护理人际关系综述.doc

护理人际关系综述2010481110 王一冰摘要：人与人之间从认识到熟悉并发展成为亲密的人际关系，时间有快有慢，过程有长有短，有时是渐进、有时可能是速成的。现代化护理服务以护理对象的健康为中心，次过程中，护士是唯一能为服务对象提供全程、整体、昼夜服务的人员。他们需要随时为服务对象的安全及健康承担各种责任，并需要与医疗机构中的各种人员配合协调，建立良好的沟通网络及人际关系，已达到为服务对象提供高质量将抗服务的目的。关键词：人际关系 护患 医患 和谐 现状 常见问题 引言：护理人际关系是护士在工作过程中所形成的多种网络人际关系的总和。科学而恰当地处理好人际关系，既有利于解决服务对象的谷中问题，促进护理学科的整体发展，还有利于护士个人的身心健康及事业发展。研究历史：莱文格及斯诺克在1972年提出，人际关系从完全的无关系到关系亲密要经过一系列的发展过程。并以人际关系状态图直接地描述了人际关系发展状态的一般规律。1976年美国学者萨斯和荷伦德提出了三种医患关系的模式，即萨斯-荷伦德模式。这种医患关系的模式同样也适用于呼唤关系。当前状况：一、护理中的人际关系。1、建立良好人际关系的意义。1.1、有利于提高护理质量级效率 良好的护理关系是做好各项护理工作的重要保证级基础，他有利于促进护士与服务对象、家属、医生、其他护士、其他医务人员之间的相互协调与信任，使护士能发挥在医疗服务体系中人际枢纽的作用，协调好各种人际关系，相互配合，共同为解决服务对象的护理问题发挥作用，是所在健康服务组织的各项活动得以顺利进行，提高护理质量级效率。121.2、有利于营造良好的健康服务氛围，促进服务对象的健康及医护人员的身心健康 在各种健康服务机构中，护士与服务对象及其他人之间所形成的相互理解、相互信任、相互关怀的人际关系，会使这些场所形成良好的社会心理氛围。这种氛围能使医护工作人员合理的心理需求得到满足。1.3、有利于陶冶护士情操 人际交往不仅满足了人的精神或物质需要，同时也是人格互动与影响的过程。它包含人与人之间认识上的相互沟通、情感上的相互交流、性格上的相互影响，行为上的相互作用等人格互动过程。在护理服务过程中，护士建立各种人际关系的过程，实质上也是一种人格净化、陶冶情操的过程。1.4、有利于贯彻以人为本的护理理念 人本主义主张每个人都有自己的独特性及完整性，强调人的主观能动性，选择权及自主权，关心人的存在、价值、本质、理想、自由、个性、尊严、创造性级生活质量。人本主义的护理理念是满足服务对象作为一个人的整体需要，护理活动更注重人的整体性及自主性。31.5、有利于促进护理学科的发展 护理作为一门专业，具有其独特性及自足性，其从业人员不仅仅只是机械地执行医嘱，而应该在服务对象的护理中用自己独特的专业知识级技能，选择对服务对象最有利的护理措施。通过与服务对象建立良好的护患关系，可以帮助护士更好地明确其需要，并用独特的护理手段促进服务对象的健康。2、护理人际关系的特征2.1、专业性 这是由护士的专业职能决定的。在护理关系中，不论是与服务对象的关系，还是与医生、其他护士或医务人员的关系，都属于专业关系。2.2、时限性 这是由护理专业任务的特定时间跨度性质所决定的。专业任务存在，保持关系；专业任务完成，关系即宣告结束。时限性在护理关系上表现的最为突出。服务对象入院，关系开始建立，服务对象康复出院，关系宣告终止。2.3、多面性 这是由护士的角色及功能所决定，护士在健康服务群体中具有多方面的角色功能。2.4、复杂性 这是由护理服务对象的特殊性与流动性所决定的。护理的服务对象是具有生命有感情的人，他们在进入护理人际关系是带有自己的社会文化背景及生活经历，有自己的特殊的生理、社会文化、精神心理需求，加上服务对象的经常流动性，会增加护理人际关系的复杂性及处理难度。2.5、协作性 这是由健康服务工作的整体性级系统性所决定的。健康服务是许多不同专业人员及后勤保障人员等所组成的服务群体，只有共同努力，相互协调配合才能完成任务。2.6、公共性 这是由护理工作的社会性所决定的。护理对象涉及社会的所有成员。护士是代表医疗机构，甚至代表国家的社会保障体系来为公众服务。10二、护患关系1、护患关系的特征1.1、护患关系是以治疗为目的的专业性、帮助性关系 护患关系十一解决服务对象在患病间所遇到的生理、社会心理、精神等方面的问题，满足服务对象需要为主要目的的一种专业性的人际关系。这种关系中所有活动是以专业活动为中心，以保证服务对象的健康为目的。451.2、护患关系是一种工作关系 与其他的人际关系不同，护患关系是狐狸工作的需要，护士与服务对象之间的人际交往是一种职业行为。由于是一种工作关系，护患关系双方应避免过度的感情卷入。应为：护患关系中双方过多的感情卷入，会导致服务对象护士感情上的高度互动，一旦产生情绪变化，不仅会影响护士的正常工作情绪，也会使服务对象的情绪产生不良变化而影响健康。护患之间的过度的感情卷入，必然导致出现其他的非工作关系，如友谊、爱情、功利等关系。过度的感情卷入，灰化肥护士大量的时间及精力去满足与护理无关的服务对象，这会影响忽视的工作效率吧，甚至个人生活。1.3、护患关系是一种以服务对象为中性的关系 一切护理活动及护患交往都必须以解决服务对象的护理问题为目的，乙服务对象的健康为宗旨。91.4、护患关系是一种多方位的人际关系 护患关系不完全局限于护士与服务对象之间，它涉及医疗护理过程中多方位的人际关系。1.5、护患关系是一种互动关系 护患关系要达到双方对健康知识产生共识，就必须有双方的互动。1.6、护患关系是一种治疗关系 研究表明，良好的护患关系能有效地减轻会消除服务对象来自与疾病、诊疗护理、环境及人际关系多方面的压力，有利于促进服务对象的健康。111.7、护患关系是一种短暂性的人际关系 护患关系是服务对象在接受护理服务过程中存在的一种人际关系，一旦护理服务结束，一般这种人际关系就会结束。62、护患关系的基本模式2.1、主动-被动型 这是一种最常见的单向性的，乙生物医学模式及疾病的护理为主导思想的护患关系模式。这种模式适用于对昏迷、休克、全麻、有严重创伤及精神病的服务对象进行护理时的护患关系。2.2、指导-合作型 这是一种微乳单项，乙生物医学-社会心理及疾病的护理为指导思想的护患关系。这种模式主要运用于对急性病服务对象护理时的护患关系。72.3、共同参与型 这是一种双向性的，以生物医学-社会心理模式级健康为中心的护患关系模式。这种模式主要适用与对慢性病服务对象的护理。3、护患关系常见问题及解决技术不到位引发矛盾 现在的患者对医护人员技术水平和服务质量的要求越来越高。要是护士在护理过程中没有一套过硬的护理技术，那就很难令患者及其家属满意。最常见的就是打针了，一针扎下去，患者最知道分量。所以说，护士要练基本功，还得从技术水平做起。护理专家们的建议是，护士不仅要多学、多练、多请教，平时还要学习各学科的知识，做个“全科护士”。服务不到位引发矛盾 虽然现在的医院越来越看重服务，但仍有个别护士因为各种各样的原因冷落了患者。例如刚入院时，患者及其家属情绪都非常焦虑，迫切地想知道有关住院治疗的一系列相关问题，而有些护士对患者的首问负责制不到位，或用“床号”代替患者姓名，或谈吐不注意忌语，如对患者的询问敷衍了事，随之矛盾也就来了。所以，护士在接待患者时就得做好“引路人”，针对其心理特点，听听患者的想法及要求，一切为患者着想，急患者所急，想患者所想，及时将相关问题解释交代清楚，患者才能更好地配合治疗。沟通不到位引发矛盾 有些护士做得并没错，但患者要是不知情，就不太能理会护士的做法，这时候就觉得沟通的重要。曾有位护士看到一位大妈打点滴的时间很长，于是一言不发就上去调整点滴，可大妈不懂她的意思，见她将药水动来动去的就不高兴了，闹得最后竟然投诉那位护士。所以，在护患之间或与患者家属的交流中，护士要特别注意自己的语言表达，另外沟通时最好能将专业术语通俗化、口语化，深入浅出，通俗易懂。因隐私问题引发矛盾 在查看病历、注射时，护士会接触到一些病人的隐私，可要是护士管不牢自己的嘴，那就可能引发矛盾。所以，医院规定护理人员不议论患者的私生活，不擅自公开患者健康状况资料，床头卡上不注明疾病诊断，在给患者擦浴、更衣、肌肉注射、导尿、使用便器或医师查房做体检时，采用屏风遮挡。84、促进护患关系的方法创造良好的护患关系气氛及环境；与服务对象建立充分的信任关系；良好的人际沟通技巧；为服务对象树立角色榜样，理解服务对象角色所承受的社会心理负担，减少服务对象的角色冲突，促进服务对象的绝数额转换；健康的工作情绪，良好的工作热情。