临终病人和家属的护理课件

RoleofCultureinPalliativeCare:FamilyMeetingPingfenTangprofessorofNursingKunmingMedicalUniversityRoleofCultureinPalliativeWHOemphasizethatthefamilyisthebasicunitofend-of-lifecare［1］，familydeathbedisverypopularinsomedevelopingcountries［2］whichthelong-termpalliativecareismainlyprovidedbythefamily［3］[1]戴红霞，殷磊．姑息护理———新型的护理方式［Ｊ］．护士进修杂志，２００２，１７（２）：１０３－１０５．[2]何婉珠，黄素枰，林利荣，等．居家晚期患者临终关怀护理的探讨［Ｊ］．现代医院，２００９，９（８）：１５１－１５２．[3]

SpillmanBC,PezzinLE.Potentialandactivefamilycaregivers:changingnetworksandthe“sandwichgeneration”[J].MilbankQ,2000,78(3):347-374WHOemphasizethatthefamilyPalliativecarecouldbedefinedasanyrelative,friendorpartnerwhohasasignificantrelationshipwithandprovidesvariousformsofsupporttoapersonwithincurableillness[1].Familymembermayexperienceaconsiderableburdenwhencaringforapersonwithcomplexandseriousconditions,whichcouldaffecttheirhealthandwellbeingnegatively[2].HudsonP,PayneS.Familycaregiversandpalliativecare:currentstatusandagendaforthefuture.JPalliatMed.2011;14(7):864–9.2.KohlerN,PernerA,AndersD,BrahlerE,PapsdorfK,GotzeH.[Familycaregiversofpalliativecancerpatients:health-relatedqualityoflifeandcare-relatedburden].PsychotherPsychosomMedPsychol.2012;62(5):157–62.PalliativecarecouldbedefinIndividual

Family&SocialSupportNetworkSystemsforHealthCareDeliveryCultural

CommunicationExpectationDecisionPlanningGriefElainWittenbery,BettyFerrellTextbookofPalliativecareIndividualFamily&SocialSuppPatient-centeredcommunicationandpalliativecareElainWittenbery,BettyFerrellTextbookofPalliativecarePatient-CenteredCommunication&PalliativeCareBeliefs,values,attitudes,preferences,goals,andemotionsBeliefs,values,attitudes,preferences,goals,andemotionsBeliefs,values,attitudes,preferences,goals,andemotionsPatient

Family

HealthcaretermPatient-centeredcommunicationIndividualFactorsAgeGenderIllnessGenePsychosocialCultureReligiousFamilyFactorsStructureFunctionRelationshipEnvironmentSocialNetworksCommunityHealthcareDeliveryIndividualOutcomesMorbidityMortalityQualityofLifeFamilyOutcomesLifestyleSatisfactionQualityoflifeEnvironmentConvenientEfficientFullservicesIndividual

Margaretel.,2006Individual-FamilyManagementModelFamilyIndividualFactorsIndividualOCulturalplayanimportantroleinPalliativeCareinChina“Raisechildrentotheelderlyendowmentanddeath”，anditalwayshasbeenemphasizedChina‘s“filialpiety”，Theelderlyarewillingtointheirownhomes,accompaniedbychildrenthroughthefinalstagesoflife.

Menxianwu．Hospicecare［Ｍ］．Tianjin：Tianjinscienceandtechnologypublishinghouse２００２：１７－１８．CulturalplayanimportantrolChinesetraditionalcultureaboutFilialPietyFilialPietyistheyoungergenerationhandlingtherelationshipwiththeeldersinthefamilyshouldhavemoralqualityandmustabidebythecodeofconductChinesetraditionalcultureabShiLihuapointout

that90%oftheelderlyaremorelikelytochoosetodieathome，caredbytheirfamilymember[1].40%-80%ofthedyingpatientsinthedevelopedcountrieschoosediedathome，becausehomeisthemostplacecanmakethemfeelcomfortableandsafeplace

[2-3]。[1]LihuaShi．UnderthebackgroundofresearchofChina'sageinghospicecareerdevelopmentstrategy[J]．Chinesemedicalethics，2009。22（4）：82-83．[2]StajdharKI。DaviesB。Variationsin

andfactorsinfluencingfamilymemberdecisionsforpalliativehomecare[J].PlliativeMed，2005，9（1）：21-32[3]Yong-xingshi.AgedcareofhospitalserviceSituationandpolicyresearchofShanghai。

