臨終病人和家屬的護(hù)理

1、Role of Culture in Palliative Care: Family Meeting,Pingfen Tang professor of NursingKunming Medical University,WHO emphasize that the family is the basic unit of end-of-life care［1］，family deathbed is very popular in

2、 some developing countries［2］which the long-term palliative care is mainly provided by the family［3］,[1]戴紅霞，殷磊．姑息護(hù)理———新型的護(hù)理方式［Ｊ］．護(hù)士進(jìn)修雜志，２００２，１７（２）：１０３－１０５．[2]何婉珠，黃素枰，林利榮，等．居家晚期患者臨終關(guān)懷護(hù)理的探討［Ｊ］．現(xiàn)代醫(yī)院，２００９，９（８）：１５１－１５２．[3]

3、Spillman B C , Pezzin L E.Potential and active family caregivers : changing networks and the “ sandwich generation”[ J] .Milbank Q , 2000 , 78(3):347-374,Palliative care could be defined as any relative, friend or partne

4、r who has a significant relationship with and provides various forms of support to a person with incurable illness [1]. Family member may experience a considerable burden when caring for a person with complex and seriou

5、s conditions, which could affect their health and wellbeing negatively [2].,Hudson P, Payne S. Family caregivers and palliative care: current status and agenda for the future. J Palliat Med. 2011;14(7):864–9.2. Kohler

6、N, Perner A, Anders D, Brahler E, Papsdorf K, Gotze H. [Family caregivers of palliative cancer patients: health-related quality of life and care-related burden]. Psychother Psychosom Med Psychol. 2012;62(5):157–62.,,,,,I

7、ndividual,Family &Social Support Network,Systems for Health Care Delivery,Cultural,Communication,Expectation,Decision,Planning,Grief,Elain Wittenbery, Betty Ferrell Textbook of Palliative care,Patient-centered commu

8、nication and palliative care Elain Wittenbery, Betty Ferrell Textbook of Palliative care,Patient-CenteredCommunication&Palliative Care,Beliefs, values,attitudes, preferences,goals, and emotions,Beliefs,values

9、,attitudes,preferences,goals, andemotions,Beliefs, values,attitudes,preferences,goals, andemotions,Patient,Family,Health care term,,,,Individual FactorsAgeGenderIllnessGenePsychosocial CultureReligious Fa

10、mily FactorsStructureFunctionRelationship Environment Social NetworksCommunityHealth care Delivery,Individual OutcomesMorbidityMortalityQuality of LifeFamily OutcomesLifestyleSatisfactionQuality of life

11、Environment ConvenientEfficient Full services,Individual,Margaret el., 2006,Individual -FamilyManagement Model,Family,Cultural play an important role in Palliative Care in China,“Raise children to the elderly endowme

12、nt and death”，and it always has been emphasized China‘s “filial piety”，The elderly are willing to in their own homes, accompanied by children through the final stages of life.,Men xianwu．Hospice care［Ｍ］．Tianjin：Tianjin

13、science and technology publishing house２００２：１７－１８．,Chinese traditional culture about Filial Piety,Filial Piety is the younger generation handling the relationship with the elders in the family should have moral quality a

14、nd must abide by the code of conduct,Shi Lihua point out that 90% of the elderly are more likely to choose to die at home，cared by their family member [1]. 40% - 80% of the dying patients in the developed countries choo

15、se died at home，because home is the most place can make them feel comfortable and safe place [2-3]。,[1] Lihua Shi．Under the background of research of China's ageing hospice career development strategy [J]．Chinese med

16、ical ethics，2009。22（4）：82-83．[2]Stajdhar KI。 Davies B。 Variations in and factors influencing family member decisions for palliative home care [J]. Plliative Med，2005，9（1）：21-32[3] Yong-xing shi. Aged care of hospita

17、l service Situation and policy research of Shanghai。 [ M] Shanghai Fudan University press., 2008 :74-75 .,Psychological Problems for Family Members in Palliative Care,Davis MP, Gutgsell T, Gamier P. What is the differenc

18、e between palliative care and hospice care?[ J]. Cleve Clin J Med, 2015, 82(9):569-571.,Family Goals for End-of-Life Care,? Patient is pain-free.? Patient is clean.? Patient is able to be with loved ones.? Environment

19、 is beautiful, peaceful.? There is a comfortable place to lie down.? Lights are gentle.? The patient’s wishes are respected.? Medication is available to manage pain.,Gwyther LP, Altilio T, Blacker S, Christ G, Csikai

20、 EL, Hooyman N.Social work competencies in palliative and end-of-life care. J Soc Work End Life Palliat Care. 2005;7:87–120.,Medical Term,Family Members,,,Cooperation,Content of Family Meeting,Encourage family emotion a

21、nd desire,Discuss the treatment & care plan,Determine the decision makers,Tell to family the patient’s last time,Rhondali W, Dev R, Barbaret C, et al. Family Conferences in Palliative Care: A Survey of Health Care Pr

22、oviders in France[J ].J Pain Symptom Manage,2014,48(6):1117-1124,Yennura J S, Dev R, Lockey M, et al. Characteristics of Family Conferences in a Palliative Care Unit at a ComprehensiveCancer Center[ J ].J Palliat Med, 2

23、008,11(9):1208-1211.,Preparation Family Meeting,Family meeting,NursePhysicianPsychological consultantSocial work/volunteersFamily membersReligious group(if need),Information,Chen, Zhao Shi,Zhu. A family meeting co

24、mmunicate the treatment for ICU terminate dying ‘s satisfaction analysis[ J ] Chinese hospital management.2011,31（3）:53-55.,Meeting skills,Using scientific communication skills such as the SPIKES and ABCDE Models and ti

25、mely transfer the “bad news“ to family members.,McFarlane J, Riggins J, Smith T J. SPIKES: A Six-Step Protocol for Delivering Bad News About the Cost of Medical Care[ J ]. J Clin Oncol, 2008, 26(25):4200-4204.,Breaking B