重症监护室患者尊严感的研究进展

介绍尊严和尊严模型的概念、重症监护室患者尊严的相关研究以及评估工具,为构建中国情境下重症监护室患者尊严模型及尊严维护体系提供参考。     

中重度尊严缺失晚期癌症患者尊严维护需求的质性研究

目的了解中重度尊严缺失晚期癌症患者尊严维护需求,为更好地维护其尊严提供参考。方法对10例中重度尊严缺失晚期癌症患者进行半结构式深度访谈,采用现象学研究方法进行资料分析、提炼主题。结果共提炼出3个主题及10项下属内容:疾病相关尊严维护需求(维持独立水平,免受生理症状困扰,维护知情及自主权),家庭社会支持需求(家庭支持,病友沟通,医疗支持),心理灵性关怀需求(角色维护,保持自我价值,活在当下,传承奉献)。结论晚期癌症患者尊严维护需求呈现症状控制、相对独立与陪伴、知情参与及安宁需求等特征,医护人员应根据需求实施针对性个体化的尊严维护与实现。     

癌症患者主要照顾者家庭尊严干预的研究进展

从家庭尊严干预的相关概念、实施方案及其应用效果进行综述，旨在提高医务人员对家庭尊严干预的意识，维护癌症患者的尊严，提高照顾者生活质量，改善癌症患者及照顾者的身心健康水平，为今后对癌症患者开展家庭尊严干预提供参考，以推动我国安宁疗护的发展。     

养老机构中老年人尊严的研究进展

综述尊严的起源、概念,总结归纳养老机构老年人尊严的测量工具、影响因素,维护尊严的措施,以及对我国养老机构维护老年人尊严的启示,希望能够增加医务人员对尊严概念的了解,将相关概念应用于对老年人的日常生活照护中,维护老年人的尊严,提高其生活质量,有尊严地安享晚年。     

医务人员对晚期癌症患儿尊严维护的质性研究

目的 了解医务人员对晚期癌症患儿尊严维护的认知及实践体验,为改善晚期癌症患儿尊严维护实践提供参考。 方法 采用描述性质性研究方法,对13名从事晚期癌症患儿治疗和照护工作的医务人员（8名护士、3名医生、2名安宁疗护志愿者）进行半结构式深入访谈,运用内容分析法对资料进行分析并提炼主题。 结果 提炼出4个主题：晚期癌症患儿尊严维护影响因素的复杂性,患儿尊严维护现存的多重困境,患儿尊严维护的重要意义,尊严维护实践的推进过程和基本要素。 结论 医务人员应了解晚期癌症患儿尊严维护影响因素的复杂性,动态持续关注患儿病程阶段和家属的医疗决策,并坚持个体化、充分沟通、尊重和人文关怀等尊严维护的基本要素,进一步推动儿童安宁疗护中尊严维护的临床实践。     

结直肠癌化疗患者尊严感现状调查及影响因素分析

目的:探究结直肠癌化疗患者尊严感现状调查及影响因素。方法:采用便利抽样法,选取2018年1月至2022年9月在我院化疗的结直肠癌患者73例为研究参与者。采用一般资料调查表收集患者一般资料,采用尊严感调查表(PDI)评估患者尊严现状。采用多元线性回归模型分析结直肠癌化疗患者PDI评分的影响因素。结果:结直肠癌化疗患者PDI总分为(70.23±8.35)分,其中精神安宁维度评分最低,处于中度尊严受损。不同性别、年龄、TNM分期、肠造口、文化程度、家庭人均月收入的结直肠癌化疗患者PDI评分比较差异有统计学意义(P<0.05);年龄、TNM分期、肠造口、文化程度、家庭人均月收入为结直肠癌化疗患者PDI评分的影响因素(P<0.05)。结论:结直肠癌化疗患者尊严现状为中度尊严受损水平,年龄、TNM分期、肠造口、文化程度、家庭人均月收入均为尊严现状的影响因素。医护应重视尊严维护护理,提升结直肠癌化疗患者的尊严感。     

住院患者尊严现状及影响因素分析

目的 了解住院患者尊严期望现状,为针对性干预提供参考.方法 采用普通话版住院患者尊严量表对442例住院患者进行问卷调查.结果 住院患者尊严期望值为48.00(40.00,53.00)分,尊严满意度为71.00(61.00,75.00)分;回归分析结果显示,性别、家庭人均月收入、住院科室是住院患者尊严期望值影响因素(均P＜0.05);近年住院经历、经济负担、文化程度是住院患者尊严满意度影响因素(均P＜0.05).结论 住院患者尊严期望值处于中度水平,满意度较高.临床护士应根据不同尊严期望值和尊严满意度患者提供个性化和针对性干预,满足其尊严期望和尊严满意度.     

