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《医学中的尊严:定义、评估与治疗》

Dignity in Medicine: Definition, Assessment and Therapy.

机构信息

Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64°, 44121, Ferrara, Italy.

Integrated Department of Mental Health, University Hospital Psychiatry Unit, Ferrara, Italy.

出版信息

Curr Psychiatry Rep. 2024 Jun;26(6):273-293. doi: 10.1007/s11920-024-01506-3. Epub 2024 May 29.

Abstract

PURPOSE OF REVIEW

Over the last 20 years, dignity and dignity-conserving care have become the center of investigation, in many areas of medicine, including palliative care, oncology, neurology, geriatrics, and psychiatry. We summarized peer-reviewed literature and examined the definition, conceptualization of dignity, potential problems, and suggested interventions.

RECENT FINDINGS

We performed a review utilizing several databases, including the most relevant studies in full journal articles, investigating the problems of dignity in medicine. It emerged that dignity is a multifactorial construct and that dignity-preserving care should be at the center of the health organization. Dignity should be also regularly assessed through the tools currently available in clinical practice. Among dignity intervention, besides dignity models of care, dignity intervention, such as dignity therapy (DT), life review and reminiscence therapy, have a role in maintaining both the extrinsic (preserved when health care professionals treat the patient with respect, meeting physical and emotional needs, honors the patient's wishes, and makes attempts to maintain privacy and confidentiality) and intrinsic dignity (preserved when the patient has appropriate self-esteem, is able to exercise autonomy and has a sense of hope and meaning). Unified trends across diverse medical contexts highlight the need for a holistic, patient-centered approach in healthcare settings. Challenges compromising dignity are pervasive, underscoring the importance of interventions and systematic efforts to address these issues. Future research and interventions should prioritize the multifaceted nature of dignity, striving to create healthcare environments that foster compassion, respect, and dignity across all medical settings.

摘要

目的综述

在过去的 20 年中,尊严和尊严维护护理已成为包括姑息治疗、肿瘤学、神经病学、老年医学和精神病学在内的许多医学领域研究的中心。我们总结了同行评议文献,并检查了尊严的定义、概念化、潜在问题和建议的干预措施。

最新发现

我们利用几个数据库进行了综述,包括在全文期刊文章中调查医学中尊严问题的最相关研究。结果表明,尊严是一个多因素的结构,尊严维护护理应该是卫生组织的核心。还应该通过目前临床实践中可用的工具定期评估尊严。在尊严干预方面,除了尊严护理模式外,尊严干预,如尊严治疗(DT)、生活回顾和怀旧疗法,在维持外在尊严(当医护人员尊重地对待患者、满足身体和情感需求、尊重患者的意愿并努力维护隐私和保密时得以保留)和内在尊严(当患者有适当的自尊心、能够行使自主权并具有希望和意义感时得以保留)方面发挥作用。不同医学背景下的统一趋势强调了在医疗保健环境中采用整体、以患者为中心的方法的必要性。危及尊严的挑战普遍存在,突出了干预和系统努力解决这些问题的重要性。未来的研究和干预措施应优先考虑尊严的多方面性质,努力在所有医疗环境中营造培养同情、尊重和尊严的医疗环境。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d88a/11147872/d9e7fa2fa926/11920_2024_1506_Fig1_HTML.jpg

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