国内外医学院校安宁疗护教育课程开展的范围综述

医学生的安宁疗护教育关系到我国未来安宁疗护事业的发展。本文对国内外安宁疗护教育课程的开设情况和教学内容、教学方法、考核方式、师资条件、教学评价及效果这些课程实施方面的现状进行了全面回顾,并在此基础上进行思考与提出建议,以期为我国医学院校开展安宁疗护教育课程提供参考。     

安宁疗护中的生死教育

安宁疗护中的生死教育非常重要,是死亡质量的重要指标之一,能够减轻患者的恐惧,帮助患者家庭增加面对丧亲的勇气,能促进医护人员的成长和改善医患关系。要做好生死教育,安宁疗护工作者自身应具有良好的生死素养。在安宁疗护中做生死教育,首先要排除安宁疗护工作中生死教育的障碍,并学会告知坏消息。对患者和家属的生死教育包括倾听、召开座谈会、做工作坊以及实施尊严疗法。安宁疗护还需要充分发掘生死教育资源,包括生死教育的人力资源、文化资源、学术资源以及社会资源。     

护理专业《安宁疗护》课程建设与探索

高等医学院校肩负培养医学人才的重要使命,安宁疗护教育是安宁疗护事业发展的关键环节,积极推进安宁疗护知识普及,加强院校教育,是促进安宁疗护发展的基础[1].为培养适应社会需求的安宁疗护专业人才,本课程团队申请开设了《安宁疗护》课程,并在教学中融入课程思政、大学生科研,发挥高校培养专业人才的优势,系统化、规范化教授《安宁疗...     

医学生安宁疗护职业素养教育

医学职业素养是医疗健康领域从业人员在医疗活动过程中表现出的综合素质,是医德医风、人道主义、专业水准三个方面的总和,而安宁疗护的核心理念是强调人本主义、身心社灵的整体观和科学的生死观,二者在本质上完全一致。因此,将安宁疗护的理念整合在医学生职业素养教育课程中,实现了理论与实践相结合,使医学职业素养的内容具体化、可视化,培养医学生反思和主动学习的能力,促进其个人健康,是医学职业素养教育的一个有益创新。     

青海省西宁市居民安宁疗护认知度现状调查分析

目的:探讨青海省西宁市居民对安宁疗护的知晓情况和认知程度.方法:收集2018年7月-2018年11月青海省西宁市常住居民为调查对象,采用问卷调查法,随机抽取484名进行调查,比较不同特征人群在安宁疗护认知方面是否存在差异.结果:484名被调查人群中:男209名(43.2％),女275名(56.8％),年龄(34～73)...     

安宁疗护的起源、发展与展望

安宁疗护在世界范围内已被许多国家和地区纳入了国家医疗服务体系。中国社会对安宁疗护需求巨大,其理念推广和实践行动正在兴起。在阐述国内外安宁疗护的起源、发展与现状基础之上,从加强顶层设计、完善医疗保险、建立安宁疗护服务体系等方面对中国安宁疗护事业的发展做出了展望。     

“互联网+”在安宁疗护领域的应用进展

通过介绍“互联网+”和安宁疗护的概念,分析“互联网+”在安宁疗护领域的优势,对“互联网+”在安宁疗护的症状监控与管理、心理与社会支持、患者健康教育与信息支持以及从业人员的信息支持及工作协调方面的应用进行梳理,总结面临的问题和发展前景,旨在为“互联网+安宁疗护”服务模式在中国进一步应用和发展提供参考。     

医学生志愿者安宁疗护培训课程的构建研究

目的构建医学生志愿者安宁疗护培训课程,以期为安宁疗护机构对医学生志愿者开展安宁疗护培训提供参考。方法在文献回顾、半结构式访谈及专家小组会议的基础上,拟定医学生志愿者安宁疗护培训课程初稿,采用德尔菲法对16位相关领域专家进行两轮专家咨询。结果两轮专家函询的积极系数分别为89%、100%,专家权威系数均为0.89。第2轮的肯德尔系数为0.196～0.328（P＜0.05）。最终形成医学生志愿者安宁疗护培训课程,包括培训目标、培训内容、培训学时、培训方式、考核方式5项一级指标,23项二级指标,40项三级指标。结论医学生志愿者安宁疗护培训课程内容全面实用、构建科学可靠,可用于安宁疗护机构对医学生志愿者进行安宁疗护志愿服务培训,以提高志愿者服务质量。     

社区安宁疗护服务发展

借鉴国内外社区安宁疗护服务经验,探讨中国本土化社区安宁疗护服务发展,提出建立并完善社区安宁疗护相关政策和法律制度;提高社区安宁疗护服务的综合能力;加大安宁疗护在社区的推广与宣传,以促进和加快中国社区安宁疗护服务更快更好地发展。     

对高等医学院校开设教育技术相关专业的思考

随着计算机信息技术在各类医疗机构中的广泛运用,此类人才需求量急增,国内一些高等医学院校也相继开设了医学教育技术相关专业.文章结合国内外有关教育技术学的基本理论和发展动态,对在医学院校开设此专业中出现的基本概念和课程体系、学科性质和学科定位、师资队伍和教材建设等关键问题进行了论述和思考.     

