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1
Chapter 6? Role Relationship Patterns?
2
what kinds of outline are the most important
in the chapter?
Role Relationship Patterns
3
OUTLINE
p.108

• Basic Concepts?
• Definitions?
• Related Terms?
• Personal Interpretations of Role?
• Societal Interpretations Role?
• Effects of Alteration in Role Performance on
  Others?

Role Relationship Patterns
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OUTLINE
p.108

• Applications?
• Professional Nurse Role?
• Types of Professional Roles?
• Role Socialization
• Role Stress?
• Self-awareness in the Professional Role?

Role Relationship Patterns
5
OUTLINE
p.108

• Client Role?
• Patient's Bill of Rights?
• Role Performance as a Nursing Diagnosis?
• Supportive Interventions?
• Developing New Solutions?
• Summary

Role Relationship Patterns
6
What are the objectives of learning or
studying in our lesson?
Role Relationship Patterns
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Objectives
p.108

• At the end of the chapter, the student will be
  able to ?
• 1. Define role and role performance?
• 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?

Role Relationship Patterns
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Objective One Define role and role performance
Role Relationship Patterns
9

Definitions
p.109-110
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).
Role Relationship Patterns
10

Definitions
p.109-110
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.
Role Relationship Patterns
11
?????????????
p.310
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??????,????????????????????????????,??????????????
????????????????????????????,?????????????????????
?
Role Relationship Patterns
12
?????????????
p.303 p.310
??????????????????????????,?????????,??????,????
????,????????????????????? ????????????,??????
?????????????????????????????????,????????????????
???????
Role Relationship Patterns
13
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??????xx(??)????????
???? ??????
??? ?? ??
?????????? ?? ????,
?????????????
???????????
Role Relationship Patterns
14

Definitions
p.109-110
What is role performance?
Role performance refers to a person's
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.
Role Relationship Patterns
15

Definitions
p.109-110
What is role transition?
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.
Role Relationship Patterns
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Definitions
p.109-110
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.
Role Relationship Patterns
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Definitions
p.109-110
What is position?
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.??
Role Relationship Patterns
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Objective Two Describe the four components of
professional role socialization
Role Relationship Patterns
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Professional Nurse Role
p.114-115
Which is the four components of professional
role socialization ?
Unlike other forms of education, the nursing
student must simultaneously(???)adjust to
learning new material while starting on the job
training in which the stakes(??)are high.
Cohen identified four goals of professional
socialization (see Box 6-4). ?
Role Relationship Patterns
20

• Box 6-4.Steps in the Socialization Process
• Learn the technology of the profession the
  facts,
• skills, and theory.?
• Internalize(????)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
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•   
• Box 6-4.Steps in the Socialization Process
• ?????????????????
• ??????????
• ????????????????????
• ??????????????????

Role Relationship Patterns
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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
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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
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Role Relationship Patterns
Exercise Looking at My Development as
a Professional Nurse

• Procedure
• What are your reasons for choosing nursing as a
  profession?
• What factors influenced your decision people,
  circumstances, or situations?
• Describe your vision of yourself as a nurse.
• What fears do you have about your ability to
  function as a professional nurse?
• How do you think being a nurse will affect your
  personal life?

25
Discussion

• In what ways is your story similar to or
  different from those of your classmates?
• As you wrote your story, were you surprised by
  any of the data or feelings?

Role Relationship Patterns
26
Discussion

• 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
• The practices nursing students will need to
  follow to achieve their vision
• The types of supports nurses need to foster their
  ongoing professional development

Role Relationship Patterns
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Objective Three Discuss the professional roles
of the nurse
Role Relationship Patterns
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Professional Nurse Role
P.116
Which are there Professional Nursing Roles

• 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
• Reinforces the natural, developmental, and
  healing processes within a person to enhance
  well-being,
• comfort, function, and personal growth

Role Relationship Patterns
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Which are Professional Nursing Roles
P.116
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
Role Relationship Patterns
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Which are Professional Nursing Roles
P.116

