还应测量平卧位和站立位血压。 高血压的诊断必须以未服用降压药物情况下2次或2次以上非同日多次血压测定所得的平均值为依据。一旦诊断高血压，必须鉴别是原发性还是继发性。原发性高血压患者需做有关实验室检查，评估靶器官损害和相关危险因素。对于偶然血压超出正常范围者，宜定期复查测量以确诊。 高血压的预后不仅与血压升高水平有关，而且与其他心血管危险因素存在以及靶器官损害程度等有关。因此，从指导治疗和判断预后的角度，现在主张对高血压患者做心血管危险分层，将高血压患者分为低危、中危、高危和极高危，分别表示10年内将发生心、脑血管病事件的概率为30%。 具体分层标准根据血压升高水平、其他心血管危险因素、糖尿病、靶器官损害以及并发症情况。 用于分层的其他心血管危险因素有：男性55岁，女性65岁；吸烟；血胆固醇5.72mmol/dl；超声或X线证实有动脉粥样斑块（颈、髂、股或主动脉）；视网膜动脉局灶或广泛狭窄。 鉴别诊断：在确诊原发性高血压前必须与继发性高血压做鉴别诊断。 继发性高血压的常见病因包括：1、肾实性高血压；2、肾血管性高血压；3、原发性醛固酮增多症；4、皮质醇增多症；5、主动脉狭窄。其他可以引起继发性高血压的疾病还有甲状腺疾病，某些心脏疾病，妊娠高血压综合征等。 慢性肾炎 图书 四、中医药治疗 本病多属实证。根据辨证可分为风寒、风热、湿热，分别予以宣肺利尿，凉血解毒等疗法。本病恢复期脉证表现不很明确，辨证不易掌握，仍以清热利湿为主，佐以养阴，但不可温补。 五、透析治疗 少数发生急性肾功能衰竭而有透析指征时，应及时给予透析（血液透析或腹膜透析皆可）。由于本病具有自愈倾向，肾功能多可逐渐恢复，一般不需要长期维持透析。 ，它有力地推进了临床医学和预防医学。治疗和预防疾病的有效（df肺25s血液f369血小板t5172 红血球gdf55m 白血球fd2）手段在20世纪才开始出现。20世纪医学发展的主要原因是自然科学的进步。各学科专业间交叉融合，这形成现代医学的特点之一。 综合医学 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 four goals of professional socialization (see Box 6-4). Which is the four components of professional role socialization ? Professional Nurse Role p.114-115 Role Relationship Patterns 21 Box 6-4.Steps in the Socialization Process Learn the technology of the profession: the facts, skills, and theory. 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.Role Relationship Patterns 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。 把职业角色整合到所有其它生活角色中。 Role Relationship Patterns 23 Exercise Looking at My Development as a Professional Nurse Purpose: To help you focus on your self- development as a professional nurse Role Relationship Patterns 24 Exercise Looking at My Development as a Professional Nurse Procedure: Write the story of how you 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. Role Relationship Patterns 25 Exercise Looking at My Development as a Professional Nurse Procedure: 1. What are your reasons for choosing nursing as a profession? 2. What factors influenced your decision; people, circumstances, or situations? 3. Describe your vision of yourself as a nurse. 4. What fears do you have about your ability to function as a professional nurse? 5. How do you think being a nurse will affect your personal life? Role Relationship Patterns 26 1. In what ways is your story similar to or different from those of your classmates? 2. As you wrote your story, were you surprised by any of the data or feelings? Role Relationship Patterns Discussion: 27 Students can discuss some of the realistic difficulties encountered as nursing students both professionally and personally and ways to handle them. Explore through discussion the following: 1. The practices nursing students will need to follow to achieve their vision 2. The types of supports nurses need to foster their ongoing professional development Role Relationship Patterns Discussion: 28 Role Relationship Patterns 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-care functions for themselves b. Implements supportive/educative actions to promote optimum health c. Reinforces the natural, developmental, and healing processes within a person to enhance well-being, comfort, function, and personal growth Professional Nurse Role Role Relationship Patterns 30 2. Teacher: 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 psychoeducation Which are Professional Nursing Roles P.116 Role Relationship Patterns 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 environment d. Acts as clients agent in coordinating effective health care services Which are Professional Nursing Roles P.116 Role Relationship Patterns 32 4. Manager: a. Coordinates staff and productivity b. Delegates differentiated tasks to appropriate personnel c. Facilitates communication within and among departments d. 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 Role Relationship Patterns 33 5. Evaluator: a. Sets quality assurance/care standards b. Reviews records and monitors compliance with standards c. Makes recommendations for improvement Which are Professional Nursing Roles P.116 Role Relationship Patterns 34 6. Researcher: Develops and implement research/grant proposals to broaden understanding of important issues in clinical practice and validate nursing theories as a basis for effective nursing practice Which are Professional Nursing Roles P.116 Role Relationship Patterns 35 7. Consultant: a. 