[M]ShanghaiFudanUniversitypress.,2008:74-75.ShiLihuapointoutthat90%oPsychologicalProblemsforFamilyMembersinPalliativeCareAnxietyPessimisticDespairDavisMP,GutgsellT,GamierP.Whatisthedifferencebetweenpalliativecareandhospicecare?[J].CleveClinJMed,2015,82(9):569-571.PsychologicalProblemsforFamFamilyGoalsforEnd-of-LifeCare♦Patientispain-free.♦Patientisclean.♦Patientisabletobewithlovedones.♦Environmentisbeautiful,peaceful.♦Thereisacomfortableplacetoliedown.♦Lightsaregentle.♦Thepatient’swishesarerespected.♦Medicationisavailabletomanagepain.GwytherLP,AltilioT,BlackerS,ChristG,CsikaiEL,HooymanN.Socialworkcompetenciesinpalliativeandend-of-lifecare.JSocWorkEndLifePalliatCare.2005;7:87–120.FamilyGoalsforEnd-of-LifeCFamilyMeetingSupporting

MedicalTermFamilyMembers

CooperationFamilyMeetingSupportingMedicContentofFamilyMeetingEncouragefamilyemotionanddesireDiscussthetreatment&careplanDeterminethedecisionmakersTelltofamilythepatient’slasttimeRhondaliW,DevR,BarbaretC,etal.FamilyConferencesinPalliativeCare:ASurveyofHealthCareProvidersinFrance[J].JPainSymptomManage,2014,48(6):1117-1124YennuraJS,DevR,LockeyM,etal.CharacteristicsofFamilyConferencesinaPalliativeCareUnitataComprehensiveCancerCenter[J].JPalliatMed,2008,11(9):1208-1211.ContentofFamilyMeetingEncouPreparationFamilyMeetingGoalsEnvironmentParticipantsRelationshipInformationCognitiveAgreementSummaryPreparationFamilyMeetingGoalFamilymeetingNursePhysicianPsychologicalconsultantSocialwork/volunteersFamilymembersReligiousgroup(ifneed)FamilymeetingNurseInformationChen,ZhaoShi,Zhu.AfamilymeetingcommunicatethetreatmentforICUterminatedying‘ssatisfactionanalysis[J]Chinesehospitalmanagement.2011,31（3）:53-55.IllnessInformationDiagnosisTreatmentFamilyRelationshipSocialSupportingReligiousCultureInformationChen,ZhaoShi,Zhu.MeetingskillsUsingscientificcommunicationskillssuchastheSPIKESandABCDEModelsandtimelytransferthe“badnews“tofamilymembers.McFarlaneJ,RigginsJ,SmithTJ.SPIKES:ASix-StepProtocolforDeliveringBadNewsAbouttheCostofMedicalCare[J].JClinOncol,2008,26(25):4200-4204.MeetingskillsUsingscientifiSPIKESWALTERF.BAILE,2000ABCDERabowMW,Mcphee,1999BreakingBadNewsModeSPIKESWALTERF.BAILE,2000ABCS:Setting•Arrangeforsomeprivacy•Involvesignificantothers&Sitdown•Makeconnectionandestablishrapportwiththepatient•ManagetimeconstraintsandinterruptionsP:Perceptionofcondition/seriousnessDeterminewhatthepatientknowsaboutthemedicalorwhatissuspected.“Beforeyoutell,ask.”,Listentothepatient’slevelofcomprehension•AcceptdenialbutdonotconfrontatthisstageI:InvitationfrompatienttogiveinformationAskpatientifwishestoknowthemedicaland/ortreatmentAcceptpatient’srightnottoknowOffertoanswerquestionslaterifs/hewishesK:KnowledgegivemedicalfactorConsidereducationallevel,socio-culturalbackground,currentemotional•Giveinformationinsmallchunks,warnthepatientbouttogivebadnews•Checkwhetherthepatientunderstoodwhatyousaid&Respondreactions•GiveanypositiveaspectsfirstE:Exploreemotions&sympath