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

Role Relationship Patterns Role Relationship Patterns 1 what kinds of what kinds of outlineoutline are are the most important the most important in the chapter?in the chapter? Role Relationship Patterns 2 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 3 Applications Professional Nurse Role Types of Professional Roles Role Socialization Role Stress Self-awareness in the Professional Role OUTLINEOUTLINE p.108 Role Relationship Patterns 4 Client Role Patients Bill of Rights Role Performance as a Nursing Diagnosis Supportive Interventions Developing New Solutions Summary OUTLINEOUTLINE p.108 Role Relationship Patterns 5 What are the What are the objectivesobjectives of learning or of learning or studying in our lesson? studying in our lesson? Role Relationship Patterns 6 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 7 Role Relationship Patterns Objective One: Define role and role performance 8 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 9 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 10 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 11 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 12 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 13 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 14 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 15 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 16 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 17 Role Relationship Patterns Objective Two: Describe the four components of professional role socialization 18 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 19 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 20 1、病毒性肝炎：由病毒造成的肝炎按照其病毒系列不同分为甲、乙、丙、丁、戊和庚共六种类型病毒性肝炎。能引起肝脏细胞肿胀，是世界上流传广泛，危害很大的传染病之一。 1908 年，才发现病毒也是肝炎的致病因素之一。1947 年，将原来的传染性肝炎（infectious hepatitis ）称为甲型肝炎（Hepatitis A, HA ）；血清性肝炎（serum hepatitis ）称为乙型肝炎（Hepatitis B, HB ）。1965 年人类首次检测到乙型肝炎的表面抗原。 我国经济和科学技术日益发展，学术文化领域百家争鸣，（df高血压958心脏病983u6 糖尿病87fr）特别是思想家的革新精神，为中医学理论的创新和突破性进展，提供了有利的文化背景。宋代陈无择著三因极一病证方论一书，（45传染病q566 丙肝964jo乙肝28jgsx甲肝gh）提出三因学说；并产生了最具盛名四大学派，刘完素倡导火热论；张从正力倡“攻邪论”；李杲提出“内伤脾胃，百病由生”的理论；朱震亨创造性地阐明了相火的演变规律。 编辑本段明清时期（df肺25s血液f369血小板t5172 红血球gdf55m 白血球fd2） 是中医学理论综合汇编、深化发展，临床各科辨证体系丰富、提高阶段。如明代楼英的医学纲目和王肯堂的证治准绳，清代吴谦等编著的医宗金鉴和陈梦雷主编的古今图书集成医部全录等。王清任著医林改错，注重实证研究，（df高血压958心脏病983u6 糖尿病87fr）纠正了古医籍中关于解剖知识的某些错误，肯定了“脑主思维”，发展了瘀血理论。温病学说的形成和发展，标志着中医理论的创新与突破，吴有性著温疫论，叶天士著温热病篇，吴鞠通著温病条辨等，在药物学研究方面，（45传染病q566 丙肝964jo乙肝28jgsx甲肝gh）李时珍著的本草纲目，总结了16世纪以前我国药物学研究的成就。医的诊察疾病能参考现代医学的微观分析，将辨证与辨病相结合，实现宏观与微观的统一，使中医诊断客观化，即把分析与综合相结合的方法引入中医理、法、方、药的研究，使二者有 机结合，互相借鉴、补充，避免各自的片面性、局限性，这将有利于中西医学的优势互补，“和而不同”，多元发展。近年来，中医药在防治非典、禽流感和艾滋病方面发挥的独特作用也证实了二者的有机结合，具有肯定的临床疗效。 编辑本段东西方医学交融 不管是中医学还是西医学，从二者现有的思维方式的发展趋势来看，均是走向现代系统论思维，中医药学理论与现代科学体系之间具有系统同型性，属于本质相同而描述表达方式不同的两种科学形式。可望在现代系统论思维上实现交融或统一，成为中西医在新的发展水平上实现交融或统一的支撑点，希冀籍此能给中医学以至生命科学带来良好的发展机遇，进而对医学理论带来新的革命。 编辑本段现代中医史 上个世纪末,本世纪初，1996 年,清华学界对中医气本质，经络实质，阴阳，五行，藏象，中医哲学观等都有了新的全面整体创造性的认识和解说。如，邓宇等发现的:气是流动着的信息能量物质的混合统一体；分形分维的经络解剖结构；数理阴阳；中医分形集：分形阴阳集阴阳集的分形分维数，五行分形集五行集的分维数；分形藏象五系统暨心系统、肝系统、脾系统、肺系统、肾系统；中医三个哲学观新提出的第三哲学观：相似观分形论等。 还包括近代针灸经络的发展史,近代中医气的进展简史,中西医结合史,中医中药史等. 六种类型的病毒性肝炎遗传因子不同，除乙型肝炎遗传因子是DNA外，其余几型肝炎遗传因子均为RNA。其中甲型肝炎的传播途径是粪口传播，乙型肝炎的传播途径是血液传播、性传播和母婴传播。疫苗。 2、酒精性肝炎：酒精性肝炎早期可无明显症状，但肝脏已有病理改变，发病前往往有短期内大量饮酒史，有明显体重减轻，食欲不振，恶心，呕吐，全身倦怠乏力，发热，腹痛及腹泻，上消化道出血及精神症状。体征有黄疸，肝肿大和压痛，同时有脾肿大，面色发灰，腹水浮肿及蜘蛛痣，食管静脉曲张。从实验室检查看，有贫血和中性白细胞增多，红细胞容积测定（MCV）大于95FL,血清胆红素增高，可达17.1moL/L 或以上，转氨酶中度升高，常大于2.0，测定线粒体AST（mAST）及其与总AST（tAST）的比值，其升高可达12.5+5.2% 。并有-GT，谷氨酸脱氢酶和碱性磷酸酶活力增高，凝血酶原时间延长。 此外，病毒性肝炎还有丙型肝炎、丁型肝炎、戊型肝炎和庚型肝炎。过去被定为己型肝炎病毒的病毒现在被确定为乙型肝炎病毒的一个属型，因此己型肝炎不存在。 在病毒肝炎的疫苗，A型、B型、D型的疫苗已研发成功；C型、E型、F型的目前无编辑本段宋金元时期 精品课件文档，欢迎下载，下 载后可以复制编辑。 更多精品文档，欢迎浏览。 21 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 22 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 23 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 24 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 25 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: 26 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: 27 Role Relationship Patterns Objective Three: Discuss the professional roles of the nurse 28 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 29 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 30 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 31 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 32 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 33 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 34 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 35 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 36 Role Relationship Patterns Objective Four: Discuss the characteristics of the sick role 37 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 38 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 39 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 40 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 41 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 42 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 43 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 44 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 45 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 46 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 47 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 48 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 49 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 50 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 righ