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Concept of Hospice Care课程教案、知识点、字幕

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

今天的课就讲到这里

谢谢

Gerontological Nursing课程列表:

CHAPTER 1: General Introduction to Geronological Nursing

-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

--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

--【Literature Recommendation】Obstacles and Policies of the Social Capital Participates in the Combination of Medical Care and Pension: A Literature Review

-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

-【Case Discussion】CHAPTER 1

CHAPTER 2: Elderly Health Assessment

-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

--【Literature Recommendation】Age-friendliness of living environments from the older person’s viewpoint: development of the Age-friendly Environment Assessment Tool

-Concept Map

--【Concept Map】Elderly Health Assessment(1)

--【Concept Map】Elderly Health Assessment(2)

-【Test】CHAPTER 2

-【Case Discussion】CHAPTER 2

CHAPTER3: Elderly Mental Health and Mental Health care

-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

--【Website Recommendation】

--【Documentary Recommendation】Depression:Out of the Shadows

--【Literature Recommendation】Management of depression in older adults:A review depression in older people

-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

-【Case Discussion】CHAPTER 3

CHAPTER4: Elderly Daily Care

-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

-【Case Discussion】CHAPTER 4

CHAPTER5:Medication Safety and Care for the Elderly

-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

--【Literature Recommendation】The American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

-5.4 Prevention of Adverse Drug Reactions in the Elderly

--Prevention of Adverse Drug Reactions in the Elderly

--【Literature Recommendation】Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies

-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

-【Case Discussion】CHAPTER 5

CHAPTER6:Nursing Care for the Elderly with Common Health Problems and Diseases

-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

--Dysphagia in the Elderly

-6.3 Urinary Incontinence in the Elderly

--Urinary Incontinence in the Elderly

-6.4 Constipation in the Elderly

--Constipation in the Elderly

--【Literature Recommendation】Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management

-6.5 Dry Mouth in the Elderly

--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

--Senile Deafness

-6.9 Elderly Delirium

--Elderly Delirium

-6.10 Elderly Frailty

--Elderly Frailty

--【Literature Recommendation】Frailty in elderly people/Frailty in older people

-6.11 Pneumonia in the Elderly

--Pneumonia in the Elderly

-6.12 Hypertension in the Elderly

--Hypertension in the Elderly

--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension

-6.13 Stroke in the Elderly

--Stroke in the Elderly

-6.14 Stable Angina in the Elderly

--Stable Angina in the Elderly

--【Literature Recommendation】2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

-Concept Map

--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases

-【Test】CHAPTER 6

-【Case Discussion】CHAPTER 6

CHAPTER7 Hospice Care for the Elderly

-7.1 Concept of Hospice Care

--Concept of Hospice Care

--【Website Recommendation】 Definition of Palliative Care,WHO

-7.2 Death Education

--7.2.1 Death Education (1)

--7.2.2 Death Education (2)

--【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

--【Journal Recommendation】

-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

-【Case Discussion】CHAPTER 7

FINAL EXAM

-Final Exam

Concept of Hospice Care笔记与讨论

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