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Medical schools teach physicians to practice "detached concern," a simultaneous emotional distance from and sensitivity toward their patients. Medical students learn detachment to protect themselves from emotion-laden experiences, including death and dying, by employing mechanisms of defense and adjustment, such as suppression and repression of emotions. In this study, the author inquires whether hospice volunteers are trained for and practice detached concern and finds that hospice volunteers are trained for concern. They are concerned for the well-being of patients and their families. The author argues that concern is a social product that can be trained; hospice volunteers are not trained to suppress and repress their emotions, and the hospice as an institution produces and transmits cultural norms, values, and practices surrounding death and dying, thus maintaining a pool of concerned volunteers.  相似文献   

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The central goal of this study was to inventory and understand difficult communication issues or dilemmas that arise among hospice volunteers, patients, and their families. Hospice volunteers reported, based on their observations and experience, that denial was the most common communication issue or dilemma for patients, family, and caregivers, followed by negative feelings and family conflicts. Volunteers reported that for themselves, the most common problem was patient impairments such as Alzheimer's or Parkinson's disease that made conversation difficult. Powerful and wide-ranging emotions were also challenging for dying patients and their caregivers. Problematic integration theory and terror management theory could be developed further by expanding the role of emotions, and trauma management theories could be enhanced by developing deeper understanding of how the loss of social bonds may be as traumatic as the loss of life.  相似文献   

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The central goal of this study was to inventory and understand difficult communication issues or dilemmas that arise among hospice volunteers, patients, and their families. Hospice volunteers reported, based on their observations and experience, that denial was the most common communication issue or dilemma for patients, family, and caregivers, followed by negative feelings and family conflicts. Volunteers reported that for themselves, the most common problem was patient impairments such as Alzheimer's or Parkinson's disease that made conversation difficult. Powerful and wide-ranging emotions were also challenging for dying patients and their caregivers. Problematic integration theory and terror management theory could be developed further by expanding the role of emotions, and trauma management theories could be enhanced by developing deeper understanding of how the loss of social bonds may be as traumatic as the loss of life.  相似文献   

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This article discusses the challenging context that health care professionals are confronted with, and the impact of this context on their emotional experiences. Care ethics considers emotions as a valuable source of knowledge for good care. Thinking with care ethical theory and looking through a care ethical lens at a practical case example, the authors discern reflective questions that (1) shed light on a care ethical approach toward the role of emotions in care practices, and (2) may be used by practitioners and facilitators for care ethical reflection on similar cases, in the particular and concrete context where issues around emotional experiences arise. The authors emphasize the importance of allowing emotions to exist, to acknowledge them and to not repress them, so that they can serve as a vehicle for ethical behavior in care practices. They stress the difference between acknowledging emotions and expressing them limitlessly. Formational practices and transformational research practices are being proposed to create moral space in care institutions and to support health care professionals to approach the emotionally turbulent practices they encounter in a way that contributes to good care for all those involved.  相似文献   

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Implementing newly legalized euthanasia or assisted dying presents challenges. The procedure is high-stakes and irreversible and the context is controversial and associated with high emotions and strong opinions. This qualitative study reports unexpected experiences of twenty-one medical doctors who provided Medical Assistance in Dying (MAID) in the first years after legalization in Canada. The phrase ‘because it was new’ occurred multiple times as doctors attributed unanticipated experiences to the lack of individual and collective experience or knowledge. Positively viewed surprises included increased awareness of palliative care and an unexpected personal sense of fulfillment from helping others. Negative surprises were attributed multiple factors including ambiguously phrased legislation, systems issues and individual inexperience. Participants described issues such as technical difficulties around provision, provider anxiety, logistical snags and inability to adequately counsel and guide families. Participants expressed desire for more guidance, mentoring, training, and team communication. This article draws on phenomenological analysis of data to present providers’ accounts of their experiences in the Canadian context. This will assist new providers and jurisdictions in anticipating and preparing for circumstances that were unexpected for the first cohort.  相似文献   

