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同学们好
今天我们要学习的内容是
《临终老年人的心理问题及护理》
心理学家伊莉莎白·库伯勒·罗斯在
《On Death and Dying》一书当中提出
临终老年人大多要经历
五个心理变化过程
分别是否认 愤怒 协商 抑郁 接纳
虽然老年人在临终前
具有一些共性的心理体验
但罗斯也强调临终患者的个体差异
他们具有一些个性的心理特征
临终老年人有2个心理特点
一是
老年人在临终前心理障碍加重
表现为暴躁 孤僻 矛盾等
二是
老年人在临终前还表现出思虑后事
包括遗体处理 家庭安排
财产分配
担心配偶的生活
子女 儿孙的工作 学业等问题
临终老年人的常见心理问题
包括抑郁 恐惧 暴躁 孤僻等
下面我们侧重学习抑郁和恐惧
研究者Susan D.Block
提出了临终病人抑郁的指征
主要包括心理指征
其他指征和历史性指征
其中
心理指征为烦燥不安
压抑低落的情绪 难过 流泪
闷闷不乐 无望 无价值感
社会性撤退 内疚 自杀念头
其他指征包括很难处理的疼痛
或其他症状 大小便过于频繁
不成比例的残疾
拒绝治疗合作或合作很差
无望 厌恶
对医务人员的影响缺乏兴趣
历史性指征包括药物滥用
抑郁或双向情感障碍的
个人史或家庭史
这里大家需要注意将临终期的抑郁
与正常的悲痛区别开来
我们来看这个表格
在诱因方面
正常悲痛是由一个
特定具体的损失
引起的感情 情绪和行为
而抑郁通常可由
生命中的各个因素引起
大多数临终病人都会体验到悲痛
但只有少数人发展成为抑郁
在临床表现方面
正常悲痛的病人体验到身体不适
睡眠和食欲紊乱
注意力下降 社会性撤退等
抑郁的病人除了体验到相似的症状外
还有无望 无助
无价值感 内疚 自杀念头
在症状特点上
正常的悲痛是起伏不稳定
常与疾病的进展联系在一起
正常悲痛的病人
依然保持着愉快的能力
而临终期抑郁是一直持续不变
呈日益增长
且病人从任何事情中
都无法享受到乐趣和愉快
在处理方式方面
正常悲痛的病人
通常自己来处置这种忧伤
对于抑郁的病人来说
药物或心理干预通常是必要的
对死亡的反应方面
正常悲痛的病人
对死亡的迅速到来
表达了被动的请求
能够盼望未来
而临床抑郁的临终病人
表达了强烈的持续稳固的自杀想法
没有一个积极的未来感
此外
临终老年人在即将死亡时
会表现出种种的恐惧心理
主要包括
对未知物的恐惧
对失去社会性自我的恐惧
对失去生理自我的恐惧
对失去自我控制的恐惧
以及对失去同一性的恐惧
在面对临终老年人的这些心理问题时
护理人员可以从触摸护理
耐心倾听 诚恳交谈
舒适护理和死亡教育等方面进行处理
首先
可以进行触摸护理
触摸护理是大部分临终病人
愿意接受的一种方法
研究表明
对老年患者进行关怀性触摸
可改善患者的抑郁 疼痛
提高其生活质量
同时能有效提高
护理人员的人文关怀品质
护士在触摸护理过程中
应注意以下几点
首先要针对不同情况
采用不同的触摸策略
大家请看这张表格
当患者所处的能量情绪级别较低时
如处于
悲伤状态
我们在触摸干预时就要
以消除孤独感和不确定感为主要目标
若是患者处于较高能量级别
如
放松
我们在触摸时
主要就是要突出友好和关怀
2
在触摸的部位上
可以选择轻轻触摸临终老年人的手
胳膊 额头 胸 腹 背部
3
触摸时动作要轻柔
手部的温度要适宜
通过对老年人的触摸
能获得他们的信赖
减轻其孤独和恐惧感
增强老年人的安全感和温暖感
其次
护理人员应耐心倾听
倾听时要集中注意力
对患者所说的每件事情
用心倾听
认真分析
全心接受
避免分散注意的动作
倾听时要适当的反应
如可以轻声地说
嗯
或者点头表示自己注意倾听并理解
接受对方诉说的内容
并希望其继续说下去
倾听时要观察非语言行为
非语言行为往往包含丰富的信息
有助于护士理解
患者的真实想法和情感
在倾听的过程中还应
恰当地进行非语言交流与反馈
如当患者感到恐惧时
应握住他的手
可以使他感到温暖和安全
减少恐惧和焦虑
再者
应与临终老年人进行诚恳交谈
通过交谈了解老年人
真实的想法和临终前的心愿
尽量照顾老年人的
自尊心 尊重他们的权利
满足其各种需求
使其没有遗憾地离开人世
患者的生理情况
也经常会影响其心理状况
因此我们要尽量做到舒适护理
为临终老年人提供温馨
安静 舒适的病房环境
建立良好的护患关系
营造温馨的家庭氛围
使老年人获得安慰
保持安静平和的心态
此外
应适时有度地开展死亡教育
首先
要尊重老年人的民族习惯和宗教信仰
根据老年人的职业 心理反应
性格 社会文化背景等
在适当时机
与老年人及其家属
共同探讨生与死的意义
其次
要帮助老年人正确认识
对待生命和疾病
从死亡的恐惧与不安中解脱出来
以平静的心情面对即将到来的死亡
再者
要对家属进行适当的死亡教育
当家属得知患者失去康复的希望时
除了做好家属的心理疏导外
做好临终者的生活护理
减轻病人的痛苦
也是对家属的关怀和安慰
今天
我们了解了临终老年人的心理状况
并学习了相应的心理护理措施
课后同学们可以阅读
《临终心理与陪伴研究》一书
以加深对
老年人临终患者心理的理解
好
今天我们的课就讲到这里
谢谢
-1.1 Human Life Expectancy and Age Classification of the Elderly
--Human Life Expectancy and Age Classification of the Elderly
--【Vedio Recommendation】 How do we measure life expectancy ?
