1、第三章高級護理實踐相關理論第三章高級護理實踐相關理論第三章高級護理實踐相關理論Brown應用整體的觀念與患者建立伙伴關系專家型的臨床思維過程和技術操作運用科研指導實踐運用不同方法進行疾病和健康管理第三章高級護理實踐相關理論第三章高級護理實踐相關理論第三章高Brown應用整體的觀念與患者建立伙伴關系專家型的臨床思維過程和技術操作運用科研指導實踐運用不同方法進行疾病和健康管理Brown清楚自身專業(yè)角色和功能區(qū)分不同層次護理實踐幫助APN提供全面和整體的護理提供護理研究框架開展課程設計清楚自身專業(yè)角色和功能Browns framework of APN (1998)Hamrics model of

2、APN (2005)Browns framework of APN (1998Browns Framework of advanced practice nursing(1998)Browns Framework of advanced Primary criteriaGraduate educationCertificationPractice focused on patient/familyCore competencies Direct clinical practice (Central competencies)Expert coaching and guidanceconsult

3、ationResearch skillsClinical and professional leadershipcollaborationEthical decision making skillsPrimary criteriaCritical environmental elements affecting APNRegulatory and credentialing requirements認證監(jiān)管Business aspects業(yè)務評價Policy making consideration健康政策Reimbursement/payment mechanisms薪酬Outcome ev

4、aluation and performance improvementMarketing and contracting市場和合同Organizational structure and cultureCritical environmental elementCalkins model of APN Population responsesKnowledge levelSkill levelPatient responses correlated with the knowledge and skill of beginning practitioners, experienced nur

5、ses and APN.Knowledge and skills of the nurses needed are based on the patient needs.3 curves were overlaid on a normal distribution chartCalkins model of APN 3 curvesShulers model of APN: a theoretical framework 1993 Holistic patient needsNP-patient interactionSelf-careHealth preventionHealth promo

6、tionwellnessShulers model of APN: a theo病人特點：恢復力易感性穩(wěn)定性復雜性資源預測性參與護理參與決策護士能力：判斷支持和代言護理實踐合作系統(tǒng)思維合適的反應臨床研究促進學習病人特點：護士能力：Strong Memorial Hospitals model of APN (Ackerman,MH et.1996)Strong Memorial Hospitals modEmpowerment賦能 Giving power to another, encouraging, or giving authority 人們獲得自己控制、決定及行動去影響自己健康的過程

7、（WHO，1986）賦能過程：共同參與、主動聆聽、共同獲得個體化知識 應用：慢性病管理Empowerment賦能TheTranstheoretical Model TTM 跨理論模式is a model of intentional change developed by Prochaska and Diclemente in the 1980s. It focuses on the decision making of the individual.The core constructs of the TTM the processes of change 改變階段 decisional b

8、alance 權衡決定 self-efficacy 自我效能 Temptation 改變方法TheTranstheoretical Model TT無意圖期意圖期準備期終止期行動期維持期無意圖期意圖期準備期終止期行動期維持期PRECONTEMPLATION (Not ready to change) The individual is not currently considering change: “Ignorance is bliss” 難得糊涂People are not intending to take action in the foreseeable future, usual

9、ly in the next six months. Techniques: Validate lack of readiness Encourage re-evaluation of current behavior Encourage self-exploration, not action Explain and personalize the risk Traditional health promotion programs are often not designed for such individuals and are not matched to their needs.

10、(Velicer, 1998) PRECONTEMPLATION (Not ready toCONTEMPLATION (Thinking of changing) Ambivalent about change: “Sitting on the fence” 左右為難Not considering change within the next month. Techniques: Encourage evaluation of pros and cons of behavior change. Re-evaluation of group image through group activi

11、ties. Identify and promote new positive outcome expectations CONTEMPLATION (Thinking of chaPREPARATION (Ready to change) Testing the waters Planning to act within 1month. Techniques: encouragement to evaluate pros and cons of behavior change. identify and promote new positive outcome expectations. E

12、ncourage small initial steps . have taken some actions in the past year Suitable for action- oriented programs for smoking cessation, weight loss, or exercise programs.PREPARATION (Ready to change) ACTION (Making change) The active work toward desired behavioral change including modification of envi

13、ronment, experiences, or behavior have been taken. At this stage people have made specific overt modifications in their life-styles within the past six months. At this stage measures should be taken against relapse. Techniques: Help the individual on restructuring cues and social support. Enhance se

14、lf-efficacy for dealing with obstacles. Help to guard against feelings of loss and frustration. ACTION (Making change) MAITANANCE (Staying on track) on ongoing, active work to maintain changes made and relapse prevention. At this stage people are less tempted to relapse and increasingly more confide

15、nt that they can continue their change. Techniques: follow-up support reinforce internal rewards discuss coping with relapseMAITANANCE (Staying on track) RELAPSE (Fall from grace) It is a form of regression to previous stages. It refers to falling back to the old behaviors after going through other

16、stages. Regression occurs when individuals revert to an earlier stage of change. Techniques: Evaluate trigger for relapse Reassess motivation and barriers Plan stronger coping strategies RELAPSE (Fall from grace) 第三章高級護理實踐相關理論課件Decisional Balanceweighing of the pros and cons of changing. weighting t

17、he importance of the Pros and Cons. Self-efficacy specific confidence that people have that they can cope with high-risk situations without relapsing to their unhealthy or high-risk habit. This concept was adapted from Banduras self-efficacy theory.Decisional BalanceSelf-efficacTemptation reflects t

18、he intensity of urges to engage in a specific behavior when in the midst of difficult situations. Temptation is the converse of self-efficacy. The most common types of tempting situations are; negative affect or emotional distress positive social situationscravingTemptation smoking cessation exercis

19、e low fat diet radon testing alcohol abuse weight control condom use for HIV protection organizational change use of sunscreens to prevent skin cancer drug abuse medical compliance mammography screening, and stress managementsmoking cessation organization基本概念社會網(wǎng)絡向個體提供的援助緩沖理論：社會支持緩沖壓力依附理論：童年形成的安全依附感對