临终患者尊严死的研究进展

介绍尊严的内涵及尊严死的概念,系统综述临终患者尊严感测量工具、影响临终患者尊严死的因素及促进临终患者尊严死的干预措施,旨在为制定促进临终患者尊严死的措施,提高临终患者死亡质量提供参考。     

安心卡引导的尊严照护模式在恶性肿瘤临终患者中的应用

目的观察安心卡引导的尊严照护模式在恶性肿瘤临终患者中的临床应用效果,探索恶性肿瘤临终患者尊严照护的实施模式。方法选取2017年12月至2018年2月符合纳入标准的17例恶性肿瘤临终患者及其主要照顾者为对照组,采用常规护理方法进行护理;将2018年3～6月符合纳入标准的17例恶性肿瘤临终患者及其主要照顾者为观察组,采用安心卡引导的尊严照护模式进行护理:引导员整理患者与家属的安心卡记录单,适时引导患者和家属道爱、道谢、道歉、道别;活动结束后,心理咨询师或引导员运用倾听、音乐、芳香等疗法对患者及家属进行心理抚慰。出院前1 d对两组患者使用尊严量表进行测评,对家属使用SCL-90量表进行测评。结果观察组患者尊严量表的5个因子得分显著低于对照组(均P0.01);观察组家属的焦虑、抑郁得分显著低于对照组(均P0.05)。结论安心卡引导的尊严照护模式的应用,增强了恶性肿瘤临终患者的尊严获得感,减轻了主要照顾者焦虑、抑郁情绪。     

分娩尊严内涵的扎根理论研究

目的 探讨分娩尊严内涵，以维护产妇分娩尊严，改善分娩结局，提高产妇分娩幸福感。方法 采用扎根理论研究方法，对江苏省4所医院的13名助产士、18名产妇进行深度访谈，通过开放式登录、关联式登录、核心式登录分析访谈资料。结果 析出分娩尊严内涵包括安全感维护（生理安全、心理安全）、自主权的体现（知情同意、共同决策）、社会网络和谐（家庭关系、社会关系）3个方面。结论 分娩尊严 内涵的确立有助于理解孕产妇分娩选择及期望，为促进医疗保健提供者和产妇之间沟通提供理论依据，对提供高质量助产护理服务的相关研究及实践具有指导意义。     

Neurosurgical education: the "other" competencies. The 2003 presidential address

In his 2003 Presidential Address to the American Association of Neurological Surgeons, Dr. Heros discusses his personal additions to the six basic competencies for which all neurosurgical residents must be tested. The basic competencies are as follows: 1) patient care; 2) medical knowledge; 3) practice-based learning and improvement; 4) interpersonal and communication skills; 5) professionalism; and 6) system-based practice. To these, Dr. Heros proposes to add six supplemental competencies: 1) intellectual honesty, which involves frank discussions about patient complications and admissions of the physician's frailties; 2) scholarship--the art and science of medicine, which recognizes the value of evidence-based medicine but does not discount knowledge derived from experience; 3) practicing in a hyperlegalistic society, which involves tailoring informed consent to fit individual patients' circumstances; 4) time- and cost-efficient practices, in which the physician strives to conserve time and resources by forgoing testing that is not strictly necessary, doing only what is needed to return patients to wellness; 5) approach to patients, which entails acknowledging and respecting the dignity of all patients; and 6) pride in being a neurosurgeon, which carries a sense of elitism without arrogance.     

Akutversorgung des Patienten mit Schlaganfall

Strokes are the third most common cause of mortality in western countries and the main cause of long-term invalidation. Systemic intravenous thrombolysis is the current therapeutical choice in acute stroke within 3 h after clinical onset but new pharmacological developments will have the potential to expand the time window for 6 h or more. To safeguard this option and for optimal treatment of stroke patients, better preclinical structures are necessary. A stroke is an extremely urgent case and emergency rescue services must treat this situation in a similar manner to polytrauma or cardiac arrest. Rescue services will need more training and knowledge in basic neurological examination and standard acute therapy, including maintaining sufficient oxidation of the brain, therapy of possible cardiac arrhythmias, blood pressure management, blood sugar disturbances and hyperthermia. Prior announcement of patients in the admitting hospital is desirable.     

Clinical experience and minority group students. A perspective from Harvard Medical School.

Medical educators realize that there are no simple predictors for student performance in the clinical training years. College grades and Medical College Admission Test scores may suggest the strength of a student's achievement in the basic sciences but cannot be relied on to predict efficacy in patient care. There is no fool proof way of assessing noncognitive abilities critical to clinical competence. However, in admissions, extracurricular activities, community service, leadership abilities, recommendations, and interviews are examined to assess personal strengths. The author's observations suggest that noncognitive attributes are important in the success of disadvantaged students. Although some, but not all, with low Medical College Admission Test scores may not excel in the basic sciences, once they reach the clinical years, a leveling of the playing field gives them an opportunity to show their special competence with patients. Minority students, perhaps because of their own life experiences, often are alert to the needs and sensitivities of patients. As a group, they are respectful of the dignity of patients. Many embrace the dictum: treat every patient as you would want a family member to be treated. Most minority students, despite pressures of being a minority in predominantly white environments, perform at a very high level in the clinical years and thereafter.     

