试论西方“批判性教育观”对中国跨文化外语教学的启示

批判性教育观强调权力平等、多元文化均衡发展、以学生为学习主体。通过分析批判性教育观在美国语言文化教学和跨文化研究领域的运用情况,思考国内跨文化外语教学的思路和方法,包括立体地理解跨文化交际概念、培养文化平等的观念和运用体验式教学法。     

英语口语教学与跨文化交际能力培养

英语口语教学要加大对学生文化知识的输入,以培养学生的跨文化语言交际能力,使学生学会在具体社会语境中正确、得体地表达与交流,做到语言能力与语用能力同步发展,成为具有跨文化交际能力的高素质人才,为改革开放和经济建设服务。     

尿毒症患者心理状态及人文关怀

尿毒症患者迫切需要人文关怀,但整个社会和许多医务人员对此缺乏正确的认识和重视,影响了患者的身心康复。履行对尿毒症患者人文关怀的必要措施有：建设注重医学人文关怀的社会环境;加强医护人员的道德情感和人文精神的培养;重视医患沟通,建立和谐的医患关系;开展健康教育,鼓励患者积极融入社会;综合社会资源,努力解决患者经济和生活困难。     

Aboriginal health workers and diabetes care in remote community health centres: a mixed method analysis

OBJECTIVE: To assess the effect of employing Aboriginal health workers (AHWs) on delivery of diabetes care in remote community health centres, and to identify barriers related to AHWs' involvement in diabetes and other chronic illness care. DESIGN, SETTING AND PARTICIPANTS: Three-year follow-up study of 137 Aboriginal people with type 2 diabetes in seven remote community health centres in the Northern Territory. MAIN OUTCOME MEASURES: Delivery of guideline-scheduled diabetes services; intermediate outcomes (glycated haemoglobin [HbA(1c)] and blood pressure levels); number and sex of AHWs at health centres over time; barriers to AHWs' involvement in chronic illness care. RESULTS: There was a positive relationship between the number of AHWs per 1000 residents and delivery of guideline-scheduled diabetes services (but not intermediate health outcomes). Presence of male AHWs was associated with higher adherence to the guidelines. Barriers to AHWs' involvement in chronic illness care included inadequate training, lack of clear role divisions, lack of stable relationships with non-Aboriginal staff, and high demands for acute care. CONCLUSIONS: Employing AHWs is independently associated with improved diabetes care in remote communities. AHWs have potentially important roles to play in chronic illness care, and service managers need to clearly define and support these roles.     

对增强医患沟通有效性的伦理思考

当前医患沟通存在着不愿沟通、不会沟通、沟通简单及沟而不通的问题.因此,医务人员需要强化社会担当意识、培养换位思考的意识、医患双方需相互理解、配合.同时,需要让医务人员学会详细解释病情、安慰患者、提醒患者等能力,以提高其沟通能力.此外,医务人员应学会倾听、学会运用技巧语言,掌握沟通技巧.医务人员在医患沟通中,还应态度真诚、与患者互动并与患者进行持续沟通,以解决＂沟而不通＂的问题.     

挂号人员如何防止医疗纠纷

挂号室工作人员的服务态度、技术能力和患者对自己疾病的了解程度等因素,是造成患者挂号时发生矛盾的主要原因.我们应该加强医德医风教育,明确服务观念,提高自身的医学知识,加强与患者的沟通、和谐相处维护医患双方的和谐和权益.     

夯实大学生本土文化教育的意义——从跨文化交际角度说起

在全球化的今天,外语教育中需要加强本土文化教育,培养学生的文化平等意识。很多学生在学习英语的过程中忽视了母语和本土文化对跨文化交际的影响。英语教学不单单要培养能够引进国外文化知识和先进技术的人才,而且也要培养向世界输出中国优秀文化的跨文化交际人才。学生在英语学习的过程中要加强本土文化的修养,这对增强中国的文化软实力将大有裨益。     

护理人员循证护理认知现状调查与分析

目的了解护理人员对循证护理（EBN）的认知现状,提出相应对策。方法采用自行设计的问卷对护理人员进行循证护理认知状况的调查。结果32％的护理学生听说过循证护理,但对循证护理有些了解的仅占8％;56％的临床护士听说过循证护理,对循证护理有些了解的占16％,对循证护理熟悉的占10％。对循证护理的态度,只有24％的人认为循证护理重要。制约护理人员实施循证护理的主要因素依次是外语水平较低、缺乏专人及相关专业知识指导、业余时间较少、计算机水平较低及不熟悉检索技巧、网络资源缺乏等。结论护理教育工作者应改革课程体系,重视、完善护生循证护理的基础知识及培养循证护理技能。医院应对临床护士给予行政支持,领导重视循证护理,确保循证护理的实施。     