12三、医护关系1、医护关系的模式1.1、主导-从属模式 由于历史及专业发展进程的变化，特别是受生物医学模式及浪漫主义哲学思潮对护理的影响，长期以来医护关系的模式乙医生为主导，护士从属为主。这种模式中，护士的工作只是医生工作的附属或助手，任何专业决定都必须听命于医生，护士并不直接对服务对象负责，只是机械的执行医嘱，仅对医生负责。1.2、独立-协作模式 随着现代健康学科的不断发展，医学级护理模式的转变，人们逐渐对健康与疾病的认识发生了根本的变化，经过护士多年的努力级护理专业从服务、教育、科研专业组织等方面的不断完善与发展，护理已经成为一个独立的专业，并在预防保健过程中与医生互相合作，共同发挥着重要的作用。、医疗与护理专业相对独立，不可相互替代。、医疗与护理专业互相协作互补，共同发挥作用。2、医护关系常见问题及原因2.1、角色压力 在实际的健康服务组织中，医护比例失调，有些医院甚至倒置，造成人员负担过重而影响医护关系。2.2、缺乏理解 健康服务群体中，不同专业的教学一般都是相对独立进行的，专业之间相互了解不足，就会影响医护合作关系。2.3、利益斗争 医生级护士是医院的主力，特别是在一线工作的医护人员更是如此。由于一线人员之间的利益分配不均或利益分配之争，会产生医护冲突。2.4、自主权之争 医务人员按照分工，在自己的职责范围内限购一定的专业自主权，但是在某些情况下，医务人员可能会感觉自主权受到侵犯，因而产生矛盾或冲突。3、促进医护沟通的方法及策略3.1、相互信任，真诚合作 医生及护士是良好合作的同事关系，其目的是促进服务对象的健康。因此，医护之间应彼此理解对方的专业特点，主动配合对方的工作。3.2、主动宣传护理专业的特点 护士在日常的医护配合中，应随时主动宣传护理专业的特点及发展趋势，对医院的新护理规定及要求及时介绍，以增加医生对护理专业的了理解及支持。3.3、尊重医生的专业自主权级专业特征 医生与护士的关系是平等的专业合作关系。3.4、坚持原则，适当解释 当出现危机服务对象安全、健康甚至生命的争议时，护士就应坚持原则，挺身而出，为服务对象的利益着想，充当服务对象的代言人，然后耐心细致的做好解释工作。结论：护士在各种健康服务机构中处于众多关键的枢纽地位。对服务对象而言，护士与服务对象接触的时间最长，最熟悉服务对象的感觉与需要，是服务对象护理的主导者；对医生来说，护士与医生需要共同协作，完成服务对象的诊治护理任务；对护理系统内部来说，护士相互协作，有利于提高护理效率，最大限度的保证服务对象的健康。13相关文献：1李小妹 护理学导论 人民卫生出版社 20062李树贞 现代护理学 人民军医出版社 20003罗润来 黄丽娜 成洪波 刘春民 姚炜彪 护理管理中处理好人际关系的探讨护士进修杂志 20044孙香爱 谈护士长在护患关系中作用 护士进修杂志 20025陈田林 陈勇飞 钟双喜 从护患关系的不协调因素分析其实质与对策 护理学杂志：综合版 2007 6穆燕红 张静 等 影响医护关系心理因素的分析及对策 护理管理杂志 20037 王惠贤 健康教育是建立新型护患关系的重要环节 实用护理杂志2001年3期8 宋爱东 护患沟通是和谐护患关系的基础 中国民康医学 2008年4期9 Scholar and Hollender Texas 1976, American10 Levin specifications and snooker 197211 Peng Lei On Communication skills and the nurse-patient relationship 201112Perry Peterson Potter Physician-patient relationship 199913Barbara Cherry Susan R Jacob Nurse-patient relationship communication skills 2001Active - passive mode is the traditional model of physician-patient relationship in modern medical practice is still widespread, is not characterized by two-way interaction between doctors and patients, but doctors play a role in patients with one-way. Doctors in the medical process fully active, decision-making and decision-making power all the doctors side. Medical authority can not be doubted, passive patients to receive treatment. Elements and features of this model is: what a patient, the advantage is to play an active role of doctors, but completely ruled out in patients with primary possibilities. Active a passive mode is mainly applied in the contemporary treatment of acute emergency situation, such as patients with serious injuries or loss of consciousness and is difficult to express the subjective consciousness.Guidance - a mode of cooperation is the doctor-patient relationship in modern medical practice based model, which is characterized by a doctor in medical activities to keep active, the patient has some initiative, but the patients physician will take the initiative to implement the premise mandatory for doctors treatment measures can only follow and cooperation, although doctors still have to play the authority of the instructor. Elements and features of this model is: tell patients what to do, the advantage of both doctors and patients can play the initiative, enthusiasm, will help to establish a harmonious doctor-patient relationship, improve diagnosis and treatment of medical errors and correct, but between doctors and patients rights is still unequal. Guidance - a partnership model for clear-headed, able to express the condition of patients with medical practitioners.Mutual participation model is looking forward to the development of modern medical new model of physician-patient