-1.2 Population Aging
--【Literature Recommendation】World Report on Ageing and Health: 2015
-1.3 Influence and Countermeasures of Population Aging
--Influence and Countermeasures of Population Aging
--【Literature Recommendation】World Population Ageing Highlights:2019
-1.4 Goals and Principles of Elderly Care
--Goals and Principles of Elderly Care
--【Book Recommendation】Evidence-Based Geriatric Nursing Protocols for Best Practice
-1.5 Theories Related to Elderly Care
--1.5.1 Personality Development Theory and Life Review
--1.5.2 Disengagement Theory and Activity Theory
--1.5.3 Self-efficacy and Chronic Disease Management
--【Vedio Recommendation】8 Stages of Development by Erik Erikson
--【Literature Recommendation】Activity Theory, Disengagement Theory, and Successful Aging
--【Book Recommendation】Self-Efficacy in Changing Societies
-1.6 Elderly Support and Elderly Care
--1.6.1 Concepts of Elderly Healthcare, Elderly Support and Elderly Care
--1.6.2 Home-based Elderly Care Model
--1.6.3 Institutional Elderly Care Model
--1.6.4 Integrated Medical and Nursing Care Model
--【Vedio Recommendation】Day in the Life of Home Care
--【Website Recommendation】Official Website of the National Institutes of Health
-Concept Map
--【Concept Map】General Introduction to Geronological Nursing
-【Test】CHAPTER 1
-2.1 Aging Changes in the Elderly
--2.1.1 Aging of the Respiratory System
--2.1.2 Aging of the Cardiovascular System
--2.1.3 Aging of the Digestive System
--2.1.4 Aging of the Urinary System
--2.1.5 Aging of the Endocrine System
--2.1.6 Aging of the Motor System
--2.1.7 Aging of the Nervous System
--2.1.8 Aging of the Sensory System
--【Literature Recommendation】Exercise Attenuates the Major Hallmarks of Aging
--【Book Recommendation】Hazzard's Geriatric Medicine and Gerontology
-2.2 Comprehensive Health Assessment of the Elderly
--Comprehensive Health Assessment of the Elderly
--【Literature Recommendation】Instruments to evaluate mental well-being in old age: a systematic review
-2.3 Principles of Elderly Health Assessment
--Principles of Elderly Health Assessment
-2.4 Assessment of the Functional Status of the Elderly
--Assessment of the Functional Status of the Elderly
--【Literature Recommendation】The Lawton Instrumental Activities of Daily Living (IADL) Scale
-2.5 Assessment of Cognitive Function in the Elderly
--Assessment of Cognitive Function in the Elderly
-2.6 Assessment and Adjustment of the Living Environment for the Elderly
--Assessment and Adjustment of the Living Environment for the Elderly
-Concept Map
--【Concept Map】Elderly Health Assessment(1)
--【Concept Map】Elderly Health Assessment(2)
-【Test】CHAPTER 2
-3.1 Overview of the Psychological Characteristics of the Elderly
--Overview of the Psychological Characteristics of the Elderly
-3.2 Influencing Factors of Psychological Changes in the Elderly
--Influencing Factors of Psychological Changes in the Elderly
-3.3 Common Psychological Issues and Their Management in the Elderly
--3.3.1 Common Psychological Issues and Their Management in the Elderly (1)
--3.3.2 Common Psychological Issues and Their Management in the Elderly (2)
--【Book Recommendation】Development Through the Lifespan
-3.4 Depression in the Elderly
--3.4.1 Overview of Depression in the Elderly
--3.4.2 Clinical Symptoms of Depression in the Elderly
--3.4.3 Caring for Elderly Patients with Depression
--【Documentary Recommendation】Depression:Out of the Shadows
-3.5 Elderly Patients with Dementia
--3.5.1 Identification of Dementia Symptoms in the Elderly
--3.5.2 Intelligence Rehabilitation of Elderly Patients with Dementia
--3.5.3 Safety Care of Elderly Patients with Dementia
--【Website Recommendation】The Global Voice on Demaentia
-Concept Map
--【Concept Map】Elderly Mental Health and Mental Health Care
-【Test】CHAPTER 3
-4.1 Precautions for Daily Care of the Elderly
--Precautions for Daily Care of the Elderly
-4.2 General Care of Elderly Skin
--4.2.1 Characteristics and General Care of Elderly Skin
--4.2.2 Skin Itching and Its Management in the Elderly
