开展临终关怀护理的体会

临终关怀 (ｈｏｓｐｉｃｅ)是一种监护方案。这个词起源于中世纪时代 ,当时用来做朝圣者或旅游者中途休息及补充体力的一个中途站或者收容所。现在是指组织一套医护方案 ,以帮助那些走到人生旅途最后一站的人 ,减少死亡前的痛苦和死亡后对家属精神上的支持。1　临终关怀学的内容　　临终关怀学是一门新兴的学科 ,它包含的内容很多 ,它包括了医学、护理学、社会学、心理学、伦理学、卫生经济学、法学等多门学科。临终关怀面对是那些肿瘤的晚期 ,各种疾病的末期 ,治疗不再生效 ,生命将结束的人 ,在他们生命的最后给于的关怀及照顾。开展临终关…     

死亡教育与临终关怀的发展

<正>完整的生命包括生存和死亡,死亡是唯一与生存相提并论的主题。现在的社会中人们对生存给予了足够的重视,但却未对死亡给予充分的关注。美国利奥.巴斯卡力博士(Leo Buscaglia)曾深切地指出"死亡是生命的导师",死亡是唯一可以跟生存相提并论的主题。作为一种自然的生理现象,死亡是     

干休所开展临终关怀服务的工作探讨

临终关怀是有组织地向临终者及其家属提供一种全面的照护,包括医疗、护理、生理、心理等方面。主要是为临终患者缓解痛苦,使患者生命得到尊重、症状得到控制、生活质量得到提高,让患者在充满人性温情的氛围中,宁静、舒适且有尊严地离去．也使临终患者的家属能更从容地面对亲人离去的现实。然而,现今人们对临终关怀的接受度和认知度还较低,患者及其家属在明知生命将无法延续的情况下却刻意回避现实,各自承受着恐惧与不安。原卫生部长陈敏章曾说过：临终关怀不仅体现了对人的尊严的维护。而且在一定程度上．可以减轻家庭和单位的负担,也是发展生产力的一部分内容。     

市场经济体制下开展临终关怀服务的设想

临终关怀是指医生、护士、志愿人员、政府、慈善团体、宗教人员等为患癌症等晚期病人所提供的全面支持与照护,它不以延长人的生命为目的,而以提高临终阶段生命的质量为宗旨。随着我国人民生活水平的提高和人口老龄化的加剧,开展临终关怀服务已成为人民的迫切需要。社会主义市场经济体制是一个完整的大系     

临终关怀护理的问题与对策

本文讨论提出在我国临终关怀存在诸多问题，包括临终关怀与中国的传统文化在某些方面存在冲突、临终关怀护理比较落后、社会支持系统尚未建立等。因此，在我国发展临终关怀具有现实必要性和紧迫性，对策有：①开展死亡教育，转变传统观念；②多渠道、多形式地建立临终关怀机构；②开展临终关怀教育，培养临终关怀的专业护士；④促使临终关怀走上社会化、规范化的道路；⑥立足本土文化，开展学术研究，建立临终关怀的学科体系等。     

在干休所开展临终关怀工作初探

目前军队干休所的离休老干部平均年龄超过84岁,人均患病超过6种,约50％以上老干部由于年老体弱、病重病残而生活不能完全自理,还有部分老干部逐渐走到了生命的尽头.如何让老干部在生命的最后时刻,生有尊严,活有质量,最后能走得安详,已成为干休所卫生工作所面临的一个重要课题.事实上,各个干休所卫生所对此问题都有不同程度的关注,积极想办法做好这部分老干部的医疗保障,对他们进行无微不至的人道主义关怀.2010年由总政干部部和总后卫生部联合颁发的《军队干休所卫生工作考评标准》,把对老干部的临终关怀作为一项工作内容提出明确要求,充分体现了各级领导对老干部的关怀,无疑也是对这项工作的一个极大的推动[1].本文就我们干休所积极开展临终关怀工作的做法进行初步探讨.     

从心理学角度看我国临终关怀现

临终关怀必然与死亡相联系,死亡是人的本质,对于个体而言,存在多种死亡方式,根据刘芳等[1]的观点,将临终方式归纳为意外事故、自杀、疾病和衰老4种,在这几种方式中,尤其以衰老和疾病中的癌症是导致死亡的重要原因.     

