如何成为一名优秀的骨科医生

目前,由于医疗模式的转变,除了对患者本身疾病的治疗外,患者的满意程度和生命质量也成为衡量治愈率高低的一个标准.因此,加强医护人员培养教育,提升医疗服务质量任重而道远.这篇文章探讨了成为一名优秀的临床医护人员所应具备的品质和能力特征.     

论医德教育的现实困境与心理养成

近些年来,对医护人员的负面报道时常见诸报端,医德问题开始成为公众注意的焦点,许多医源性伤害事件的发生,不断使社会对医护人员这一职业群体产生怀疑,导致公众对医护人员职业信任度的降低,这已经在一定程度上损害了医护人员群体的形象,间接影响到了医护人员在患者心目中的地位,进而影响到医疗护理的质量。     

论医德教育的现实困境与心理养成

近些年来,对医护人员的负面报道时常见诸报端,医德问题开始成为公众注意的焦点.许多医源性伤害事件的发生,不断使社会对医护人员这一职业群体产生怀疑,导致公众对医护人员职业信任度的降低,这已经在一定程度上损害了医护人员群体的形象,间接影响到了医护人员在患者心目中的地位,进而影响到医疗护理的质量.     

门诊老年患者医疗服务中存在的问题及其改进

文章从门诊老年患者就医需求的角度对医疗服务进行思考,认为医护人员在服务理念、有效沟通以及主动服务等方面存在的问题亟需改进。提出医护人员应当确立以老年患者需求为中心的门诊医疗服务理念,做到主动关心、及时询问、有效沟通、合理安排,从而提高老年患者就诊的满意度。     

门诊老年患者医疗服务中存在的问题及其改进

文章从门诊老年患者就医需求的角度对医疗服务进行思考,认为医护人员在服务理念、有效沟通以及主动服务等方面存在的问题亟需改进.提出医护人员应当确立以老年患者需求为中心的门诊医疗服务理念,做到主动关心、及时询问、有效沟通、合理安排,从而提高老年患者就诊的满意度.     

医患预期效价差:一项理论的分析框架

医患预期效价差受患者感知水平、医疗资源供需矛盾、医护人员执业行为、医疗执业标准和规范、信息不对称、法律责任等众多因素的影响。医患预期效价差的扩大会带来医患关系的紧张,严重影响正常医疗秩序,给社会稳定带来隐患。医患预期效价差的弥合需要全社会的共同努力。政府应加大对医疗卫生的投入,加强医疗卫生知识宣传,并不断完善医疗责任认定。医疗机构应建立健全规章制度和医疗质量控制制度,不断提高医护人员执业水平和诊疗效果。患者需要增强对医学医患知识的学习,并采取合法的方式来维护权益。     

呼唤医疗保护制度法制化

医疗服务是一项专业性、技术性很强的工作,他的直接对象是身心患有各种疾病的人。特殊的职业,要求从事医疗卫生工作的人必须具有较高素质。随着《中华人民共和国执业医师法》的颁布实施,医生行医已纳入法制的轨道。“依法行医”是每个医生的神圣职责,医生的医疗行为在受到新闻媒体、公众舆论监督的同时,更受到法律的约束。不可否认,在舆论的关注和监督以及法律的约束下,对于医疗行业改善服务态度、提高医疗护理质量起到了一定的促进作用。但如果我们只注重保护患者的利益,而忽视了医疗单位及医护人员的合法权益,不仅会压制医护人员…     

医疗群体的外延思维

本文基于临床观察的具体情况 ,对医患关系的潜在含义进行以下浅析。1　现代医疗群体的特征1 .1　医疗群体的不对称性随着科学技术的发展 ,医学也不断发展 ,逐渐从哲学中分化出来成为独立的学科 ,医患关系的不平等更加明显 ,具体表现在 :其一 ,由于医学知识的普及教育十分薄弱 ,人们的医疗知识普遍匮乏 ,所以 ,具有特殊专业知识技能的医疗者 ,自然处在知情者的优势地位 ,而患者群体则处在不知情的劣势地位。这种专业知识的不对等 ,造成了患者对医护人员 ,一是盲目信任 ,二是缺乏理解。知识的不对等是医疗群体间的特色。其二 ,在医患关系中 ,…     