Guidelines for a palliative approach for aged care in the community setting: A suite of resources

In Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary.The Guidelines for a Palliative Approach for Aged Care in the Community Setting were published by the Australian Government Department of Health and Ageing to inform practice in this area. There are three resource documents. The main document provides practical evidence based guidelines, good practice points, tools, and links to resources. This document is written for general practitioners, nurses, social workers, therapists, pastoral care workers, and other health professionals and responded to needs identified during national consultation. Evidence based guidelines were underpinned by systematic reviews of the research literature. Good practice points were developed from literature reviews and expert opinion. Two ‘plain English’ booklets were developed in a process involving consumer consultation; one is for older people and their families, the other for care workers.The resources are intended to facilitate home care that acknowledges and plans for the client’s deteriorating functional trajectory and inevitable death. At a time when hospitals and residential aged care facilities are under enormous pressure as the population ages, such a planned approach makes sense for the health system as a whole. The approach also makes sense for older people who wish to die in their own homes. Family needs are recognised and addressed. Unnecessary hospitalisations or residential placements and clinically futile interventions are also minimised.     

医学院校专业英语课程设置的现状及对策研究

目前,国内大部分医学院校英语课程的设置仍然沿用传统的模式,未能真正开展专业英语教学,从而制约了对医学复合型人才的培养。文章围绕目前医学院校专业英语课程的设置进行分析,并提出了相应的对策以解决目前所存在的问题。     

"Please, I want to go home": ethical issues raised when considering choice of place of care in palliative care

Many palliative care patients would prefer to receive care, and to die, at home. Despite this many die in institutions. In response to this, politicians and charities have adopted policies aimed at increasing the opportunities for care and death at home. The need to discuss plans for discharge with most inpatients reinforces expectations of a choice of place of care. However, many palliative patients do not have a choice of care at home. This article will explore the circumstances in which patients are unable to choose home care and consider changes in clinical practice that can help to maximise choice. We shall argue that there is a distinction between the preferences of patients and the choices actually available to them. In attempting to make this distinction we advocate consideration of the balance between the ethical principles relevant to each case.     

Improving the delivery of palliative care through predictive modeling and healthcare informatics

ObjectiveAccess to palliative care (PC) is important for many patients with uncontrolled symptom burden from serious or complex illness. However, many patients who could benefit from PC do not receive it early enough or at all. We sought to address this problem by building a predictive model into a comprehensive clinical framework with the aims to (i) identify in-hospital patients likely to benefit from a PC consult, and (ii) intervene on such patients by contacting their care team.Materials and MethodsElectronic health record data for 68 349 inpatient encounters in 2017 at a large hospital were used to train a model to predict the need for PC consult. This model was published as a web service, connected to institutional data pipelines, and consumed by a downstream display application monitored by the PC team. For those patients that the PC team deems appropriate, a team member then contacts the patient’s corresponding care team.ResultsTraining performance AUC based on a 20% holdout validation set was 0.90. The most influential variables were previous palliative care, hospital unit, Albumin, Troponin, and metastatic cancer. The model has been successfully integrated into the clinical workflow making real-time predictions on hundreds of patients per day. The model had an “in-production” AUC of 0.91. A clinical trial is currently underway to assess the effect on clinical outcomes.ConclusionsA machine learning model can effectively predict the need for an inpatient PC consult and has been successfully integrated into practice to refer new patients to PC.     

姑息护理对老年晚期胃癌患者心理状况的影响

目的 探讨姑息护理对老年晚期胃癌患者心理状况的影响.方法 选择晚期胃癌患者46例,随机分为对照组和治疗组,各23例,入组前测量SAS(焦虑自评量表)和SDS(抑郁自评量表),并于姑息护理干预后再次对2组患者进行评定.结果 入组前2组患者心理状况比较,差异无统计学意义(P＞0.05),入组后治疗组经过姑息护理措施干预后心理状况有明显改善,2组比较差异有统计学意义(P＜0.05).结论 姑息护理能够有效地缓解老年晚期癌症患者的精神痛苦,维护其生命尊严.     

某三甲医院老年专科病房护士对缓和医学认知情况的调查分析

目的 总结某三甲综合医院老年专科病房护士对缓和医学知识的掌握情况并根据调查结果分析其影响因素.方法 采用问卷调查法对某医院老年专科病房护士210名进行调查.调查问卷是在参考相关文献的基础上自行修改而成.主要涉及调查对象的一般资料、对死亡的态度及照顾终末期患者的经历、对缓和医学的了解情况等.结果 发放问卷210份,回收有效问卷194份,有效回收率92.4％.结果显示,仅有24.2％调查对象能很公开和家人讨论死亡,55.7％未参加过死亡教育或临终关怀相关的课程或培训,57.2％的研究对象没有阅读过有关死亡的文章或书籍,仅有27.8％通过毕业后医院的继续教育获得有关死亡或临终关怀的相关知识.29.4％知道缓和医学的概念,94.3％未接受过缓和医学方面的教育培训.结论 应加强关于缓和医学的继续教育,采取有效措施促进老年专科病房护士对缓和医学知识的掌握,进而促进缓和医学在老年终末患者中实施以提高患者及家属的生活质量.     

我国社区安宁疗护现状及发展策略

通过梳理中国社区安宁疗护的发展模式和经验,分析社区安宁疗护发展存在的主要问题,为社区安宁疗护发展提出合理化建议,如加大支持保障力度、加强人才队伍建设、树立正确的生死观等,以促进国内社区安宁疗护服务更快更好地发展。     

医学院校人文选修课设置与规范管理探讨

医学院校开设人文类选修课的目的在于拓宽医学生的知识面,提升学生的人文素养。在目前医学院校的选修课程教学中,还存在着课程设置随意性大,学生选课具有盲目性和缺乏学习积极性等问题,通过对国内医学院校的人文选修课状况对比分析,认为解决好这些问题,应在课程计划设置、选修课管理、师资建设、质量监控和选修课教学环境的优化等方面予以完善。