浅谈在基层工作中开展临终关怀护理

当前,在基层开展临终关怀越来越成为可能,从高度尊重患者的自我和社会需要的基础上,运用科学的方法提高患者最后阶段的生命质量,是对生命的尊重．对人类的尊重。本文提出了临终关怀的理念,认识和工作的职责。     

浅谈在基层工作中开展临终关怀护理

当前,在基层开展临终关怀越来越成为可能,从高度尊重患者的自我和社会需要的基础上,运用科学的方法提高患者最后阶段的生命质量,是对生命的尊重、对人类的尊重。本文提出了临终关怀的理念、认识和工作的职责。     

高校医院开展临终关怀和护理的实践与体会

临终关怀和护理是为生命即将结束的患者提供全面的身心照料与支持,旨在减少患者的痛苦,增加患者的舒适,提高其生活质量,维护临终患者的尊严,使其在有限的时光内,安详、无憾地到达生命的终点。临终关怀和护理是社会发展的需要,是人类文明的一个重要标志。目前,随着我国社会的发展进步和人们生活质量的提高,医疗机构以及临终患者和家属对临终关怀和护理正不断予以高度的重视。     

上海市安宁疗护政策扩散研究——基于56份安宁疗护政策的文本分析

安宁疗护在改善终末期患者及其家属的生活质量、提高医疗资源效率、提升社会福利水平上发挥着重要作用。本文以政策扩散理论为框架,以上海市2012—2021年56份安宁疗护政策文本为研究对象,利用NVivo、ArcGIS、ROST、UCINET软件,分别从时间、空间、内容、组织维度研究安宁疗护政策扩散现象,分析多重维度下上海市安宁疗护政策扩散的外部表现特征。研究发现：在时间维度上,政策扩散速度由慢变快再减慢,近似表现为“S”型分布;在空间维度上,呈现出吸纳—辐射相结合的试点型扩散;在内容维度上,既有政策领域的拓展,也有政策的细化与深化;在组织维度上,参与主体数量众多且类型多元、部门间协作紧密。该发现丰富了政策扩散理论知识图谱,拓宽了安宁疗护领域的研究视角,为深化开展全国安宁疗护服务工作提供借鉴。     

Teaching health care ethics: the importance of moral sensitivity for moral reasoning

Abstract My discussion reflects on the nature of moral sensitivity. The inquiry is guided by a pedagogical concern: if the goal of teaching practical‐minded nurses about health care ethics is to develop the capacity to be aware of ethical implications of certain acts, events and treatments in the health care setting as well as the skills to resolve ethical dilemmas, it seems important to have a clear sense of what it means to be morally sensitive. How, for example, does a health care worker come to recognize in a particular and institutionally defined situation his or her moral responsibilities towards the other? What exactly is moral sensitivity? Is it something that academic philosophers can teach? I argue that moral sensitivity is a capacity for relatedness indispensable to moral theorizing that can be either cultivated or undermined and therefore ought not to be ignored by educators nor those responsible for ethically weighted decision‐making situations.     

新农合基金流失的道德风险与防范对策

道德风险是新型农村合作医疗基金流失的重要原因,有效控制道德风险对保障基金安全非常重要。通过对需方、供方和监管方道德风险的分析,从相关法律法规、相关制度和监督管理体制三个方面提出了具体的描施。例如,及时修订相关法律法规,尝试采取定点医疗机构合同制,加强针对供、需、监三方的宣传和教育,建立信息披露与评价机制等,以规避道德风险,防范新型农村合作医疗基金的流失。     

Virtues of autonomy: the Kantian ethics of care

Abstract The ethics of care, adopted in much of the nursing literature, is usually framed in opposition to the Kantian ethics of principle. Irrespective of whether the ethics of care is grounded in gender, as with Gilligan and Noddings, or inscribed on Heidegger's ontology, as with Benner, Kant remains the philosophical adversary, honouring reason rather than emotion, universality rather than context, and individual autonomy rather than interdependence. During the past decade, however, a great deal of Kantian scholarship – including feminist scholarship – has rendered this series of oppositions questionable, challenging the view that an ethics of care and Kant's moral law are irreconcilable. This paper therefore re‐examines Kant's writings, drawing on recent scholarship, and argues both that they provide the care ethicists with everything they require, and that they offer something beyond an ethics of care, something that repairs the deficits in philosophies of caring. It concludes by suggesting that a Kantian ethics of care has significant implications for the construction of nursing knowledge.     

