BEHAVIORAL ASSESSMENT FOR PEDIATRIC INTENSIVE CARE UNITS1

Two studies were conducted to analyze behaviors of staff and patients on a Pediatric Intensive Care Unit (PICU). In the first study, behavioral observation procedures were employed to assess patient state, physical position, affect, verbal behaviors, visual attention and activity engagement, and staff verbal behavior. On the average, one-third of the patients were judged to be conscious and alert but markedly nonengaged with their environment. In the second study, a member of the hospital staff provided alert patients with individual activities to determine whether a simple environmental manipulation could positively affect behavior of children in intensive care. Employing a reversal design, the activity intervention was found to increase attention and engagement and positive affect, and to decrease inappropriate behavior. Both studies demonstrate that behavioral assessment procedures can provide an empirical basis for designing PICU routines affecting children's psychosocial status, and, thus, complement current procedures designed to provide quality medical care.     

INCREASING EXTENDED CARE FACILITY RESIDENTS' ATTENDANCE AT RECREATIONAL ACTIVITIES WITH CONVENIENT LOCATIONS AND PERSONAL INVITATIONS1

Residents of extended care facilities generally exhibit a low level of attendance at recreational and therapeutic activities. Spatial arrangement of rooms, prompting, snacks, and small prizes have been suggested as factors that affect attendance. The present study examined the effects of an extensive system of prompts and the location of activity areas on the attendance of residents at a variety of activities. Twenty-six subjects were randomly selected from the ambulatory population of the facility. The first time each subject entered the activity room during the first 6 min of an activity session their name was recorded. Reliability measures were taken at 10 sessions, with a 95% mean agreement between observers. The variables examined were the amount of individualization of subjects (experimental group I: names announced versus experimental group 2: names not announced), room location (central or peripheral), use of names in announcements (activity only versus activity and group I names), and mode of announcement (PA system only versus PA system and in-person). A counter-balanced group design with repeated measures was used, with a randomly determined order of application of experimental treatments. An analysis of variance split plot 2.222 (Kirk, R. E. Experimental Design: Procedures for the Behavioral Science. Belmont, Ca.: Brooks-Cole, 1968.) of the level of subject attendance yielded significant main effects for room location, F(1, 24) = 5.47, p < 0.05, and type of announcement, F(1, 24) = 9.10, p < 0.01, and significant interactions for Individualization × Use of Names in Announcements, F(1, 24) = 5.57, p < 0.05, and Room Location × Mode of Announcement, F(1, 24) = 7.90, p < 0.01. The results indicate that using a centrally located room and announcement of resident names increases attendance at a variety of activities. The increased social and environmental interaction generated by activity attendance has potential therapeutic benefits for the residents involved. Furthermore, the kind of information reported here and by others should be taken into consideration by planners of a variety of group living facilities, ranging from nursing homes to residential treatment cottages.     

关于实验动物运动模型建立的伦理思考

基于目前广泛应用的动物实验伦理3R和5F原则,通过深入分析已有运动干预文献中的动物运动模型构建方法,分别就运动模型建立前实验动物的选取,运动模式、运动剂量的确定,模型建立过程中不同阶段不同运动形式所涉及的伦理问题,以及实验动物安乐死等各个方面进行伦理分析,探讨伦理关怀在动物运动模型建立中的必要性和重要性。运动模型的构建作为研究运动干预的关键环节是极其重要的,此建立过程中涉及到诸多动物实验伦理问题。

     

医务社会工作对医护联盟信任关系提升的支持研究

选取江苏省某医院的癌症幸存者、严重心脑血管疾病患者（术后）作为研究对象,采用医疗保健联盟问卷、医学面对方式、创伤后成长量表进行统计学分析,共发放问卷165份。结果显示,医护联盟在性别和年龄两个方面差异具有统计学意义（P＜0.05）。医护联盟与面对、创伤后成长呈显著正相关,屈服与医护联盟、面对呈显著负相关。且87.2%的重症患者对医护联盟的信任呈不满意状态。从医务社会工作的角度出发,探讨影响患者对于医护联盟的信任度的因素并提供建议。