relationship, which is characterized by doctors in patients with similar equal rights and status, the two sides complement each other, to participate in medical decisions and implementation. Highlights and features of this model is to help patients self-treatment, the advantage of the model will help improve understanding between doctors and patients, to eliminate patient barriers to establish a good doctor-patient relationship. Mutual participation model for chronic disease, and medical science has a certain level of knowledge of patients.First, the meaning of interpersonal relationshipsRelationships (interpersonal relationship) is that people in joint activities to meet each others needs and to seek to establish the relationship between the psychological. We can say that the origin of human relationships is synchronized with the occurrence of an extremely ancient social phenomenon.Relationships with the characteristics of the following aspects:(1) individuality. Performance of the specific nature of interpersonal relationships of individuals in the interactive process. In interpersonal relationships, the teacher and students, boss and subordinate and other factors relegated to secondary status roles, and the other is not your favorite, or who are willing to close a major problem. This is the relationship of the individual characteristics of the performance.(2) direct, can be emotional. Interpersonal relationships in people and even face to face directly the process of interaction formed, it reflects the needs of others to meet their psychological state, everyone can truly feel its presence. In general, there is no direct contact is no contact and relationships, and establish a relationship as long as, certainly for the people directly experience.(3) affective. The basis of relationships between peoples emotional activities. Emotional factors are the main component of interpersonal relationships. Interpersonal emotional tendencies can be summarized into two categories: one is close to each other or attract peoples feelings, that even an emotion. Secondly, to enable people to mutually exclusive and opposing emotions, that the separation of emotion.Second, the interpersonal basis of the social psychologyHuman beings are social animals, with a gregarious and social tendencies. People most of the time spent with others. Read Larson et al (1982) on peoples time use were studied. They let a young adult sample and a sample was tested in every week to carry a pager. Every day from early morning to late at night, researchers are testing several random calls, the call of the subjects were required to complete a short questionnaire, indicating that they are doing, is alone or together with other people. The results show that people in nearly 3 / 4 of the non-sleep time together with others, only to do household chores, bathing, listening to music or studying at home when alone. In contrast, when people at school or work, the more likely and others together. And together with others, individuals could be more happy, alert and excited. Why do people need so accompanied it with others? Psychologists have made a variety of interpretations.