安徽医科大学护理学院思维与沟通课件 第四章.ppt

Peplau suggested that a general rule of thumb in working with clients is to: Struggle with the problem , not with the patient. Working phase 1.Defining problem 2.Pacing 3.Developing realistic goals 4.Planning alternative solutions Defining problem Observation Communication 事例 一九九三年八月十五日，在荷兰留学的何辛放学后，向家走去。在经过一十字路口时，被一飞驰而来的卡车撞倒。送往医院后，经检查腿部断裂。在送往医院的途中及住院的前两日，何辛神智清醒，没有出现其他不适症状。第三日，何辛突然出现危急状态，陷入昏迷，抢救无效死亡。经医检，系颅内出血所致。 Working phase Identification Client: Fluctuates among dependence,independence,and interdependence Change appearance Nurse: Help express needs, feelings Assesses and adjusts to needs Provides information cues Exploitation Client: Makes full use of services Identifies new goals Self-directing Nurse: Continues assessment Understands reasons for shifts in behavior Initiates rehabilitative plans Support(pacing): Help express feelings,needs Provides information Therapeutic Help  Appropriate words: Nonverbal behaviors:such as careful listening ,concern,body language Provide information General knowledge of the disease,successful case,the situation of the prognosis Therapeutic: Disposing of sense:lack of visit,quiet and comfortable environment Music therapeutic Developing realistic goals Achievable Behavioral Realistic Planning alternative solutions All life situations have many element Some thing can go wrong There are mistakes Difficulties Planning alternative solutions Nursing interventions should have a broad focus Anticipating reactions of others Constructive coping mechanism Challenging resistant behaviors Reasons of resistant behaviors Patient: 1 Lack of awareness Lack of knowledge No money Will is not strong enough Nurse: Nurse’s response A good way to change the resistant behaviors: Honest,patient, mild,enthusiastic and a welcome way of talk Termination phase Definition Preparation for discharge Different client,different