临终病人和家属的护理.ppt

Role of Culture in Palliative Care: Family Meeting,Pingfen Tang professor of Nursing Kunming Medical University,WHO emphasize that the family is the basic unit of end-of-life care1，family deathbed is very popular in some developing countries2which the long-term palliative care is mainly provided by the family3,1戴红霞，殷磊姑息护理新型的护理方式护士进修杂志，（）： 2何婉珠，黄素枰，林利荣，等居家晚期患者临终关怀护理的探讨现代医院，（）： 3 Spillman B C , Pezzin L E.Potential and active family caregivers : changing networks and the “ sandwich generation” J .Milbank Q , 2000 , 78(3):347-374,Palliative care could be defined as any relative, friend or partner who has a significant relationship with and provides various forms of support to a person with incurable illness 1. Family member may experience a considerable burden when caring for a person with complex and serious conditions, which could affect their health and wellbeing negatively 2.,Hudson P, Payne S. Family caregivers and palliative care: current status and agenda for the future. J Palliat Med. 2011;14(7):8649. 2. Kohler N, Perner A, Anders D, Brahler E, Papsdorf K, Gotze H. Family caregivers of palliative cancer patients: health-related quality of life and care-related burden. Psychother Psychosom Med Psychol. 2012;62(5):15762.,Individual,Family &Social Support Network,Systems for Health Care Delivery,Cultural,Communication,Expectation,Decision,Planning,Grief,Elain Wittenbery, Betty Ferrell Textbook of Palliative care,Patient-centered communication and palliative care Elain Wittenbery, Betty Ferrell Textbook of Palliative care,Patient- Centered Communication & Palliative Care,Beliefs, values, attitudes, preferences, goals, and emotions,Beliefs, values, attitudes, preferences, goals, and emotions,Beliefs, values, attitudes, preferences, goals, and emotions,Patient,Family,Health care term,Individual Factors Age Gender Illness Gene Psychosocial Culture Religious Family Factors Structure Function Relationship Environment Social Networks Community Health care Delivery,Individual Outcomes Morbidity Mortality Quality of Life Family Outcomes Lifestyle Satisfaction Quality of life Environment Convenient Efficient Full services,Individual,Margaret el., 2006,Individual -Family Management Model,Family,Cultural play an important role in Palliative Care in China,“Raise children to the elderly endowment and death”，and it always has been emphasized Chinas “filial piety”，The elderly are willing to in their own homes, accompanied by children through the final stages of life.,Men xianwuHospice careTianjin：Tianjin science and technology publishing house：,Chinese traditional culture about Filial Piety,Filial Piety is the younger generation handling the relationship with the elders in the family should have moral quality and must abide by the code of conduct,Shi Lihua point out that 90% of the elderly are more likely to choose to die at home，cared by their family member 1. 40% - 80% of the dying patients in the developed countries choose died at home，because home is the most place can make them feel comfortable and safe place 2-3。,1 Lihua ShiUnder the background of research of Chinas ageing hospice career development strategy JChinese medical ethics，2009。22（4）：82-83 2Stajdhar KI。 Davies B。 Variations in and factors influencing family member decisions for palliative home care J. Plliative Med，2005，9（1）：21-32 3 Yong-xing shi. Aged care of hospital service Situation and policy research of Shanghai。 M Shanghai Fudan University press., 2008 :74-75 .,Psychological Problems for Family Members in Palliative Care,Davis MP, Gutgsell T, Gamier P. What is the difference between palliative care and hospice care? J. Cleve Clin J Med, 2015, 82(9):569-571.,Family Goals for End-of-Life Care, Patient is pain-free. Patient is clean. Patient is able to be with loved ones. Environment is beautiful, peaceful. There is a comfortable place to lie down. Lights are gentle. The patients wishes are respected. Medication is available to manage pain.,Gwyther LP, Altilio T, Blacker S, Christ G, Csikai EL, Hooyman N.Social work competencies in palliative and end-of-life care. J Soc Work End Life Palliat Care. 2005;7:87120.,Medical Term,Family Members,Cooperation,Content of Family Meeting,Encourage family emotion and desire,Discuss the treatment & care plan,Determine the decision makers,Tell to family the patients last time,Rhondali W, Dev R, Barbaret C, et al. Family Conferences in Palliative Care: A Survey of Health Care Providers in FranceJ .J Pain Symptom Manage,2014,48(6):1117-1124,Yennura J S, Dev R, Lockey M, et al. Characteristics of Family Conferences in a Palliative Care Unit at a Comprehensive Cancer Center J .J Palliat Med, 2008,11(9):1208-1211.,Preparation Family Meeting,Family meeting,Nurse Physician Psychological consultant Social work/volunteers Family members Religious group(if need),Information,Chen, Zhao Shi,Zhu. A family meeting communicate the treatment for ICU terminate dying s satisfaction analysis J Chinese hospital management.2011,31（3）:53-55.,Meeting skills,Using scientific communication skills such as the SPIKES and ABCDE Models and timely transfer the “bad news“ to family members.,McFarlane J, Riggins J, Smith T J. SPIKES: A Six-Step Protocol for Delivering