Sensitivity to patient''s psychosocial concerns: Relationships among ratings by primary care and traditional internal medicine house officers and patient self-assessments

This study examined house officers' sensitivity to patients' psychosocial concerns. Primary care house officers, traditionally trained internal medicine house officers, a social worker, and 104 ambulatory care patients independently completed an assessment instrument to indicate the extent to which a set of 20 defined psychosocial issues concerned the patients. We examined the magnitude of difference and extent of correlation in the independent reports of the patient, house officer, and social worker. These analyses were conducted on both the individual psychosocial issues and on sets of concerns derived from an oblique rotation factor analysis of the patients' responses. Primary care trainees' assessments of their patients' concerns correlated more frequently with the independent assessments of the patients and a social worker than did the judgments of the traditionally trained house officers. The factor analysis identified six factors that accounted for 64.4% of the variance in patients' responses. The correlations between the primary care trainees' and patients' assessments were statistically significant on five of these six factors; the correlations between the traditionally trained residents' and patients' assessments were statistically significant on two of the factors. These results provide evidence of the primary care house officer training program's achievement of the goal of enhanced physician awareness of patients' psychosocial concerns. The results also support training efforts aimed at increasing physicians' ability to assess their patients' psychosocial concerns.     

Don't break out the champagne: continued slowing of health care spending growth unlikely to last

Aaron Catlin and colleagues report a fourth year of slowing of the rate of growth of personal health care spending. But many factors indicate that relief for purchasers and consumers will be short-lived. Research on local health care markets suggests that rapid expansion of provider capacity and incentives to increase volume of care are continuing. Increasing incidence of obesity is a major factor behind rising costs. The influence of the economic cycle on health spending, which has lowered the trend in recent years, is likely to reverse its impact shortly.     

Better together: Coexistence of for-profit and nonprofit firms with an application to the U.S. hospice industry

Many markets maintain a nontrivial mix of both nonprofit and for-profit firms, particularly in health care industries such as hospice, nursing homes, and home health. What are the effects of coexistence vs. dominance of one ownership type? We show how the presence of both ownership types can lead to greater diversity in consumer types served, even if both firms merely profit-maximize. This is the case where firms serve consumers for multiple consumption durations, but where donations are part of a nonprofit firm objective function and happen after services have been provided. This finding is strengthened if the good or service has value beyond immediate consumption or the direct consumer. We show these predictions empirically in the hospice industry, using data containing over 90 percent of freestanding U.S. hospices, 2000–2008. Nonprofit and for-profit providers split the patient market according to length of stay, leading to a wider range of patients being served than in the absence of this coexistence.     

新合作医疗保健制度下农村医生卫生服务行为的转变

目的：探索在试点现场建立的适用于社会主义市场经济条件下经济欠发达地区的新型农村合作医疗保健制度模型,对农村医生卫生行为的影响,为该模型的修正与完善提供依据。方法：采用社会干预实验研究方法,选择河南省的开封县和淮阳县为研究现场,建立了新型农村全医疗保健制度,并对该模型建立前后的农村医生的卫生服务行为进行分析。结果：该模型在提高农村卫生机构的综合服务能力的同时,极大地影响着农村医生的卫生服务行为,使其由过去重治疗轻预防的单一模式向医疗、预防保健并举的综合社区服务模式转化。结论：新型合作医疗保健制度较大程度地满足了农民的基本医疗预防保健需求。     

The 2016 proposal for the reorganisation of urgent care provision in Belgium: A political struggle to co-locate primary care providers and emergency departments

Internationally the number of emergency department (ED) visits is on the rise while evidence suggests that a substantial proportion of these patients do not require emergency care but primary care. This paper presents the Belgian 2016 proposal for the reorganisation of urgent care provision and places it into its political context. The proposal focused on re-designing patient flow aiming to reduce inappropriate ED visits by improving guidance of patients through the system. Initially policymakers envisaged, as cornerstone of the reform, to roll-out as standard model the co-location of primary care centres and EDs. Yet, this was substantially toned down in the final policy decisions mainly because GPs strongly opposed this model (because of increased workload and loss of autonomy, hospital-centrism, etc.). In fact, the final compromise assures a great degree of autonomy for GPs in organising out-of-hours care. Therefore, improvements will depend on future developments in the field and continuous monitoring of (un-)intended effects is certainly indicated. This policy process makes clear how important it is to involve all relevant stakeholders as early as possible in the development of a reform proposal to take into account their concerns, to illustrate the benefits of the reform and ultimately to gain buy-in for the reform.