(A) and the need to pro-Atkinson (Atkinson) and others that affect peoples social interaction, there are two motives: one is the pro-and demand (the need of affiliation), is seeking a number of positive relationships and maintain the desire that people have accompanied by a tendency to need and others; the other is the intimate needs (the need of intimacy), is that people seeking a warm, intimate relations.Affinity for human needs, the American psychologist Schacht (Schachter) has a well-known experiment. He designed a window, but not air-conditioned room, which in addition to a table, a chair, a bed, a toilet, a lamp outside the no other things, three meals a day a small hole through the door at the end of the delivery into. Who can stay in this room one day to get a substantial reward for the purpose of measuring what people think in such a scenario can be isolated spend a few days. Five college students served as subjects, the result is one of them spent 20 minutes just can not stand to give up the experiment, two people for two days, the longest subjects spent only eight days. This exploratory study shows that people are lonely endurance there is a difference, but who can hardly live in endless lonely environment.Psychologists and social needs of the factors affecting the pro-conducted in-depth study and found that with fear, anxiety and other closely related.1 and need to fear and pro-In the 1950s, Schacht (Schachter) conducted a series of classic experiments, trying to understand the need to enhance peoples affinity factors. He proposed the fear of people facing a stronger affinity with behavioral tendencies, the hypothesis. To verify this, his female students were tested for the relevant experiments. Were tested by giving different guidance language to manipulate the level of fear level. The researchers told the women were tested on how they want to participate in a shock experiment affect the physiological responses. In the high fear group, the subjects were told very painful shock but will not cause permanent injury; low fear of the subjects were told only a little pain, shock, or hemp up feeling a bit itchy. In fact they are not subjected to electric shocks, the experimenter just want to believe that they will soon be tested by such a shock. After Schacht were told that the experimental equipment used has not yet assembled, asked them for 10 minutes. And were told that they can separate themselves, but also together with other subjects and so on.Adapted from Friedman, eds: Social Psychology, Heilongjiang Peoples Publishing House, 1984, p. 62.The results shown in Figure 8-1, in the case of high-fear, people choose to wait along with others, and in the case of low fear alone is more willing to wait. Schacht with social comparison theory (Social comparison theory) to explain this phenomenon, social comparison emphasize social comparison is that people get through and around the world on their own knowledge. Therefore, it is to get close with others, their feelings with other people in similar situations more. Miller (Miller, 1984) further believes that people not only through social comparison to judge their own ability and self-concept, and through it to get emotional about their choice of information and even friends.(2) anxiety and needs and pro-Unlike fear, anxiety, is another persons emotional state. Fear is there because of the actual or anticipated threats to the threat scenario will come to arouse emotions arising from anxiety generated by the non-reality is not possible to determine the causes. We already know that fear is stronger, the higher affinity and needs. So whether anxiety and fear, as will tend to enhance the affinity of people?Faced with embarrassing or self-awareness but not with the physical pain of the scene will cause people anxiety reaction. Accordingly, Shanuo Fu (Sarnoff) and