     

国内外预立医疗照护计划社会经济效益的探讨

从卫生经济学视角,探讨预立医疗照护计划的社会经济效益。通过分析预立医疗照护计划的卫生经济政策、经济分析模式及社会经济效益评价研究等发现,预立医疗照护计划具有较明显的社会经济效益。借鉴国外经验和结合我国文化背景提出预立医疗照护计划在我国发展的对策和建议,包括建立相关政策突破发展障碍;构建激励制度,加强人才培养以支撑预立医疗照护计划发展;开展评价预立医疗照护计划经济效益的研究,以价值为导向构建本土化的医疗模式,以期为我国发展预立医疗照护计划的卫生经济学研究领域提供理论依据。

     

安宁疗护患者生活质量评估工具的研究进展

准确评估临终患者的生活质量能更好地实施和评价安宁疗护。国内外相关评估工具各有特点,国外相关研究较为成熟,已有较完善且应用广泛的评估工具;而我国此方面的研究起步较晚,相关工具数量少且应用局限。介绍了国内外安宁疗护患者生活质量评估工具的发展过程、适用对象、测量内容、信效度以及使用方法,并对各工具的基本情况和应用现状进行比较分析,以期为临床研究选用合适的评估工具、国内学者汉化及开发相关评估工具提供参考。

     

互动支持者在临终病人与家属关于临终问题互动中的作用——基于田野研究之情境分析

通过在某三级医院安宁疗护科为期5个月的田野研究,分析临终病人与家属的临终互动过程,阐明互动支持者在促进其临终互动过程中的作用。期间共收集21例研究对象的20份家庭会议录音、79张照片、21份个案笔记,梳理出7个临终互动情境。研究显示,互动支持者发挥的作用有互动促发激发互动意愿、互动支持增加互动勇气和互动保障促进互动进行。由此得出结论,互动支持者作为病人与家属的互动桥梁,通过互动促发、互动支持和互动保障,翻译其行为背后的情感与期待、转述情感的表达,促进有效陪伴和及时表达爱,使病人善终、家属善别。

     

ICU患者出院后重返工作岗位相关研究进展

通过查阅国内外文献,从综合ICU患者出院后重返工作岗位相关概念及现状、影响因素（包括人口统计学因素,社会心理学因素,院前、院内、院外相关因素）及干预措施（包括早期康复活动、ICU患者出院后随访、社会支持）四个方面进行综述,同时提出了促进ICU出院后患者重返工作岗位的建议及未来展望,旨在为学者开展ICU出院后患者重返工作岗位相关研究提供参考、为临床工作人员促进ICU患者康复提供护理干预建议,也为社会工作者提供就业指导。

     

免除伦理审查制度适法性与可操作性探讨

结合我国现行法律和基本伦理原则,深入分析了免除伦理审查的前置条件和适用情形在适法性与可操作性上可能存在的问题,并在此基础上提出了可行性的建议：第一,明确监管范围,免除伦理审查是一种特殊的审查方式,而非不进行伦理审查;第二,全面评估风险,对研究的风险判断不仅要考虑因研究给个人带来的生理风险,还应考虑其心理、经济、社会以及法律等方面的风险,尤其是对最小风险应明确界定;第三,界定前置条件中的具体概念,以及在此基础上适用情形的判断,制定具体、合理、合法的实施细则,为免除伦理审查的实施提供参考。

     

关怀伦理的介入：医患关系重构的新视角

梳理有关学者的关怀伦理理论观点,并基于关怀伦理的相关思想对疾病状态下患者的特性（脆弱性、自主性和依赖性）进行分析,在此基础上,讨论目前医疗机构中主流医患关系模式理论（包括律法关系、家长制关系和自主决策关系）的局限性与不足,并将这类主流医患关系说纳入到基于关怀的医患关系之中,以重构适用于当前医疗行为模式和医疗行业现状、体现己他两利关怀思想的医患关系模式,最后阐述了基于关怀的医患关系中的“关怀”实践路径,包括引导性双向叙事、同情与移情以及关怀美德。