"以病人为中心"医疗服务模式的理念与发展

纵观20世纪医疗服务的发展历程,医疗服务的发展经历了“以疾病为中心”的传统医疗服务模式到“以病人为中心”的新的医疗服务模式的转变;目前,以“以病人为中心”的医疗服务模式已经成为我国现代医院改革与发展的主题。因此,在阐述医疗服务模式变革与发展的基础上,系统论述了“以病人为中心”的医疗服务模式的内涵与特点,新的理念、新的认识,也带来了新的希望,新的医疗服务模式将不断地改善与提高人们的健康状况与生活质量。     

Caring,Social Policy,and Homelessness

Care theory offers a way to overcome a weaknessof liberalism – its reluctance to intervene inthe private lives of adults. In caring for thehomeless, we must sometimes use a limited formof coercion, but our intervention is alwaysinteractive, and the process of finding asolution is one of negotiation between theneeds expressed by the homeless and the needswe infer for them.     

Health Focused Psychotherapy In Treating a Dual Diagnosed Patient

Health-focused psychotherapy offers a contemporary model used in assessment, treatment planning and evaluation in addressing patients with both medical and psychiatric diagnoses. Clinicians in the health and mental health disciplines must know and understand the importance of standards of care and models of intervention and evaluation in clinical practice for this type of patient. Examined is the use of a specific model providing a tailored orientation to patient education, along with the development and use of a clinical algorithm and care pathway for clinical practice. Provided is a case study for applying the development and use of a clinical algorithm and care pathway for a dual diagnosed patient receiving health-focused psychotherapy.     

Concordant Spiritual Orientations as a Factor in Physician--Patient Spiritual Discussions: A Qualitative Study

Objectives: To understand the impact of physicians and patients religious/spiritual orientation on discussions of spiritual issues. Methods: We performed semi-structured interviews of 10 Missouri family physicians and 10 patients of these physicians, selecting subjects nonrandomly to represent a range of demographic factors, practice types, and chronic or terminal illness. We coded and evaluated transcribed interviews for themes. Results: Respondents expressed that similar belief systems facilitate patient–physician spiritual interactions and bring confidence to their relationships. Those holding dissimilar faiths noted limited ability to address spiritual questions directly. They cited significant barriers to spiritual interaction but considered that ecumenism, use of patient-centered care, and negotiation skills lessen these barriers. Conclusions: Our respondents view spirituality similarly to other aspects of the physician–patient relationship involving differing viewpoints. Where discordance exists, cross-cultural, patient-centered, diplomatic approaches facilitate spiritual discussions.     

Stewardship Models of Pastoral Care,Counselling and Supervision: The Commonians Meet Ricoeur at Worship

The common factors debate in psychology and, more recently, marriage and family therapy is slow to erupt in pastoral care and counselling. This article introduces the common factors debate into pastoral science by proposing the Stewardship Models of Pastoral Ministry and Supervision. The model integrates common factors research and pastoral practice using Ricoeur’s “economy of the gift” ethic. The model’s focus is pastoral care, counselling and supervision in congregations, a unique community context in search of an adequate pastoral praxis.     

Care of the Self and Patient Participation in Genetic Discourse: A Foucauldian Reading of the Surgeon General's “My Family Health Portrait” Program

Critics of genetic discourse are concerned that deterministic and discriminatory views of genetics are increasingly becoming adopted. These views argue that current genetic discourse becomes a source of power whereby powerful institutions harm people with so-called “bad” genes. This essay argues that current analyses of the power of genetics discourse are grounded in an improper reading that disempowers patients. Deploying Michel Foucault's concept “care of the self,” this essay claims that genetics discourse is better understood as a way that patients take on power through rhetoric rather than a force that has power over patients. Through a close reading of the “My Family Health Portrait” program, this paper argues that patients experience a process of “subjection” wherein they become agents of and objects of genetics discourse both. This alternative mode of analyzing the power of genetics discourse has implications for our collective understanding of the operations of the care of the self and the uses of genetic information that we propose.     

The Double Life of Double Effect

The U.S. Supreme Court's majorityopinion in Vacco v. Quill assumes thatthe principle of double effect explains thepermissibility of hastening death in thecontext of ordinary palliative care and inextraordinary cases in which painkilling drugshave failed to relieve especially intractablesuffering and terminal sedation has beenadopted as a last resort. The traditionaldoctrine of double effect, understood asproviding a prohibition on instrumental harmingas opposed to incidental harming or harming asa side effect, must be distinguished from otherways in which the claim that a result is notintended might be offered as part of ajustification for it. Although double effectmight appropriately be invoked as a constrainton ordinary palliative care, it is not clearthat it can be coherently extended to justifysuch practices as terminal sedation. A betterapproach would reconsider double effect'straditional prohibition on hastening death as ameans to relieve suffering in the context ofacute palliative care.     

Predicting who benefits from psychoeducation and self help for panic attacks

Self-help and psychoeducation have been identified as effective methods for delivering treatment, yet not everyone benefits from these brief interventions. Therefore it is clinically and economically useful to identify who is likely to require more intensive assistance. This paper develops a prognostic scale which predicts who will recover from panic attacks and who will require more assistance. Method: Random regression models were used to evaluate the relationship between predictive variables, baseline severity, and the rate of improvement in 117 people with DSMIV panic attacks who participated in a trial of a psycho-educational booklet, a self-help workbook, and brief group CBT over a 9-month period. ROC analysis was used to choose cut-off points on a scale made up of significant predictors. Results: Panic disorder and agoraphobia symptom measures were predicted by baseline social anxiety, and general mental health. There was no significant effect on the outcome for baseline depression or anxiety sensitivity. While general mental health (SF12 Mental Component scores) was predicted by the age at first panic attack, neuroticism, panic disorder and/or agoraphobia symptoms and a positive screen for alcohol use disorders. A prognostic scale based on simple additive scoring was equivalent to standard scores and significantly better than chance at predicting who would recover and who required face-to-face therapy. Conclusions: The prognostic scale may be used to guide the choice of psychoeducation, self-help or face-to-face therapy as the first step in stepped care.     

Brief training to promote the use of less intrusive prompts by nursing assistants in a dementia care unit

We evaluated the efficacy of a brief staff-training procedure to increase the use of graduated prompting by 2 certified nursing assistants (CNAs) while they helped to dress 3 persons with dementia in a seven-bed dementia care unit. The multiple baseline design across participants showed that CNAs dressed residents with minimal resident involvement during baseline observations. Following brief in-service training, CNAs provided graduated prompts and praise appropriately, suggesting that CNAs can promote active involvement in personal care routines by older adults with dementia.