Zimbardo (Zimbardo) designed an experiment to study the anxiety, fear, and the relationship between pro-and tendencies. Beginning of the experiment, the experimenter asked the subjects to special requirements in order to manipulate the subjects anxiety reaction. High anxiety group were tested in the experiment were told they need to wear a bib, pacifier sucking; low-anxiety group, subjects were told that they need in the experiment sounded the whistle. High and low anxiety group of experimental results with high and low fear group results just the opposite: high anxiety subjects than low anxiety subjects were more willing to wait for a single person beginning of the experiment. This shows that the fear will increase the pro-and demand, but it will reduce anxiety, pro-and demand. In other words, when a person together with other people not only can not give him comfort, but will make him look embarrassed, he would prefer a separate experience embarrassment. Friedman (Friedman) was tested by measuring the degree of sexual excitement in order to trigger their anxiety, but also tend to be the result of lower affinity.(B) interpersonal rewardsWith the growth of our society need to become more complex and diverse. We will have fun together with those who can help, or to accept a strong relationship between the formation of our people. These relationships can bring us benefits. Social exchange theory (social exchange theory) that get people through the exchange of social psychological and material rewards, so people will try to seek and reward than to pay to maintain relationships. People get the benefits from the relationship formation and maintenance of interpersonal relationships is an important reason, Weiss (R. Weiss, 1974) to determine the relationship can provide an important reward of six individuals:Attachment (attachment): refers to the intimate relationships available to the individuals sense of security and comfort, the attachment point to parents, child, spouse or adult is for close friends.Social integration (social integration): Through affinity interaction with others and with others have the same views and attitudes, resulting in groups a sense of belonging. Usually from friends, colleagues, teammates, comrades and other relations access.Determine the value (reassurance of worth): to get people to support themselves when they have the ability to produce valuable sense.Reliable ally sense (a sense of reliable alliance): By establishing a good relationship with others, let us form when needed someone to help our understanding.For guidance (the obtaining of guidance): interaction with others so that we can get there from the valuable guidance of others, such as from doctors, friends and teachers, etc.The opportunity to take care of others (the opportunity of nurturance): responsible for the health of others when we are there to take care of someone is to us a sense of need and self-important.(C) get rid of lonelinessPeople interact with others, the third reason is to get rid of loneliness. Loneliness (loneliness) means that when people lack some important features of social relations, when the subjective experience of discomfort. This defect may be quantitative, we may not have friends or friends less than we expected; it may be quality, and we may feel superficial relationships or fail to meet the desired extent.Note that, loneliness and isolation (aloneness) is different with others, loneliness is an objective state of isolation, loneliness can be pleasant or unpleas