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[如何有效地干预临终患者]

[How to intervene effectively with a dying patient].

作者信息

Gagné F L, Robichaud-Ekstrand S

出版信息

Can Nurse. 1995 Feb;91(2):47-51.

PMID:7780926
Abstract

Nurses are in a strategic position to meet the needs of the dying patient. However, when confronted with death, nurses often utilize avoidance behaviors, such as: tending to the dying patient only if a technique is required; initiating conversations on casual topics or directing the conversation towards the patient's "health"; requesting consults to avoid talking about dying; and unnecessarily overmedicating the patient. This paper explains the rights and needs of the dying patient and describes associated nursing interventions. For example, the dying patient has the primordial right to choose whether or not to receive treatment. For nurses to intervene effectively, they must learn to manage their own emotions relating to death. A strong theoretical understanding of the dying process must be acquired. They must also develop internal strengths and receive help from various resources. By doing so, nurses reinvest their shared life experiences and apply them to other dying patients continuously refining their conceptual model of loss. Through verbal and non-verbal cues, nurses transmit profound messages to their patients. Some efficient nursing interventions consist of: providing basic care and medications to prevent terminal suffering; offering an attentive and reassuring presence; respecting the contemplative phases; listening for latent messages in conversations; understanding symbolic language; respecting family dynamics; allowing family members to choose physical and psychosocial interventions to improve the patient's comfort; frequently visiting the patient and intensifying their presence; permitting the dying patient to verbalize fears and anxieties; and consistently offering tenderness, empathy, acceptance, warmth and respect. As death nears, scientific and technological aspects of nursing become less important for the patient, and the art of sincere human empathy becomes paramount.

摘要

护士在满足临终患者需求方面处于战略地位。然而,面对死亡时,护士常常会采取回避行为,例如:仅在需要某项技术时才照料临终患者;开启闲聊话题或把谈话引向患者的“健康”状况;要求会诊以避免谈论死亡;以及不必要地给患者过度用药。本文阐述了临终患者的权利和需求,并描述了相关的护理干预措施。例如,临终患者拥有选择是否接受治疗的首要权利。护士若想有效干预,就必须学会管理自身与死亡相关的情绪。必须深入理解死亡过程的理论知识。他们还必须培养内在力量,并从各种资源中获取帮助。通过这样做,护士将自身共同的生活经历重新投入使用,并将其应用于其他临终患者,不断完善他们关于丧失的概念模型。通过言语和非言语线索,护士向患者传递深刻的信息。一些有效的护理干预措施包括:提供基本护理和药物以防止临终痛苦;给予专注且令人安心的陪伴;尊重沉思阶段;倾听谈话中的潜在信息;理解象征语言;尊重家庭动态;允许家庭成员选择身体和心理社会干预措施以提高患者舒适度;频繁探访患者并加强陪伴;允许临终患者说出恐惧和焦虑;以及始终给予温柔、同理心、接纳、温暖和尊重。随着死亡临近,护理的科学技术层面对于患者而言变得不那么重要,而真诚的人文同理心艺术则变得至关重要。

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