Trusting patients, trusting nurses

Abstract  The general expectation that patients should be willing to trust nurses is rarely explored or challenged despite claims of diminishing public trust in social and professional institutions. Everyday meanings of trust take account of circumstance and suggest that our understanding of what it means to trust is contextually bound. However, in the context of health care, to trust implies a particular understanding which becomes apparent when abuses of this trust are reported and acknowledged as scandals. The predominant assumption in the literature that trust is something that occurs between equally competent adults cannot explain trust in nursing precisely because of the unequal power relationships between patients on the one hand and healthcare professionals on the other. Moreover, the tendency to conflate terms such as trust, reliance, confidence and so on suggests that confusion permeates discussions of trust in nursing. In this paper, I argue in support of Annette Baier's requirement of good will (or lack of ill will) as the essential feature of trust, and outline how this account (i) enables us to make the necessary distinctions between trust on the one hand and 'trust pretenders' on the other; and (ii) lays the foundations for understanding trust in relationships, such as those between patients and nurses, where power differentials exist.     

武汉市民遗体捐赠意愿因素的问卷调查与分析

目的:了解武汉市民的捐献意愿及影响不同阶层市民捐献意愿的主要因素.方法:对武汉市武昌区10个社区的居民进行随机访问,并发放问卷,然后对问卷进行对比研究分析总结.内容:法制因素、情感因素、传统观念、社会舆论等.结果:法制因素和情感因素为最显著因素.结论:武汉市对遗体捐献进行立法是非常正确的,但要想收到预期的效果还应加大遗体捐献知识的宣传普及力度.     

A holistic approach to chronic pain management that involves all stakeholders: change is needed

Chronic pain affects a large proportion of the population, imposing significant individual distress and a considerable burden on society, yet treatment is not always instituted and/or adequate. Comprehensive multidisciplinary management based on the biopsychosocial model of pain has been shown to be clinically effective and cost-efficient, but is not widely available. A literature review of stakeholder groups revealed many reasons for this, including: i) many patients believe healthcare professionals lack relevant knowledge, and consultations are rushed, ii) general practitioners consider that pain management has a low priority and is under-resourced, iii) pain specialists cite non-adherence to evidence-based treatment, sub-optimal prescribing, and chronic pain not being regarded as a disease in its own right, iv) nurses’, pharmacists’ and physiotherapists’ skills are not fully utilized, and v) psychological therapy is employed infrequently and often too late.

Many of the issues relating to physicians could be addressed by improving medical training, both at undergraduate and postgraduate levels – for example, by making pain medicine a compulsory core subject of the undergraduate medical curriculum. This would improve physician/patient communication, increase the use of standardized pain assessment tools, and allow more patients to participate in treatment decisions. Patient care would also benefit from improved training for other multidisciplinary team members; for example, nurses could provide counseling and follow-up support, psychologists offer coping skills training, and physiotherapists have a greater role in rehabilitation. Equally important measures include the widespread adoption of a patient-centered approach, chronic pain being recognized as a disease in its own right, and the development of universal guidelines for managing chronic non-cancer pain.

Perhaps the greatest barrier to improvement is lack of political will at both national and international level. Some powerful initiatives and collaborations are currently lobbying policy-making bodies to raise standards and reduce unnecessary pain – it is vital they continue.     

“意治法”初探

[目的] 探析中医临证思维方法“意治法”。[方法] 通过对“意治法”的古今文献进行探析,从论述“医者意也”意治法的核心,到病患之意、病症之意、药味之意三个方面,初步探析意治一法,对其认识进行详细阐述。[结果] “意治法”或从病患之意究其源,或从病症之意审证明因,或从药味之意组方遣药,但整个思维过程中始终不脱离“医者意也”,其应用需立足于博学之上,凭借记忆、经验、观察、判断、类推等能力诊治疾病,再借砭石汤药纠人体之偏,治病方能获“十全”之效。[结论] “意治法”以“医者意也”为核心,借病患、病症、药味为载体,察体之所需,审证求因,组方遣药,为临床辨治与教学提供一定的思路和启示。     

英国伦理委员会的现状与分析

伦理委员会的主要职责是保护药物临床试验受试者的权益、安全和健康.现对英国伦理委员会的法律、法规、申请及审评程序等进行归纳分析,旨在对规范我国伦理委员会的运作具有参考借鉴作用.     

Alteration to will as an experience of technology and nursing

This paper presents one finding to arise from a recent qualitative research study that examined ways of understanding technology in surgical nursing, and examines its implications for nursing and health care practice. Although the research reported identified eight qualitatively different ways of understanding technology, this paper examines the specific experience that technology can alter will (volition). The experience described is a new area of knowledge and is in need of further examination and research. Nonetheless, it is significant to understanding technology, contemporary nursing practice and the provision of health care services. The paper concludes with some suggested approaches for curtailing the experience and a discussion related to challenges that arise from the finding that technology can alter the free will of nurses.     

情志神概念辨析

"七情"、"五志"是中医基础理论中两个重要的概念,在病因学中多情志并称,因此有些学者便将"七情"与"五志"等同起来,还有人将"神"也与七情混为一谈。但实际上,情、志、神是3个既密切相关,又有所区别的概念。     

玉龙县农民参加新型农村合作医疗意愿分析

通过对玉龙县农民参加新型农村合作医疗意愿的影响因素分析显示,不同经济状况和不同疾病家庭经济风险、不同合作医疗满意度的农户在是否愿意或赞成合作医疗等方面存在明显区别,人口数、年总支出、年教育费用、是否有熟人得到补偿4个因素影响参合率,逐一分析其根本原因,对政策制定提供相应建议.     

“诊籍”情志病的病因病机和证候分析

为发展中医心理学基础理论,笔者对西汉名医淳于意“诊籍”的心理学认识进行理论探索。诊籍中讲述了由于情志所引起的疾病,并且通过诊脉,用中药和针灸治疗此类患者,疗效显著,说明淳于意对情志的病因、病机和证候的认识已经达到相当高的水平。