• 3. Client advocate
• a. Protects client's 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
• Acts as client's agent in coordinating effective
  health care services

Role Relationship Patterns
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Which are Professional Nursing Roles
P.116

• 4. Manager
• a. Coordinates staff and productivity?
• b. Delegates differentiated tasks to appropriate
  personnel
• Facilitates communication within and among
• departments ?
• Serves on committees to improve and maintain
  quality of care?
• e. Makes decisions and directs relevant changes
• to ensure quality care

Role Relationship Patterns
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Which are Professional Nursing Roles
P.116

• 5. Evaluator
• a. Sets quality assurance/care standards?
• Reviews records and monitors compliance with
• standards?
• c. Makes recommendations for improvement

Role Relationship Patterns
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Which are Professional Nursing Roles
P.116
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
Role Relationship Patterns
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Which are Professional Nursing Roles
P.116

• 7. Consultant
• 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

Role Relationship Patterns
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Which are Professional Nursing Roles
P.116

• 8. Case Manager
• a. Administers care for a caseload of clients?
• b. Coordinates cost-effective care options?
• Monitors client progress toward expected
  behavioral outcomes?
• Collaborates with other professionals to ensure
  quality care across health care settings

Role Relationship Patterns
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Objective Four Discuss the characteristics of
the sick role?
Role Relationship Patterns
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How to understand Client role , role
relationships, performance and transition?
p.119

• From the client perspective, loss of or changes
  in normal roles, role relationships, and role
  performance are important dimensions(??/?)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.

Role Relationship Patterns
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p.119
How to understand Client role , role
relationships, performance and transition?

• The nurse may be the only person who has the
  expertise and willingness to facilitate
  discussions of the implications of role changes
  stemming from(??)altered health status for the
  client in an objective, compassionate manner.

Role Relationship Patterns
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How to understand Client role , role
relationships, performance and transition?
p.119

• 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

Role Relationship Patterns
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How to understand Client role , role
relationships, performance and transition?
p.119

• Most people do not assume the sick role
  voluntarily.
• Illness or trauma(??)can change an individuals
  social role from one of independent
  self-sufficiency to one of vulnerability(???)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(??) and helplessness. ?

Role Relationship Patterns
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How to understand the transition of Client role ,
role relationships, and role performance?
p.119

• At the hospital door, the client
  forsakes(??)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 (??),
  questions about role performance inevitably
  arise.
• Often clients must learn new role behaviors that
  are unfamiliar and unsettling to previously held
  self-concepts.

Role Relationship Patterns
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How to understand the transition of Client role ,
role relationships, and role performance?
p.119

• 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.?