Overseas-trained doctors in Aboriginal and Torres Strait Islander health services: many unanswered questions

Aboriginal and Torres Strait Islander health services are heavily dependent on overseas-trained doctors (OTDs). These OTDs are increasingly from countries with variable English language and educational equivalency compared with locally trained doctors. Aboriginal and Torres Strait Islander health services create particular demands for all doctors, such as negotiating "cultural domains" and acknowledging the contribution of Aboriginal health workers. Little is known about the roles and experience of OTDs in health service provision in Indigenous communities. Barriers to effective research into the experience of OTDs include privacy legislation and a lack of standardised data. Researching the narratives of OTDs in Indigenous health services offers an opportunity to explore the diversity and complexity of the cultural interfaces in health service provision.     

Navigating the process of developing a research project in Aboriginal health

Research in Aboriginal health may be hampered by a lack of experience with the process of collaboration with Aboriginal communities, and additional ethics approval requirements. Awareness of resources and advice from Aboriginal mentors with in-depth knowledge of clinical and research issues can greatly assist researchers. A collaborative approach between researchers and Aboriginal communities is pivotal to developing a research project consistent with Indigenous cultural values and health concepts, with the potential to improve services and outcomes for Aboriginal peoples. Planning and broad consultation can ensure that research is feasible, ethical, culturally sensitive and beneficial. This article outlines lessons learned from personal experience of developing a project in Aboriginal health, which we hope may serve as a practical guide for others.     

Challenging perceptions of non-compliance with rheumatic fever prophylaxis in a remote Aboriginal community

AIM: To identify factors that affect rheumatic fever prophylaxis for remote-living Aboriginal patients, and to determine the proportion who received adequate prophylaxis. DESIGN AND SETTING: Interview (with analysis based on principles of grounded theory) of patients with a history of rheumatic fever or rheumatic heart disease and their relatives, and health service providers in a remote Aboriginal community; audit of benzathine penicillin coverage of patients with rheumatic heart disease. PARTICIPANTS: 15 patients with rheumatic heart disease or a history of rheumatic fever, 18 relatives and 18 health care workers. RESULTS: Patients felt that the role of the clinic was not only to care for them physically, but that staff should also show nurturing holistic care to generate trust and treatment compliance. Differing expectations between patients and health care providers relating to the responsibility for care of patients absent from the community was a significant factor in patients missing injections. Neither a biomedical understanding of the disease nor a sense of taking responsibility for one's own health were clearly related to treatment uptake. Patients did not generally refuse injections, and 59% received adequate prophylaxis (> 75% of prescribed injections). CONCLUSION: In this Aboriginal community, concepts of being cared for and nurtured, and belonging to a health service were important determinants of compliance.     

中医院校大学生跨文化传播能力现状调查与分析

本研究通过调查中医院校大学生跨文化传播能力,客观地反映中医院校大学生语言能力、文化能力、交际能力、专业能力的现状及存在的问题.研究发现,中医院校大学生跨文化传播能力较低;学生中医药外语能力较差,尤其医学英语听说能力最为薄弱;学生跨文化传播意愿较强,但对跨文化知识的掌握程度较差;学生比较注重运用交际策略和技巧,但在话题的...     

末期癌患者的预后自觉度、生存意志与医护期望

目的:透过对末期癌患者的访问和研究,探讨他们对病情严重度的认知和预后自觉程度,如何影响其生存意志,及其在生命的晚期的医护期望.对象与方法:对象是首次入住安宁护理病区的20名病人,共6男14女,平均年龄是68.9岁,全确诊为扩散性末期癌症.以半结构的面谈方式,让癌患者诉说其疾病及生活经验,内容包括住院的期望,及身、心、灵等方面的关注.采用范甘的"查验解说"进行了资料分析.结果:所有病人均能说出所患疾病,但没有一人是直接从医生口中确定自己的诊断.病人从自己的病征病状,院方给予的诊疗方案、及医护人员/家属的神情等途径"意会"到自己的病情严峻.病人的生存意志有三种表现:拼命求生、无奈接受现实和要求加速死亡.生存意志与病人的生存质量相关,也影响他们对医护的期望.结论:医护人员要在"保密避谈"及"坦诚沟通"间取得平衡,给予病人最佳临终护理.研究结果显示医护人员跟终末期病患者"坦诚沟通"并非不可行,也不一定如传统观念般带来不良后果.反之,能够了解病人所关注和关心的事情,帮助他们安然走过最后一段日子,才符合临终关怀的宗旨.医护人员跟病人坦诚交谈有助增强彼此的互信关系,建立合理的医护期望和改善病人的生存质量.     