癌症患者对医疗风险的感知及对临床决策的影响

由于医学的复杂性和癌症疾病的不确定性,癌症的临床决策存在着一定的风险性。癌症患者对医疗风险的感知也因人而异,继而影响着临床决策。本研究应用癌症患者医疗风险感知问卷对唐山市4家三级综合医院内住院治疗的320名癌症患者进行调查,调查结果显示,癌症患者对于经济风险（67．5％）的感知和社会心理风险（40．3％）的感知均高于对身体功能风险的感知（21．6％）,患者的性别、家庭月收入和年龄影响患者对医疗风险的感知,患者对经济风险和社会风险的感知影响患者对临床决策的意愿。临床医护人员应注重评估癌症患者对医疗风险感知的特点,帮助患者制定适宜的临床决策。     

叙事医学模式下的临终关怀——以阿图·葛文德《最好的告别》为例

在临终阶段,帮助患者克服对死亡的恐惧,与患者建立心灵和情感上的沟通,帮助其提高生命质量,有尊严、有意义地度过生命最后的时光显得尤为重要。运用叙事医学理论,结合阿图·葛文德《最好的告别》一书中的案例,分别从医护人员、患者、患者家属三个视角,探讨叙事医学对临终关怀发展的指导意义。相较于传统医学模式,叙事医学模式下的临终关怀能够引导医护人员和患者正确对待衰老与死亡、促进医护人员叙事能力的提高、鼓励患者自我需求的叙事表达、关注家属面对亲人离世时的心理护理、改善家属在医疗决策中的辅助作用。叙事医学对临终关怀的发展具有指导意义,有望进一步推进临终关怀的应用进程。     

Tensions of Accountability: Scientists,Technicians and the Ethical Life of Data Production in Astronomy

ABSTRACT

Laboratory ethnographies have emphasized the importance of trust and accountability among scientists and technicians when working in co-presence. But what happens to their relations when data production is outsourced, widely separating scientists and technicians? In contemporary astronomy, observing has largely become a service that observatory staff members do for researchers. This has increased the efficiency of telescope use while also resulting in arrangements prone to some researchers’ dissatisfaction and a raised visibility of technicians’ work. Attending ethnographically to situated evaluations reveals that some data-using researchers and data-producing technicians typify each other as moral figures: staff observers come to be seen as objects of blame and scientists as excessively demanding users. Wherever data travel, the quality and quantity of data can serve as ethical affordances for assigning blame to staff technicians. By contrast, the moral figure of the excessively demanding data user does not travel beyond the observatory, and the social accountability of interactions that visiting astronomers experience in the observatory’s control room is confined to its situated enactment. As scientist–technician interactions have become discontinuous and fraught, moral figures and ethical accounts thus travel unevenly in the landscape of data production, and the importance of social interactions remains often unrecognized.     

当代体育运动心理学跨文化研究述

采用文献检索法,对12份重要的国际期刊上1988~2004期间的文章进行检索,最终从其中的8份期刊中检索到33篇体育运动心理学跨文化研究的文献,在此基础上尝试从研究的方法论及研究的内容两方面来述评当代体育运动心理学跨文化研究的发展情况。方法论方面的述评主要包括数据收集方法、“文化”代表物、被试等值性,以及概念等值性四个方面的内容;研究内容方面的述评主要包括运动成就动机、教练-运动员关系、生涯转折,以及心理品质/心理技能四个方面的内容。文章最后对未来的研究提出了“建立指导研究的理论构架”、“发展指导研究的方法论模型”、“注重研究的实践应用价值”三点建议,并提出三阶段理论构架和四阶段方法论模型,分别尝试作为指导未来研究的理论构架和方法论模型     

采用人性化护理管理降低护理差错的思考

随着社会的迅速发展及人们生活水平的不断提高,人们对医疗服务的需求增加,护理工作者所面对的压力增大,产生护理差错的概率增加。同时,护理工作者知识结构水平的改变,整体素质上升,对护理管理要求提高,人性化管理成为当今谈论的焦点,也成为减少护理差错、提高护理质量的重要手段。     

Staff and Resident Involvement in a Therapeutic Community: For Better or Worse?

Therapeutic communities are a commonly used context for counseling persons with drug problems or emotional problems and for other populations of clients. The group dynamics of therapeutic communities are very complex. When the staff members of a therapeutic community develop communication problems with one another or when these staff members become overly involved with residents, staff problems almost always have a negative impact on the program of the therapeutic community. This article describes how staff problems can negatively affect the program of a therapeutic community and also relates the kinds of problems encountered in a therapeutic community to the problems encountered in rehabilitation programs in other settings.     

