美国院前急救医患沟通＂十条金律＂解析

医患沟通的能力和技巧是院前急救人员必备的重要素养之一,与院前急救服务的效率和质量密切相关.在美国急救医疗服务体系中,普遍遵循医患沟通＂十条金律＂,包括：（1）保持职业化状态;（2）始终保持与患者目光接触;（3）给予患者恰当的称呼;（4）使用患者听得懂的语言;（5）保持恰当的语速、语调和语气;（6）与他人谈论患者病情务必谨慎;（7）当心自身的肢体语言;（8）给患者留下回答问题或反应的时间;（9）告诉患者病情真相;（10）注重与特殊群体的沟通.本文简要解析了＂十条金律＂的内涵与意义,对我国院前急救人员或有借鉴意义.     

Modelling elderly patients’ perception of the community pharmacist image when providing professional services*

Professional pharmaceutical services may impact on patient’s health behaviour as well as influence on patients’ perceptions of the pharmacist image. The Health Belief Model predicts health-related behaviours using patients’ beliefs. However, health beliefs (HBs) could transcend beyond predicting health behaviour and may have an impact on the patients’ perceptions of the pharmacist image. This study objective was to develop and test a model that relates patients’ HBs to patient’s perception of the image of the pharmacist, and to assess if the provision of pharmacy services (Intervention group-IG) influences this perception compared to usual care (Control group). A qualitative study was undertaken and a questionnaire was created for the development of the model. The content, dimensions, validity and reliability of the questionnaire were pre-tested qualitatively and in a pilot mail survey. The reliability and validity of the proposed model were tested using Confirmatory Factor Analysis (CFA). Structural Equation Modelling (SEM) was used to explain relationships between dimensions of the final model and to analyse differences between groups. As a result, a final model was developed. CFA concluded that the model was valid and reliable (Goodness of Fit indices: x²(80) = 125.726, p = .001, RMSEA = .04, SRMR = .04, GFI = .997, NFI = .93, CFI = .974). SEM indicated that ‘Perceived benefits’ were significantly associated with ‘Perceived Pharmacist Image’ in the whole sample. Differences were found in the IG with also ‘Self-efficacy’ significantly influencing ‘Perceived pharmacist image’. A model of patients’ HBs related to their image of the pharmacist was developed and tested. When pharmacists deliver professional services, these services modify some patients’ HBs that in turn influence public perception of the pharmacist.     

Relationship between religious beliefs and post-traumatic growth in patients with cancer in southeast of Iran

Information about religious beliefs and post-traumatic growth is limited in Iranian cancer patients. This study was conducted to determine the relationship between religious beliefs and post-traumatic growth among cancer patients in Iran. This correlational study included a convenience sample of 200 eligible cancer patients who were hospitalized in the oncology wards and outpatient clinics. Using Post-traumatic Growth Inventory (PTGI) and Religious Beliefs Scale, data were collected. Findings showed that, the total mean score of PTG was 93.81 (SD?=?15.25). Among the categories, the lowest score belonged to “appreciation of life” component (7.67±1.99), and the highest score belonged to “spiritual change” component (67.49 ± 17.78). The mean score of Religious Beliefs Scale was 67.20 (12.35). Post-traumatic growth positively correlated with religious beliefs (r?=?.345; p?=?.001). The results suggest that, information about religious beliefs and post-traumatic growth should be included in the continuous and in-service education of cancer patients and nurses who work with them.     

TRANSFERENCE BEFORE TRANSFERENCE

This paper is predominantly a clinical presentation that describes the transmigration of one patient's transference to another, with the analyst functioning as a sort of transponder. It involves an apparently accidental episode in which there was an unconscious intersection between two patients. The author's aim is to show how transference from one case may affect transference in another, a phenomenon the author calls transference before transference. The author believes that this idea may serve as a tool for understanding the unconscious work that takes place in the clinical situation. In a clinical example, the analyst finds himself caught up in an enactment involving two patients in which he becomes the medium of what happens in session.     

Exploring definitions of bullying among personality disordered patients in a maximum‐secure hospital

The current study explored the perceptions of staff and patients concerning how patient‐to‐patient bullying should be defined and what behaviours it should include. Participants were randomly selected from the Personality Disorder Unit of a maximum secure hospital. A total of sixty interviews were conducted (30 staff and 30 patients). Problems in attempting to utilise definitions of bullying developed for use in other contexts, i.e., schools, were identified. Patients and staff presented with similar views about how it should be defined: both felt that aggression did not have to be repeated or severe in order to be classed as bullying, that bullying could be accidental, that the power imbalance between perpetrator and victim was not always explicit and, finally, that victims could provoke bullies unintentionally. Indirect (i.e. covert) forms of aggression were less likely to be considered bullying than direct (i.e. overt) forms. A number of differences were found between staff and patients regarding how bullying was conceptualised. Staff were more likely than patients to hold the belief that some patients liked being bullied, and appeared to acknowledge a broader definition of bullying than patients, accounting for a wider range of aggressive behaviours. A number of similarities between the current study and previous prison‐based research were found. The implications of these findings for current research and the value in attending to prison‐based research are highlighted. Aggr. Behav. 00:000–000, 2005. © 2005 Wiley‐Liss, Inc.     

医患冲突与诚信的缺失

在新的历史条件下,医患冲突表现出更为复杂的特点,从深层次研究医患冲突的原因,诚信的缺失往往被人们所忽视.多数医疗纠纷源于医患双方缺乏诚信,以自我为中心,过分强调经济利益,缺少人文关怀.必须加强诚信道德教育,建立健全信用法律制度,使诚实守信成为人人自我约束、自觉遵守的行为规范.     

目前形势下临床教学问题的探讨与改革

当前医疗大环境的改变,社会评价的影响及病人的维权、自我保护意识等使临床教学工作发生了很大变化.需要我们采取相应的变革,注重病历的书写,基本功的培训,语言能力的指导和改变查房的方式,以完成培养新一代合格医生的任务.     

当代中国医患关系的合理重构--论我国社会转型期医患利益的调节与平衡

我国社会转型,为当代中国医患关系的合理重构提供了平台,但社会转型期中出现的诸多医患利益冲突也向人们提出了严峻的挑战,亟需对其加以调节和平衡.这种调节与平衡,不能完全甚至不能主要地交由市场这双"看不见的手"去运作,不能完全任凭甚至不能主要地任凭医患双方自由地去博弈;政府必须明确并履行自己的职责,为正确调节与平衡我国社会转型期的医患利益创立一个全方位的合理的框架,使医患之间在有控制的理性的双赢的利益博弈中合理地重构当代中国医患关系的基本格局.     

反思医院泄露病人隐私现象

医院泄露病人隐私现象,是阻碍医患关系的和谐发展的绊脚石,是一种医疗领域人文缺失的表现.作为医院要设身处地的多为患者考虑,把尊重病人隐私当成一种常态,作为病人、家属及探视者,要自觉形成保护他人隐私的公德意识.     

终末期癌症病人诊治中的心理特征与人文关怀

在诊治终末期癌症病人过程中不仅要关心他们的躯体方面,更要关心他们的心理方面,在诊治过程中要根据他们的独特的心理特征来进行人文心理关怀,维持生命质量和保证他们应有的人格尊严.