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Chapter 6Chapter 6 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 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 21 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 22 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 23 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 24 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: 25 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: 26 Role Relationship Patterns Objective Three: Discuss the professional roles of the nurse 27 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 28 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 29 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 30 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 31 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 32 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 33 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 34 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 35 Role Relationship Patterns Objective Four: Discuss the characteristics of the sick role 36 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 37 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 38 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 39 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 40 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 41 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 42 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 43 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 44 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 45 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 46 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 47 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 48 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 49 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 communications and records pertaining to care will be treated as confidential by the hospital, except in cases such as suspected abuse and public health hazards, when reporting is permitted or required by law. p.121 Role Relationship Patterns 50 What is a Patients Bill of Rights ? Client RoleClient Role 8.The patient has the right to review records pertaining to medical care and to have the information explained or interpreted as necessary, except when restricted by law. 9.The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service, and referral as indicated by the urgency of the case. p.121 Role Relationship Patterns 51 What is a Patients Bill of Rights ? Client RoleClient Role 10.The patient has the right to ask and be informed of the existence of business relationships among the hospital, educational institutions, and other health care providers or payers that may influence the patients treatment and care. p.121 Role Relationship Patterns 52 What is a Patients Bill of Rights ? Client RoleClient Role 11.The patient has the right to consent decline to participate in proposed research studies or human experimentation affecting care and treatment or requiring direct patients involvement and to have those studies fully explained before consent. p.121 Role Relationship Patterns 53 What is a Patients Bill of Rights ? Client RoleClient Role 12.The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers of available and realistic patient care options when hospital care is no longer appropriate. The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities and to be infor