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 Which are Professional Nursing Roles P.116 Role Relationship Patterns 36 8. Case Manager: a. Administers care for a caseload of clients b. Coordinates cost-effective care options c. Monitors client progress toward expected behavioral outcomes d. Collaborates with other professionals to ensure quality care across health care settings Which are Professional Nursing Roles P.116 Role Relationship Patterns 37 Role Relationship Patterns 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 important 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 also impacts role relationships with others and self-esteem. How to understand Client role , role relationships, performance and transition? p.119 Role Relationship Patterns 39 The nurse may be the only person who has the expertise and willingness to facilitate discussions of the implications of role 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? Role Relationship Patterns 40 Talking about the meaning of role change is just as important as talking about how to 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 relationships, performance and transition? p.119 Role Relationship Patterns 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 personal 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? p.119 Role Relationship Patterns 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 performance 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? Role Relationship Patterns p.119 43 Adjustment to a change in health care 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-concept. How to understand the transition of Client role , role relationships, and role performance? Role Relationship Patterns 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 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 relationships in health care settings. How to understand the transition of Client role , role relationships, and role performance? Role Relationship Patterns p.119 45 Client RoleClient Role Clients are expected to act as participating, cooperative agents in their recovery process. However, an Asian client may appear 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 Role Relationship Patterns 46 What is a Patients Bill of Rights ? p.121 1. The patient has the right to considerate and respectful care. Client RoleClient Role Role Relationship Patterns 47 What is a Patients Bill of Rights ? p.121 2. The patient has the right to, and is encouraged to obtain from physicians and other direct caregivers, relevant, current, and understandable information concerning diagnosis, treatment, and prognosis. Except in emergencies when the patient lacks decision making capacity and the need for treatment is urgent, the patient is entitled to the opportunity to discuss and request information related to the specific procedures and treatments, risks involved, length of recuperation, and medically reasonable alternatives and their accompanying risks and benefits. Client RoleClient Role Role Relationship Patterns 48 What is a Patients Bill of Rights ? Client RoleClient Role 3.Patients have the right to know the identity of physicians, nurses, and others involved in their care, as well as the status of the caregivers (e.g., when those involved are students, residents, or other trainees.). p.121 Role Relationship Patterns 49 What is a Patients Bill of Rights ? Client RoleClient Role 4.The patient has the right to make decisions about the plan of care before and during the course of treatment, to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy, and to be informed of the medical consequences of this action. p.121 Role Relationship Patterns 50 What is a Patients Bill of Rights ? Client RoleClient Role 5.The patient has the right to have an advance directive (such as living will, health care proxy, or durable power of attorney over health care) concerning treatment or designating a surrogate decision maker with the expectation that the health care institution will honor the intent of that directive to the extent permitted by law and hospital policy. Health care institutions must advise patients of their right to make informed medical choices. p.121 Role Relationship Patterns 51 What is a Patients Bill of Rights ? Client RoleClient Role 6.The patient has the right to every consideration of privacy. Case discussion, consultation, examination, and treatment should be conducted so as to protect the patients privacy. 7.The patient has the right to expect that all comm