Minimally invasive options for gastric tumors

INTRODUCTION: Depending on the origin of the tumor tissue, gastric tumors may be more or less accessible for biopsy diagnostics. However, especially submucous tumors present a diagnostic problem. Entity and dignity may remain unclear particularly in larger tumors and may not be clarified before operative excision via gastrotomy and frozen section diagnostics. Similar problems may occur in the diagnostics of epithelial tumors, if a reliable appraisal of the dignity based on forceps biopsy is impossible. To clarify their entity and dignity, tumors can be completely extirpated with minimally invasive techniques. PATIENTS AND METHODS: Apart from the endoscopic mucosa resection (EMR), laparoscopic intragastric tumor resection and laparoscopic wedge resection were performed, especially in larger tumors. In the period from December 1999 to December 2001, we saw an indication for minimally invasive procedures in 22 patients. There were 5 cases of submucous tumors of unclear entity and 17 epithelial lesions. The epithelial lesions included 12 patients with tumors of unclear dignity and five cases with early gastric carcinomas. RESULTS: The EMR was performed without complications in all 14 cases. One of the three cases with wedge resection was followed by a gastrectomy for oncological reasons. One early postoperative bleeding occurred, which was controlled laparoscopically. Conversion to open surgery due to technical problems was necessary in two cases of laparoscopic intragastric resection, and in one case a gastrectomy was required for oncological intention. CONCLUSION: Beside the diagnostic aspect, the mentioned techniques also enable a minimally invasive therapy of locally excisable gastric tumors. In addition to benign and low grade malignant lesions, early gastric carcinomas of the intestinal type present an indication.     

Post stroke urinary loss,incontinence and life satisfaction: When does post‐stroke urinary loss become incontinence?

AIMS: While urinary incontinence (UI) has been extensively studied after stroke, the threshold for when it becomes a social problem by affecting life satisfaction or social participation has not been established. The study goal was to establish this threshold, examine the impact of UI on life satisfaction and participation, and determine whether UI contributes independently to poor stroke outcome. METHODS: Retrospective analysis was performed on prospectively collected data from a cohort of consecutive admissions to the acute Neurology Stroke Service of a large metropolitan teaching hospital. Four hundred and sixty patients with ischemic stroke were prospectively evaluated for stroke severity, medical, and demographic factors. Telephone interviews were completed with 361 community-dwelling subjects 6 months after stroke onset. RESULTS: The FIM bladder item was used to determine the frequency of urinary loss. All patients were continent before stroke onset, 16% reported UL at 6-month follow-up. ROC analysis suggested that UI once per month or more is associated with diminished quality of life and activity participation. Logistic regression found poor life satisfaction associated with ADL impairment, cognitive disability, low SF12 physical and mental health scores, and incontinence. Poor outcome was independent of stroke severity. CONCLUSIONS: Urinary loss became incontinence when it occurred at least monthly. UI was associated with greater dependence in basic and instrumental ADL, decreased participation and low life satisfaction.     

Withdrawing life-sustaining treatment: ethical considerations

Withdrawing life-supporting technology from patients who are irremediably ill is morally troubling for caregivers, patients, and families. Interventions that enable clinicians to delay death create situations in which the dignity and comfort of dying patients may be sacrificed to spare professionals and families from their elemental fear of death. Understanding of the limits of treatment, expertise in palliation of symptoms, skillful communication, and careful orchestration of controllable events can help to manage the withdrawal of life support appropriately.     

Palliative management of esophageal carcinoma

The surgical treatment of esophageal carcinoma is palliative surgery in 90 percent of cases. Much can be done by the motivated surgeon to ease the suffering of the patients and to help them die with dignity. In this context, compassion is more important than surgical statistics. Age, depletion resulting from complications and distant metastases are no longer contraindications to palliative surgery as defined herein.     

Diagnostic tumor resection in kidney tumors of unclear quality

From 1985 to June 1989 diagnostic tumour resections have been performed on 37 kidney tumours with unknown dignity following the preoperative imaging techniques. The kidney tumours were completely excised with about 1 cm of adjacent parenchyma outside the pseudocapsule during temporary ischemia. The tumours and biopsies from the resection margins were sent to quick frozen section. In case of benign histology or low grade clear cell carcinomas with exophytic growth and a size of less than 5 cm in diameter the operation was finished without removing of the kidney. In 21 patients with benign and 11/16 with malignant disease the kidneys could be preserved. In 5/16 patients the kidneys were removed after tumour resection and result of the quick frozen section. In our opinion the diagnostic kidney tumour resection in cases of kidney tumours with unknown dignity should be preferred to fine needle biopsies combining diagnostic and therapeutic proceeding in selected cases. On the other hand tumour resections without nephrectomy in patients with renal cell carcinoma and normal contralateral kidney should be done only in low grade tumours of small size.