Verführung in der Gegenübertragung

The author presents a counter-transferential dream of the director of a flat sharing community for mentally disabled persons. On the one side she realizes hereby a tension between the performances which have to be presented for external quality assurance and the “work which is not to be seen”, i.e. the coping with emotions and phantasies of the caring staff. On the other side she discovers, motivated by Freud, Morgenthaler and most of all by Elisabeth Lenk, in this dream a mimetic (ecstatic, sexual) dimension which may become a threat for the coherence of the subject. An attempt at interpretation leads to the extremes of exhibitionism and voyeurism as they are activated in the care work. Institutions produce their own counter-transferences steeped in the phantasms prevailing in these institutions (here: mental disability). In the counter-transference dream analyzed here the author discovers elements of the primal scene and examines the relevance of the associated phantasies in the constitution of the subject of the caring staff, of the cared-for persons and of the author herself.     

Pastoral consultation through a community Mental Health Center

Conclusion Pastoral consultation through a mental health center in Kansas has been a beneficial experience for participating clergymen and the mental health center staff. This consultation has provided interested clergymen an opportunity to learn effective ways of serving parishioners through the church. The clergymen and mental health center staff have also begun to realize the mental health implications of religious resources, as well as ways in which ministers and the mental health center staff can effectively work together in serving troubled individuals within the local community. Pastoral consultation may become a means through which other community mental health centers and local clergymen can form meaningful professional relationships. The continuance of a pastoral consultation program over a longer period of time is needed to determine its possibilities and liabilities for assistingA report of one aspect of a special study project on Community Clergy and Mental Health, made possible by a grant from W. Clement Stone to the Menninger Foundation.     

Developing a Framework for Assessing Responsible Conduct of Research Education Programs

Education in the responsible conduct of research (RCR) in the United States has evolved over the past decade from targeting trainees to including educational efforts aimed at faculty and staff. In addition RCR education has become more focused as federal agencies have moved to recommend specific content and to mandate education in certain areas. RCR education has therefore become a research-compliance issue necessitating the development of policies and the commitment of resources to develop or expand systems for educating faculty and staff and for assuring compliance. These changes implied the need to develop a program evaluation model that could be applied to institutional RCR education programs, which were expected to differ from traditional academic credit-bearing courses targeting trainees. Information gleaned from the examination of corporate compliance models was analyzed in order to create a program evaluation module that could be used to document and assess educational programs focused on teaching RCR. A programmed series of questions for each of the nine RCR content areas identified by the United States Office of Research Integrity was created based on a performance-monitoring evaluation model. The questions focus on educational goals, resources provided to support the educational efforts, educational content, content delivery, educational outcomes, compliance requirements and feedback. Answers collected in response to the questions could be used to both document and continually improve the quality of RCR educational programs through on-going formative assessment and feedback.     

Reducing obstacles to the provision of quality diabetic care

Abstract

High quality diabetic care is seen as influenced by the organisation of care, health care workers' involvement in diabetes-specific areas, co-operation among staff members, the availability of resources, and the competence of medical staff (including both physicians and nurses). In a prospective study we have tested a programme for improvements of the quality of diabetes services which combined organisational development and continuing medical education (CME) measures. The study involved 34 primary health care centres over an 18 month period and was based on the responses to questionnaires answered by 123 general practitioners and 247 registered nurses at the 34 PHCCs.

The combined programme had a considerable influence on inter-group co-operation, staff members' perceptions of resources available, and nurses' involvement in diabetic care (54 versus 30% seeing diabetic patients for regular check-ups).

The results show that, in order to diminish obstacles to high quality care, organisation of care as well as care workers' theoretical knowledge has to be focused.     

Health-related Quality of Life, Marital Satisfaction, and Social Support in Medical Staff in Iran

Quality of life is a subjective and multidimensional concept that includes all aspects of an individual’s life. Many investigations indicate that marital satisfaction is an important determinant of quality of life and social support affects both marital satisfaction and quality of life. Since medical staff face job stressors in their everyday life, in the present cross-sectional study, the relationships between quality of life, marital satisfaction, and social support in medical staff in Tehran were analyzed. Data collection was performed in 653 medical staff using socio-demographic questions, the SF-36 questionnaire, the ENRICH Marital Satisfaction Inventory, and the Social Support Questionnaire. The results revealed that men reported significantly higher quality of life and marital satisfaction than women, but there was no gender difference in social support. The quality of life and marital satisfaction domains were found to be differentially correlated among male and female participants. All domains of marital satisfaction were found to be significantly associated with the “vitality” and “mental health” domains among females and “physical functioning” domain in the male. Also, social support was associated with almost all quality of life domains in both sexes. The multiple regression analyses indicated that all the study variables combined with socio-demographic factors can explain between 12 % and 28 % of the variance in quality of life domains. Therefore, focusing on these factors could be an effective approach to improve quality of life in medical staff as a group with a stressful job.