Morse J M, Havens G A, Wilson S
School of Nursing, Pennsylvania State University, University Park 16802, USA.
Sch Inq Nurs Pract. 1997 Winter;11(4):321-43; dscussion 345-7.
In this article we argue that the separate literatures on the nurse-patient interaction and the nurse-patient relationship artificially fragment a unified process, and a model incorporating both interaction and relationship is critically needed. The Comforting Interaction-Relationship Model, in which the nurse-patient interaction is proposed as a means for the nurse and the patient to negotiate and establish a desired therapeutic relationship is presented. Nursing actions are described as three interrelated levels: 1) comforting strategies, or separate discrete actions which together form nurses' styles of care, 2) styles of care, or sets of comforting strategies, and 3) patterns of relating, or normative, professional behaviors. These three processes are provided in response to patient signals of distress, indices of discomfort, and patterns of relating that form patient actions. It is through this interaction of nursing actions and patient actions that the nurse-patient relationship is negotiated. This model is patient-led, dynamic, interactive, and context dependent. Even though the model is driven by the patient's behavioral state, actions, and reactions, both the nurse and the patient maintain control--the nurse selects the strategy or style to be used, and the patient, in negotiating, relinquishing, and accepting care, maintains control. Suggestions for future research are presented.
在本文中，我们认为，关于护患互动和护患关系的独立文献人为地割裂了一个统一的过程，因此迫切需要一个同时纳入互动和关系的模型。本文提出了“安慰性互动 - 关系模型”，其中护患互动被视为护士与患者协商并建立理想治疗关系的一种方式。护理行为被描述为三个相互关联的层次：1）安慰策略，即共同构成护士护理风格的单独离散行为；2）护理风格，即安慰策略的集合；3）关系模式，即规范的专业行为。这三个过程是针对患者的痛苦信号、不适指标以及构成患者行为的关系模式而提供的。正是通过护理行为与患者行为的这种互动，才协商出护患关系。该模型以患者为主导，具有动态性、互动性且依赖于具体情境。尽管该模型由患者的行为状态、行动和反应驱动，但护士和患者都保持着控制权——护士选择要使用的策略或风格，而患者在协商、放弃和接受护理的过程中保持控制权。本文还提出了对未来研究的建议。
