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精神背景及其与终末期 DNR 医疗决策的关联。

Spiritual background and its association with the medical decision of, DNR at terminal life stages.

机构信息

Skilled Geriatric Nursing Department, Herzog Hospital, Affiliated with the Hebrew University Hadassah Medical School, Jerusalem, Israel.

出版信息

Arch Gerontol Geriatr. 2014 Jan-Feb;58(1):25-9. doi: 10.1016/j.archger.2013.08.004. Epub 2013 Sep 9.

Abstract

In recent years personal and clinical dilemmas relating to terminally ill patient-care medical, decisions have increased significantly. Although understanding the patient's medical, nursing and, social background is important, a comprehensive appraisal essential for treating the "whole patient" is, incomplete without a spirituality assessment. Religious beliefs and practices affect medical and health, care decisions and require recognition as a dynamic in coping with suffering, loss, life, and death. Taking a spiritual background obtains information that is meaningful to the patient's life and may, influence the medical decision-making relating to health. A study was undertaken to determine, whether assessing the spiritual background influences medical decisions-making regarding the use of, DNR. The target population was 46 family-member caregivers of non-communicative patients in the Herzog, Hospital Skilled Nursing ward located in Jerusalem. The spiritual assessment questionnaire was the, acronym FICA (faith, importance, community and addressing). Two-thirds of the families were opposed to a determination utilizing do not resuscitate (DNR). Multivariate, analysis of the findings found that only religious affiliation was statistically significant (p=0.003). The doctors recommend DNR in 67% of the cases while the family caregiver accepted this decision in, only 33% of the cases. The hypothesis was verified. People who are perceived as being religious or as being greatly influenced, by faith/spirituality opposed the recommendation implementing DNR. Obtaining a spiritual background assists the physician to understand the patient or family spirituality, facilitates sensitivity to value frameworks and preferences in making medical and health-related, decisions.

摘要

近年来,与绝症患者医疗护理相关的个人和临床困境决策显著增加。尽管了解患者的医疗、护理和社会背景很重要,但全面评估对于治疗“整体患者”是不完整的,如果没有灵性评估。宗教信仰和实践会影响医疗和健康决策,需要认识到它们是应对痛苦、丧失、生命和死亡的动态因素。了解患者的灵性背景可以获取对其生活有意义的信息,并可能影响与健康相关的医疗决策。一项研究旨在确定评估灵性背景是否会影响关于使用 DNR 的医疗决策。目标人群是位于耶路撒冷的 Herzog 医院熟练护理病房中无法沟通的非传染性患者的 46 名家属护理人员。灵性评估问卷的缩写是 FICA(信仰、重要性、社区和处理)。三分之二的家庭反对使用不复苏(DNR)的决定。对调查结果的多变量分析发现,只有宗教信仰具有统计学意义(p=0.003)。医生建议在 67%的情况下使用 DNR,而家属护理人员仅在 33%的情况下接受这一决定。假设得到了验证。被认为是宗教人士或受信仰/灵性极大影响的人反对实施 DNR 的建议。获取灵性背景可以帮助医生了解患者或家庭的灵性,促进对价值框架和医疗健康相关决策中的偏好的敏感性。

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