04.临终关怀PPT演示课件

,临终关怀,1,Outlines,StagesoflifeGettingolderRisksofdyingExpectationsImprovingpalliativecareIssuesSafety,生命阶段老龄化死亡的危险迟早要发生的事姑息治疗的改进其他的事项安全,2,Outlines,PainAssessmentofpainforthecognitiveimpairedpatientsIncidentalPainSpiritualpainNauseaandvomitingDeliriumDyspneaEndoflifeexperience,疼痛认知障碍患者中疼痛评估诱发的疼痛精神痛苦恶心和呕吐谵妄呼吸困难临终时刻的感受,3,StagesofLife生命的阶段,4,By2026,1in5personswillbeover65years;到2026年在5人中就有一个是大于65岁的老人91%ofallindividualsover65diagnosedwithatleast1chroniccondition；65岁以上老人中有91%至少患有1种慢性病。Thedisabilityrateforpersonsaged65andolderis40.5%.-65岁以上老人中有残障的占40.5%Agingofthepopulationandadvancesinmedicaltechnologymeanmanyindividualswillbediagnosedandlivelongerwithoncefataldiseases.人口老龄化和越来越先进的医学技术使许多患上曾经被认为是不治之症的人能活得更长,GettingOlder年纪越来越大,5,LifetimeRiskforDEATH生命进程中死亡的危险,心脏病,恶性肿瘤,老年痴呆,糖尿病,帕金森病,死亡,男,女,年龄,6,Highlevelofskillandknowledgeinpainandsymptomcontrol控制疼痛等症状的丰富知识和良好技术Communicationwithpatientand/orfamily与病人和家属交流的能力Clear,honest,respectful整洁,诚恳,礼貌Proactive/preemptivewhenissuespredictable主动积极处理可预见问题AvailabilityandAccessibility易接近，肯帮忙Dignityconnectiontothe“who”involved;theperson,应有的基本素质,7,Howwecanachievethebestcarefortheendoflife我们怎样才能做到最好的临终关怀,8,Standardsofpracticeforsymptommanagement,availability,responsiveness,communication-症状处理，提供服务，服务应答，以及与服务对象交流的标准化。Specialtyareaandeducation-对某些姑息措施严格掌握，比如姑息性安眠。,Corecompetencies核心质量Curriculuminundergradandpost-gradinallinvolveddisciplines本科和研究生课程Continuingeducation毕业后教育,Corerequirementsforfacilityandprogramaccreditation专业和设施认证。Riskmanagement-beawarethatpoorpalliativecareisariskRe-framegoodpalliativecareasprevention/promotion好的姑息治疗注重预防,Raiseawarenessandexpectations-提高认知度Improve“deathculture”改进“死亡文化”。Empowerin加强决定权decision-making,ProfessionalPractice,PublicAwareness,ServiceAvailability,姑息治疗的改进,教育,职业管理,公众认知,服务提供,9,Pain疼痛Non-painsymptoms非疼痛症状Nausea恶心,dyspnea呼吸困难,fatigue乏力,constipation便秘Function功能ADLs（activitiesofdailyliving)-日常活动Psychiatricandpsychologicalsymptomsrecognize.开放，认可Empathize(putyourselfintheirposition)同情Suspendjudgement.Realizeyoudonthavetoagree,believe,understand.justBE不评价，不表态Supportforall(patients,families,co-workers)支持所有人（病人，家属，同事）Normalizetheexperience让这种经验正常化。,26,Deathisuniversalbutdyingisculturallyspecific.Thatis,weallwilldiebutwewillallapproachthisfinalstageoflifethroughourinterpretationofcriticalcomponentsofourculturalbackground死亡是必然的，但死亡也有其文化特性。我们都会死，但我们对生命最后阶段的理解却取决于我们特定的文化背景。,(Fisher,Ross&MacLean,1993),TheENDorbeginningofanewexperience?!?最终还是一个全新的体验开始?!?,27,References参考文献,AgencyforHealthcareResearchandQuality.(2001,May).Clinicalpracticeguidelinesarchives.RetrievedApril2011,18,from/clinic/cpgarchv.htmAmericanPainSociety.(2010).Treatmentofpainattheendoflife.RetrievedApril18,2011,from/advocacy/treatment.htmBrayne,S.,Farnham,C.,&Fenwick,P.(2006).Deathbedphenomenaandtheireffectonapalliativecareteam:Apilotstudy.AmericanJournalofHospice&PalliativeMedicine,23(1),17-24.Brayne,S.,&Fenwick,P.(2008).Thecasefortrainingtodealwithend-of-lifeexperiences.EuropeanJournalofPalliativeCare,15(3),118-120.Brayne,S.,&Fenwick,P.(2008).End-of-lifeexperiences:Aguideforcareersofthedying.Availableat:inaGloucestershirenursinghomeasreportedbynursesandcareassistants.AmericanJournalofHospice&PalliativeMedicine,25(3),195-206.Brickner,L.S.(2005,July29).BarrierstoHospiceCareandReferrals:SurveyofPhysiciansKnowledge,Attitudes,andPerceptionsinaHealthMaintenanceOrganization.RetrievedApril2011,fromJournalofPalliativeMedicine:,28,References,Chittenden,E.A.(2010,October).Hospiceandpalliativecareassessment.RetrievedApril18,2011,fromAmericanAcademyofHospiceandPalliativeMedicine:/uploads/files/toolkit/pfc3-c.docDosa,D.(2007).AdayinthelifeofOscarthecat.NewEnglandJournalofMedicine,357(4),328-329.Ferrel,B.(2010,November11).PainManagementattheendoflife.RetrievedApril,18,2011,fromMedscapeNurses:,29,References,NationalCaregiversLibrary.(2010,May).Hospicevs.palliativecare.RetrievedApril18,2011,from/Default.aspx?tabid=375NationalHospiceandPalliativeCareOrganization.(n.d.).Caringconnections.RetrievedApril23,2011,from/i4a/pages/index.cfm?pageid=3328NationalComprehensiveCancerNetworkNCCN.(2009).Practiceguidelines:Oncologyadultcancerpain.RetrievedApril18,2011,from/professionals/physician_gls/f_guidelines.aspOConnor,D.(20