Role Relationship Patterns
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How to understand the transition of Client role ,
role relationships, and role performance?
p.119
Differences in perspectives play a major part in
determining which illnesses and disorders are
recognized as legitimate(???), the roles clients
assume in their health care, and who becomes the
culturally assigned expert (? ...????) 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 body's functioning.
These cultural understandings can affect
role relationships in health care
settings.?
Role Relationship Patterns
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Client Role
p.120
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.?
Role Relationship Patterns
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Client Role
What is a Patient's Bill of Rights ?
p.121
1. The patient has the right to considerate and
respectful care.
Role Relationship Patterns
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Client Role
What is a Patient's 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.?
Role Relationship Patterns
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Client Role
p.121
What is a Patient's Bill of Rights ?
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.).?
Role Relationship Patterns
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Client Role
p.121
What is a Patient's Bill of Rights ?
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.?
Role Relationship Patterns
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Client Role
p.121
What is a Patient's Bill of Rights ?
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.?
Role Relationship Patterns
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Client Role
p.121
What is a Patient's Bill of Rights ?
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 patient's
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.?
Role Relationship Patterns
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Client Role
p.121
What is a Patient's Bill of Rights ?
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.?
Role Relationship Patterns
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Client Role
p.121
What is a Patient's Bill of Rights ?
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 patient's treatment
and care.?
Role Relationship Patterns
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Client Role
p.121
What is a Patient's Bill of Rights ?
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.?
Role Relationship Patterns
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Client Role
p.121
What is a Patient's Bill of Rights ?
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
informed of available resources for resolving
conflicts.?
Role Relationship Patterns
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Vocabulary
compensation substantial finding counseling
supervision delegation execution
regimen registered nurse accountable
responsible competency statute territory
monitor prioritize coordinate personnel
board mandate
licensure legal confidentiality identification
informed consent ethical code consideration
inconsiderate impulse appetite caprice
parameters sequence assume discipline prescribe
appropriate mutually performance
representative violation revise articulate
benchmark oncological gerontological
psychiatric tenet relevance tort benchmark
judge negligence breach document falsify
withhold privileged communication
compromise mandate communicable statutory In
addition to in any way Informed Consent
knowledgeable
56
(No Transcript)
57
OUTLINE
Basic Concepts American Nurses Association's
Definition of Professional Nursing
Practice Professional Licensure Nurse Practice
Acts Professional Standards of Care Legal
Standards Confidentiality Informed
Consent Protecting Client Rights
58
OUTLINE
Ethical Code for Nurses Applications Nursing
Process Nursing Process and Professional
Relations Assessment Diagnosis Planning and
Outcome Identification Implementation
Evaluation Critical Pathways Summary
59
OBJECTIVES
1.Define professional nursing 2.Discuss the
implications of nurse practice acts in the
nurse-client relationship 3.Identify professional
standards of care 4.Discuss legal
standards 5.Discuss implications of the code of
ethics with interpretive statements for the
nurse-client relationship 6.Describe the nursing
process as a frame-work for professional
nursing practice and the nurse-client
relationship 7.Discuss critical pathways as a
method of communication  
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If a man's actions are not guided by thoughtful
considerations, then they are guided by
inconsiderate impulse, unbalanced appetite,
caprice or the Circumstances of the moment .

John Dewey (1933)
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??????????????

?? Dewey(1933)
61
Professional Licensure

• The registered nurses professional license
  ensures that each individual nurse has
  successfully completed nursing program
  requirements and can demonstrate the knowledge,
  skills, and competencies to function as a health
  provider of safe, effective nursing care.
• All persons practicing nursing are required
  by law to have a current license in the state in
  which they practice and to update their licensure
  yearly. This license requires anyone practicing
  nursing to comply with all state laws governing
  practice.
• The ANA tests core nursing knowledge before
  granting a nurse a professional license. Nursing
  licensure helps maintain standards for nursing.
  Each state currently has the right to determine
  who does and who does not practice in that
  state.?

62
Box 2-1.Professional Standards Guiding the
Nurse-Client Relationship
Standards of Care ?.Assessment The nurse
collects client health data.? ?.Diagnosis The
nurse analyzed the assessment data in determining
diagnoses.? ?.Outcome Identification The nurse
identifies expected outcomes individualized to
the client.? ?.Planning The nurse develops
a plan of care that prescribes interventions to
attain expected outcomes.? ?.Implementat
ion The nurse implements the interventions
identified in the plan of care.? ?.Evaluation
The nurse evaluates the client's progress toward
attainment of outcomes.
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BOX2-1 ???????????
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?.???? ????????????? ?.?? ????????,??????????????
????? ?.?? ????????????????? ?.??
????????????????
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Standards of Professional Performance
?.Quality of Care The nurse systematically
evaluates the quality and effectiveness of
nursing practice ?.Performance Appraisal
The nurse evaluates his/her own nursing practice
in relation to professional practice
standards and relevant statutes and regulations.
? ?.Education The nurse acquires and maintains
current knowledge in nursing practice.? ?.Collegia
lity The nurse contributes to the
professional development of peers, colleagues,
and others.? ?.Ethics The nurses
decisions and actions on behalf of clients are
determined in an ethical
manner.? ?.Collaboration The nurse
collaborates with the client, significant others,
and health care providers in providing
client care.? ?.Research The nurse uses
research findings in practice.? ?.Resource
Utilization The nurse considers factors
related to safety, effectiveness, and cost in
planning and delivering client care.
65
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