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同学们好
今天我们要学习的内容是
《临终护理的概念》
最近一篇关于缓和医疗的文章
引起护士小林的兴趣
她想了解更多这方面的资料
但是在网上一搜
网上好多资料都提到了缓和医疗
姑息疗法 临终关怀 临终护理
安宁疗护等几个关键词
可把小林给绕晕了
这几个词的含义等同吗
可以同义替换吗
今天我们就一起来理清这几个概念
为什么会出现多个概念呢
简单来说
这几个概念词都是从两个英文短语
hospice care
和 palliative care
翻译过来的
又因为大陆 台湾
日本地区翻译不一样
导致出现多个概念
临终关怀 安宁疗护 安宁疗法
宁养照护来源于英文 hospice care
本意是疾病晚期病人的安养院
收容所
目前大陆地区多使用临终关怀这一词
台湾地区则使用安宁疗护
缓和医疗 舒缓医疗
姑息疗法来源于英文
palliative care
本意是缓解
保守的疗法
国内最初翻译为姑息疗法
姑息者
苟且求安
无原则地宽容也
略带贬义
业内现在更多使用缓和医疗这个叫法
而舒缓医疗是日本 台湾地区
对palliative care的翻译
也能直观的表达此疗法
的目的是让患者舒服
临终关怀和缓和医疗有何区别呢
北京军区总医院
前肿瘤科主任刘端祺教授指出
今天的缓和医疗已经
不等同于临终关怀
而是涵盖了临终关怀的概念
是对于老年病 慢性病和危重病人
从确诊开始的全程照护和对症治疗
那临终护理等同于临终关怀吗
临终护理是对已失去治愈希望的病人
在生命即将结束时
所实施的一种积极的综合护理
是临终关怀的重要组成部分
它的特点是
从单纯治愈疾病
向综合性对症和整体化护理转化
护理的重点是症状控制
心理支持和家属的安慰
临终护理的核心是关心
其目的是尽最大努力
最大限度地减轻病人的痛苦
稳定情绪
缓和面对死亡的恐惧与不安
维护其尊严
提高生命质量
使临终病人在亲切 温馨的环境中
离开世界
达到优死的目的
姑息治疗又与临终关怀有何区别呢
很多人认为二者等同
事实上这样理解是非常片面的
姑息治疗并不是放弃治疗
而是把治疗的目标由疾病转向了症状
相比临终关怀
姑息治疗更加的积极
使用的方法更加的多样
我们通过以下表格对两者进行比较
在治疗对象方面
姑息治疗面向所有严重疾病的人
而临终关怀是针对患有严重疾病
且生命期小于6个月的患者
在缓解症状方面
两者是一样的
都是尽可能多地缓解症状
在是否继续治疗方面
姑息治疗是可以继续接受治愈性治疗
而临终关怀只提供症状缓解
在照顾时间方面
姑息治疗是取决于患者所需要的护理
而临终关怀仅限于生命最后几个月
在服务地点方面
两者均可在居家 医院
疗养院 辅助生活机构
临终关怀还可以在临终关怀机构
为了让同学们更好地理解二者的区别
我们一起来看以下两个案例
案例一
劳拉是一位43岁的女性
在接受乳腺癌治疗时出现贫血
姑息治疗专家
建议她接受输血治疗贫血及缓解疲劳
在控制症状的同时
劳拉继续进行治疗性化疗
从这个案例可以得知
在姑息治疗中
病人不必放弃可能治愈严重疾病的治疗方法
姑息治疗可与治愈性治疗一起提供
并可在疾病诊断时开始实施
随着时间的推移
如果医生或姑息治疗团队
认为正在进行的治疗不再有帮助
则有两种可能性
一是医生认为该病人
有可能在6个月内死亡
那么姑息治疗可以过渡到临终关怀治疗
二是姑息治疗团队可以继续为其提供舒适护理
案例二
从美国空军退休的约翰
在70岁时诊断患有肺癌
随着病情的进展
呼吸变得更加困难
他想参加临床实验性治疗来减缓疾病
退伍军人健康管理局为其提供了姑息治疗
包括疾病的实验性治疗
护理和情绪支持
此外
还通过各种措施支持约翰的妻子
使她在家里能更容易地照顾约翰
当治疗不再有帮助时
约翰接受了临终关怀
3个月后
他在家中安宁过世
案例二告诉我们
当疾病无法治愈时
或对治疗尝试无效时
或者患者选择不接受治疗时
可以选择临终关怀
就像姑息治疗一样
临终关怀也会提供全面的安抚护理
以及对家庭的支持
但是在临终关怀中
会停止尝试治疗患者的疾病
虽然这几个概念存在着一定的差异
但不论是
hospice care
还是 palliative care
care都是关键词而不是用treat
因此护士在缓和医疗中起重要作用
在安宁病房中
除医生 护士外
还有大量社工 志愿者
居家护理师 宗教师
心理师 关怀师等
参与到治疗的整个过程中
所以回到课前小林护士的疑问
我们可以知道这几个词既有联系又有区别
希望同学们可以理清其中的含义
正确使用这些词
好
今天的课就讲到这里
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
-Final Exam