The application of a domains‐based analysis to family processes: implications for assessment and therapy

Social domains are classes of interpersonal processes each with distinct procedural rules underpinning mutual understanding, emotion regulation and action. We describe the features of three domains of family life – safety, attachment and discipline/expectation – and contrast them with exploratory processes in terms of the emotions expressed, the role of certainty versus uncertainty, and the degree of hierarchy in an interaction. We argue that everything that people say and do in family life carries information about the type of interaction they are engaged in – that is, the domain. However, sometimes what they say or how they behave does not make the domain clear, or participants in the social interactions are not in the same domain (there is a domain mismatch). This may result in misunderstandings, irresolvable arguments or distress. We describe how it is possible to identify domains and judge whether they are clear and unclear, and matched and mismatched, in observed family interactions and in accounts of family processes. This then provides a focus for treatment and helps to define criteria for evaluating outcomes.     

Family crisis intervention in war contexts: a case study of a traumatised Palestinian family

The aim of this study was to analyse the phases of an innovative in vivo exposure intervention in which all family members were present at the scene of a traumatic incident. Clinical practice has borne out the efficacy of family intervention and its benefits for traumatised individuals and family groups. The intervention discussed here was conducted with a Palestinian family that had suffered trauma in a missile attack during the Israeli–Lebanese war of summer 2006. Narrative and meaning-reconstruction methods were combined with cognitive-behavioural techniques. The study highlights the limitations of the intervention as well as suggesting future directions for integrated models of crisis intervention; development of an evidence-based model is recommended.     

角色压力、工作家庭冲突和心理抑郁的中美比较--社会支持的调节作用

在中国和北美两个样本中,探讨了工作家庭冲突模型的共性和差异。首先使用多组验证性因子分析找到适用于中美样本的模型,然后采用结构方程模型和多层次回归进行假设检验。结果显示,中美员工感知到的工作-家庭(家庭-工作)冲突在工作(家庭)角色压力和心理抑郁的关系中都起中介作用。此外,情境的差异导致中美员工在工作支持和家庭支持的调节作用上有不同的表现,即中国员工感受到的工作(家庭)支持对角色压力和冲突间关系的调节作用不显著,在北美样本中,工作支持负向调节工作角色压力到工作-家庭冲突的关系,而工作支持和家庭支持正向调节家庭角色压力到家庭-工作冲突的关系。本文的发现能够帮助管理者意识到情境因素的重要作用,从而制定更为有效的管理决策。     

关于患者家属在复苏现场的思考

医疗水平不断地发展和进步使越来越多的疾病可以在医院得到救治。但有研究显示,在医院接受心肺复苏（CPR）的患者中,只有很小的部分能被救治成功。由于CPR的成功率低,在CPR时是否允许有患者的家人陪伴在其身边逐渐成了医患双方共同关注的问题。家人的陪伴,或许能让患者抢救或死亡的过程变得更人性化,同时成为增加医患双方相互理解的渠道。但是这个过程的实施仍然面临许多问题,要让其成为常规制度,还有很长的路要走。     

前景理论在重症医学临床决策中的应用

临床决策是每一个医生每天面临的工作,正确的临床决策不仅可以带给患者较好的结果,同时也可以让医生与患者及家属沟通更加良好。本文首先论述了重症医学的临床决策特点,每一个救治方案的收益与损失的权衡不仅仅是取决于患者病情,而且与决策者的风险偏好有明显关系。为了更好地解决这个问题,把诺贝尔奖获奖者丹尼尔的前景理论引入到重症患者的...     

晚期癌症患者家属的病情告知态度探究

本文采用自行设计的调查问卷,对200例晚期癌症患者家属进行问卷调查,以探讨晚期癌症患者家属对病情告知的态度。结果显示,认为病情应绝对保密者55例（27．5％）;暂时保密者107例（53．5%）;而不保密者38例（19．0％）。晚期癌症患者家属普遍采取“慈悲原则”,对患者病情持保密态度;癌症患者家属普遍缺乏病情告知策略。临床医生在执行知情同意时应该依据患者不同的家庭情况,有针对性地进行告知。     

也谈慢性心衰中西医结合治疗的临床策略

着眼于目前中西医结合治疗慢性心力衰竭（CHF）的困惑所在,提出了几点临床策略：（1）抓预防,做好慢性心衰一级预防;（2）开展大规模流调,规范证候辨识标准;（3）挖掘和整理地区验方;（4）发挥行业协会作用,探索多方力量参与验方筛选与评价;并提出充分发挥中西医结合的诊疗特色,重点优化CHF的中西医结合诊疗方案和评价方法符合我国基本国情.     

从《夷坚志》看宋代旴江医家为医处世之道

吁江,古称吁水,流经江西16个县市.其流域自古人文荟萃,不仅有名闻天下的文人学士,更不乏学验俱丰的医药学家.南宋洪迈所著笔记小说集《夷坚志》中记载了王、李两位吁江医家的小故事.从这则诊疗故事可以窥见古代吁江医家的生存状态,认为古代吁江医家不仅有着高超的治疗技术,更秉承传统医学一贯的医德思想,对病人细心体贴、对同行互敬互帮.更为难得的是,在金钱利益面前能做到重义轻利,表现出了谦虚谨慎的为医态度与谦和有礼的处世智慧.