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This study uses Australian data based on interviews with nurses and participant observation in an in-patient hospice and a community based hospice service to demonstrate how hospice nurses perceive stress in their work environment and cope with caring for dying patients. Stressors are discussed within a cultural context and are viewed as threats to the nurses' shared system of values which centres on the Good Death. The Good Death is conceptualised as a series of social events that involve the dying person as well as the other interactants who may include family, friends and health professionals. The death is defined as ‘good’ if there is an awareness, acceptance and preparation for death by all those concerned. The nurses' coping strategies and social supports are negotiated within the context of the hospice environment, and relate directly to the protection and affirmation of the nurses' shared value system.  相似文献   

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In this article, the authors select two categories of dying patients, "troubled" and "credible," from two larger studies conducted in three palliative care settings. They explore how nurses construct dying patients' moral identities and how they use emotion talk to interpret patients' behavior. The authors carried out a microanalysis of talk-in-action using discourse analysis and conversation analysis. Strategies used for the construction of moral identities include the production of atrocity stories and emotional editing. The authors identify moments when emotions are made relevant in palliative care nurses' daily practices, which serve to smooth social interaction and give a voice to dying patients' words and actions. The dying trajectory, the deteriorating emotional body, and the sound mind are resources used in the characterization of the credible and troubled patient. The authors argue that emotion talk is significant because it reveals how nurses manage conflict and tension in talk-in-interaction.  相似文献   

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杜旦  王睿  王玉 《疾病控制杂志》2011,15(4):323-326
目的 了解兰州市乙肝患者及其家属乙型肝炎相关知识、行为情况,探讨影响该人群对乙肝知识认知的人口学和社会经济学等因素,为有针对性地开展乙肝防治健康教育和健康促进提供依据.方法 按照兰州市市县乡三级医院的特点进行分层整群抽样,利用自编的知识、态度、行为(KAP)调查表对抽取的兰州市住院治疗的乙肝患者及其家属进行调查.结果 本次调查乙肝患者及其家属300人,收回有效问卷294份,应答为98.00%.研究发现乙肝患者和家属中对乙肝相关知识的最高得分分别为14.67分和14分,最低得分分别为1分和1.33分;按得分占满分的60%为合格,乙肝患者合格率为45.00%,患者家属的合格率为55.22%;其中乙肝患者对乙肝能够引起肝硬化的知晓率最高(89.31%),对乙肝的围产期传播的知晓率最低(25.66%);而患者家属对孩子出生时需要接种乙肝疫苗的知晓率最高(94.74%),对成人感染乙肝能够自愈的知晓率最低(32.82%).多因素非条件Logistic回归分析结果表明对于乙肝患者而言,文化程度和职业(工人、医务人员)是得分的影响因素;对患者家属而言,职业(医务人员)和收入状况是得分的影响因素.结论 兰州市乙肝患者及其家属对乙型肝炎相关知识的掌握情况不理想.相关医务人员应有针对性地进行健康教育,使其建立科学的生活方式.  相似文献   

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Background Increasingly, people with neurodegenerative illness are cared for at home until close to death. Yet, discussing the reality of dying remains a social taboo. Objective To examine the ways, family caregivers of people living with motor neurone disease (MND) experienced the dying of their relative and to identify how health practitioners can better prepare families for end‐of‐life care. Design Secondary analysis was undertaken on data sets generated from two longitudinal qualitative studies employing similar data collection and analysis methods. Combining data sets increased participant numbers in a low incidence disease group. Setting and participants Primary studies were undertaken with family caregivers in England and Australia. Interview and observational data were collected mostly in home. Participants who discussed dying and death formed the sample for secondary analysis. Results Combined data revealed four major themes: planning for end of life, unexpected dying, dignity in the dying body and positive end to MND. Despite short survival predictions, discussions among family members about dying were often sporadic and linked to loss of hope. Effective planning for death assisted caregivers to manage the final degenerative processes of dying. When plans were not effectively communicated or enacted, capacity to preserve personhood was reduced. Discussion and Conclusion Returning death and dying to social discourse will raise the level of community awareness and normalize conversations about end‐of‐life care. Strategies for on‐going, effective communication that facilitates advance care planning among patients, their families and practitioners are essential to improve dying and death for people with MND and their family caregivers.  相似文献   

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