--【Website Recommendation】American Academy of Dermatology
-4.3 Clothing Hygiene for the Elderly
--Clothing Hygiene for the Elderly
--【Literature Recommendation】The Design Methods of Functional Clothing for the Elderly
-4.4 Dietary Care for the Elderly
--4.4.1 Nutritional Needs of the Elderly and Influencing Factors of these Needs
--4.4.2 Dietary Care for the Elderly
--【Book Recommendation】Nutrition Care of the Older Adult: a Handbook for Dietetics
--【Website Recommendation】Nutrition for older persons
-4.5 Sleep Guidance for the Elderly
--4.5.1 Sleep Characteristics of the Elderly
--4.5.2 Sleep Guidance for the Elderly
--【Book Recommendation】An Occupational Therapist's Guide to Sleep and Sleep Problems
--【Website Recommendation】American Academy of Sleep Medicine
-4.6 Exercises Guidance for the Elderly
--4.6.1 Evaluation of Exercise Intensity in the Elderly
--4.6.2 Precautions Elderly Undertaking Exercises
--【Website Recommendation】American College of Sport Medicine
--【Book Recommendation】Handbook of Activities for the Elderly
-Concept Map
--【Concept Map】Elderly Daily Care
-【Test】CHAPTER 4
-5.1 Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly
--Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly
--【Website Recommendation】How Drugs Work In the Elderly
-5.2 Common Adverse Drug Reactions and Their Causes in the Elderly
--Common Adverse Drug Reactions and Their Causes in the Elderly
-5.3 The Principles of the Use of Medications in the Elderly
--The Principles of the Use of Medications in the Elderly
-5.4 Prevention of Adverse Drug Reactions in the Elderly
--Prevention of Adverse Drug Reactions in the Elderly
-5.5 Medication Compliance in the Elderly
--Medication Compliance in the Elderly
-Concept Map
--【Concept Map】Medication Safety and Care for the Elderly
-【Test】CHAPTER 5
-6.1 Falls in the Elderly
--6.1.1 Epidemiological Characteristics of Elderly Falls
--6.1.2 Risk Factors for Falls in the Elderly
--6.1.3 Prevention of Falls in the Elderly
--【Website Recommendation】CDC STEADI(Stopping Elderly Accidents, Deaths & Injuries Tool Kit)
-6.2 Dysphagia in the Elderly
-6.3 Urinary Incontinence in the Elderly
--Urinary Incontinence in the Elderly
-6.4 Constipation in the Elderly
-6.5 Dry Mouth in the Elderly
--【Website Recommendation】Academy of Nutrition and Dietetics
-6.6 Elderly Nutritional Deficiencies
--Elderly Nutritional Deficiencies - emaciation
-6.7 Visual Impairment in the Elderly
--Visual Impairment in the Elderly
--【Website Recommendation】Senior Eye Exams
-6.8 Senile Deafness
-6.9 Elderly Delirium
-6.10 Elderly Frailty
--【Literature Recommendation】Frailty in elderly people/Frailty in older people
-6.11 Pneumonia in the Elderly
-6.12 Hypertension in the Elderly
--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension
-6.13 Stroke in the Elderly
-6.14 Stable Angina in the Elderly
--Stable Angina in the Elderly
-Concept Map
--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases
-【Test】CHAPTER 6
-7.1 Concept of Hospice Care
--【Website Recommendation】 Definition of Palliative Care,WHO
-7.2 Death Education
--【Book Recommendation】The Meaning of Death by Herman Feife
-7.3 Nursing for Pain in the Dying Elderly
--Nursing for Pain in the Dying Elderly
-7.4 Nursing for Major Bleeding in the Dying Elderly
--Nursing for Major Bleeding in the Dying Elderly
-7.5 Nursing for Delirium in the Dying Elderly
--Nursing for Delirium in the Dying Elderly
-7.6 Nursing for Dyspnea in the Dying Elderly
--Nursing for Dyspnea in the Dying Elderly
--【Website Recommendation】The Hospice and Palliative Nurses Association,HPNA
-7.7 Psychological Problems and Nursing in the Dying Elderly
--Psychological Problems and Nursing in the Dying Elderly
--【Book Recommendation】On Death and Dying ,by Elisabeth Kübler-Ross
-7.8 Grief Counseling for the Widowed Elderly
--Grief Counseling for the Widowed Elderly
--【Book Recommendation】I Wasn't Ready to Say Goodbye,by Noel·Brook,Blair·Pamela
-Concept Map
--【Concept Map】Hospice Care for the Elderly
-【Test】CHAPTER 7