基层医院防范护患纠纷的措施

护患纠纷的发生原因很多,主要表现在护理人员编制不足超负荷工作、对护理工作的巨大压力理解不足、护理人员与患者或家属法律意识的反差、护患沟通欠缺、护理文书书写欠规范、护理制度落实欠缺等。针对以上原因,我们采取了以下措施,如提高法律意识、加强护理管理、增加护理人员编制、加强人文关怀、转变服务态度、加强沟通、规范护理文书的书写等,努力减少纠纷的发生,增强医院的核心竞争力。     

Improving access to specialist care for remote Aboriginal communities: evaluation of a specialist outreach service.

OBJECTIVE: To identify barriers faced by Aboriginal people from remote communities in the Northern Territory (NT) when accessing hospital-based specialist medical services, and to evaluate the impact of the Specialist Outreach Service (SOS) on these barriers. DESIGN: Combined quantitative and qualitative study. SETTING: Remote Aboriginal communities in the "Top End" of the NT, 1993-1999 (spanning the introduction of the SOS in 1997). PARTICIPANTS: 25 remote health practitioners, patients and SOS specialists. MAIN OUTCOME MEASURES: Numbers of consultations with specialists; average cost per consultation; perceived barriers to accessing hospital-based outpatient care; and perceived impact of specialist outreach on these barriers. RESULTS: Perceived barriers included geographic remoteness, poor doctor-patient communication, poverty, cultural differences, and the structure of the health service. Between 1993 and 1999, there were 5,184 SOS and non-SOS outreach consultations in surgical specialties. Intensive outreach practice (as in gynaecology and ophthalmology) increased total consultations by up to 441% and significantly reduced the number of transfers to hospital outpatient clinics (P< 0.001). Average cost per consultation was $277 for SOS consultations, compared with $450 at Royal Darwin Hospital and $357 at the closest regional hospital. Outreach has reduced barriers relating to distance, communication and cultural differences, and potentially bolsters existing primary healthcare services. CONCLUSIONS: When compared with hospital-based outpatient services alone, outreach is a more accessible, appropriate and efficient method of providing specialist medical services to remote Aboriginal communities in the NT.     

Bioethics for clinicians: 20. Chinese bioethics

Chinese Canadians form one of the largest groups in the Canadian cultural mosaic. Many of the assumptions implicit in a Western autonomy-based approach to bioethical deliberation may not be shared by Chinese Canadians. In traditional Chinese culture, greater social and moral meaning rests in the interdependence of family and community, which overrides self-determination. Consequently, many Chinese may vest in family members the right to receive and disclose information, to make decisions and to organize patient care. Furthermore, interactions between Chinese patients and health care workers may be affected by important differences in values and goals and in the perception of the nature and meaning of illness. Acknowledging and negotiating these differences can lead to considerable improvement in communication and in the quality of care.     

Improving the health status of aboriginal people in Canada: new directions, new responsibilities.

The study findings reported in this issue by Dr. Harriet L. MacMillan and associates (see pages 1569 to 1578) demonstrate that aboriginal people in Canada bear a disproportionate burden of illness compared with the general population. In this editorial the author examines some of the factors that have contributed to this situation, such as poverty, cultural barriers and jurisdictional problems. The way forward lies in supporting the aspirations of aboriginal people for self-determination. Aboriginal people in Canada need to recognize and use their own professional human resources and to adopt more responsibility for improving the health status of their communities. At the same time, there is a need for greater acceptance by aboriginal people of existing initiatives for health promotion and disease prevention.     

关于广州市护患关系现状的调查及分析

影响护患关系主要原因是服务态度、沟通技巧、对病情的了解程度，而不是护理技术水平；护理人员应在护患关系中起着主导作用；护患之间不能换位思考，导致护患冲突发生；护理人员与患者都有强烈的意愿进行病情讨论，除此之外，医务人员之间缺乏有效的沟通与团队合作，将不利于缓解医患关系的。     

论医学类高校英语教学中跨文化意识的培养

文化教学不仅能提高高校学生学习英语的兴趣,而且是学生真正掌握语言、运用语言进行交流的手段.医学类高校英语教师应着力培养学生跨文化意识,使学生了解中西医文化之间的差异,消除文化偏见,吸取西医文化之精髓,促进中西医文化的交流.     

“综合性课程设计”在医患沟通外语教学中的应用

在医学教育国际化以及“一带一路”倡议背景下,医患沟通外语教学发挥着日益重要的作用。根据“综合性课程设计ICD”模式,通过分析情境因素、确立学习目标、确定反馈及评估方法、设计教学活动和综合基础因素五个步骤,设计和实施医患沟通外语教学,以提高学习者的英语语言能力、跨文化沟通能力和涉外医疗服务能力。教学实践和评估结果表明,“综合性课程设计”能行之有效指导医患沟通外语教学,医学院校应当积极开展此教学并树立跨文化视域下的医患沟通外语教学理念。