论以专业照护为依托的多维安宁疗护模式

通过对安宁疗护中患者和家属的双向关怀相关概念及其需求现状进行概述,分析在传统文化影响下我国安宁疗护服务领域中医护人员专业照护的关键主导地位以及家庭照护中患者-家属双向关怀的重要补充作用,强调两者协同提高患者和家属生命质量对于实现安宁疗护“优逝”目标的重要意义,并结合国内外研究和临床实践现状,以家庭系统理论为指导,构建一种以医护专业照护为依托,将患者-家属双向关怀嵌入其中的多维协同创新安宁疗护模式,以期为实现“优逝”目标提供帮助,并为提升我国安宁疗护服务质量提供参考借鉴。

     

生前预嘱制度的伦理困境与化解路径

随着医疗技术在医疗领域的迅速发展,个人对医疗措施具备了更宽泛的选择权。然而,我国对生前预嘱制度的引入存在较大的伦理争议,主要表现为基于目标冲突、责任冲突和角色冲突导致的伦理困境。通过解析救死扶伤的时代理解、父权主义的时代抛弃、自然死亡的时代定位与生前预嘱的时代需求,提出我国应对救死扶伤进行重新定义、确立个人中心主义、正确对待自然死亡、推进生前预嘱制度入法的应对策略,以从根本上破解生前预嘱制度的伦理困境,促进生前预嘱制度在我国的落地实施。

     

围生期叙事照护与生育关怀叙事生态研究

围生期死亡并未引起医护人员和社会的重视与关注,往往导致失胎或失婴家庭成员陷入严重的创伤叙事闭锁。以生命健康叙事理念为框架,从创伤叙事闭锁之后的两种不同哀伤应对方式,即工具性舒缓和叙事性调节作为出发点,阐述由围生期胎儿死亡造成的哀伤剥夺给失胎和失婴家庭成员带来的巨大痛苦,进而倡导全社会积极创设关于失胎和失婴主题的良好叙事生态,旨在通过妇产科医护人员的叙事照护,引导“天使父母”分享自己的故事,再现痛苦历程,并藉由叙事赋能,得到关注、找到归属、重构身份,走出创伤叙事闭锁,开始全新的生命旅程。

     

儿童死亡教育绘本的内在逻辑探讨

围绕儿童死亡教育绘本的本然之性,即求真之认识生死规律、至善之明晰生命意义、尽美之珍爱生命健康,发现我国儿童死亡教育绘本受民族、文化、社会的诸多因素影响,其实然之境堪忧,包括“生”与“死”比例失衡、“质”与“量”难以保证、“支持系统”松散无序。针对存在的问题,提出可以采取同等看待生死价值、优质优量本土化开发与运用、构建家校社教育链条的应然之策,以推进儿童死亡教育绘本的可持续发展,最终帮助儿童悦享幸福人生。

     

走向死亡话语素养

基于对医疗领域“死亡素养”和社会语言学“新素养研究”的文献梳理,提出“死亡话语素养”概念,并阐释其内涵。死亡话语素养即人们使用各种话语形式谈论死亡（和濒死）相关议题,参与社会实践,探索和积极建构生命意义的能力与过程。随后以生前预嘱为例,论述死亡话语素养如何在具体社会情境中养成和实践。死亡话语素养是人们为争取死亡质量需要投入的一种文化资本,其养成和实践有利于促进人们的生命福祉,推动新的谈生论死话语惯习的形成。

     

对死亡恐惧的形而上追问

死亡恐惧与自我意识相伴而生,成为人类无法根除的永恒性焦虑。它既根源于他人之死呈现出的经验性恐惧,也来自于拒斥死亡的社会文化所导致的认知性恐惧以及面临“自我”之死时产生的形而上恐惧。死亡恐惧不能彻底消解只能消减,保持适当的死亡恐惧是必要的,也是有益的,它是人类一切精神性追求的内在动力。人们通常力求通过外向性的追求去摆脱或超越死亡恐惧,然而只有通过反躬自省,不假外求的方式,才能最终完成对生命的觉解与超越。     

Terror mismanagement: evidence that mortality salience exacerbates attentional bias in social anxiety

Death anxiety is a basic fear underlying a range of psychological conditions, and has been found to increase avoidance in social anxiety. Given that attentional bias is a core feature of social anxiety, the aim of the present study was to examine the impact of mortality salience (MS) on attentional bias in social anxiety. Participants were 36 socially anxious and 37 non-socially anxious individuals, randomly allocated to a MS or control condition. An eye-tracking procedure assessed initial bias towards, and late-stage avoidance of, socially threatening facial expressions. As predicted, socially anxious participants in the MS condition demonstrated significantly more initial bias to social threat than non-socially anxious participants in the MS condition and socially anxious participants in the control condition. However, this effect was not found for late-stage avoidance of social threat. These findings suggest that reminders of death may heighten initial vigilance towards social threat.     

The role of mortality awareness in hero identification

Three studies examine hypotheses derived from terror management theory to investigate the relationship between mortality concerns and hero identification. Study 1 found reminders of death, followed by a distraction task and a self-prime, led to greater inclusion of heroes in the self. Study 2 found that writing about a personal hero, but not other’s heroes or acquaintances, led to lower death-thought accessibility after being reminded of mortality. Finally, Study 3 found that after death reminders, participants led to identify with a hero exemplifying traits of legacy and/or sacrifice showed lower death thought accessibility. Findings are discussed as generative for heroism research, informing a previously overlooked motivation underlying hero identification and the existential function of such identification.     

Revisiting the crisis in Freud's libido theory and Abraham's concept of the oral‐sadistic phase as a way out of it

The now available unabridged correspondence between Freud and Abraham leads to a re‐evaluation of the significance of Abraham's work. The author proposes the thesis that clinical observations by Karl Abraham of the ambivalence of object relations and the destructive‐sadistic aspects of orality have an important influence on the advancement of psychoanalytical theory. The phantasy problem of the Wolf Man and the question of the pathogenic relevance of early actual, or merely imagined traumata led Freud to doubt the validity of his theory. He attempted repeatedly to solve this problem using libido theory, but failed because of his problematic conception of oral erotics. The pathogenic effect of presymbolic traumatizations cannot be demonstrated scientifically because of the still underdeveloped brain in the early stage of the child's development. Consequently, the important empirical evidence of a scientific neurosis theory could not be provided. A revision of the theory of the instincts thus became necessary. With Abraham's clinical contributions and other pathologic evidence, Freud was, with some reservation, forced to modify his idea of oral erotics by ascribing to it a status of a merely constructed and fictive phase of oral organization. A solution was eventually facilitated via recognition of non‐erotic aggression and destruction, thereby opening libido theory to fundamental revisions. Driven by the desire to develop a scientific theory, Freud initially had, in his first theory of the instincts, assumed a strongly causal‐deterministic view on Psychic Function. His third revision of theory of the instincts, Beyond the Pleasure Principle including the death instinct hypothesis, considered the hermeneutic aspect of psychoanalytic theory, which had previously existed only implicitly in his theory. Further development of the death instinct hypothesis by Melanie Klein and her successors abandoned quantitative‐economic and causal‐deterministic principles, and instead focused on the practical utility of the psychoanalytic theory.