关于麻醉后监测治疗室的伦理思考

麻醉后监测治疗室(post-anesthesia care unit,PACU)中医学高新技术设备对确保手术后患者的安全发挥极其重大的作用,然而PACU中也产生许多危机与伦理冲突。为了PACU的良性发展,我们认为如下伦理准则必须遵循:科学认定准则、最佳选择准则、精益求精准则、无伤准则、患者自主准则。     

The Impact of Wellness‐Focused Supervision on Mental Health Counseling Practicum Students

Professional counseling organizations tout the importance of wellness for counselors and counselors‐in‐training. The authors used a wellness‐focused supervision model with mental health practicum students to assess the model's degree of treatment effect at improving students' wellness over the course of the semester. Participants' demographics included three women, one man, three European Americans, and one Latino/a. Single‐case design results revealed that ongoing wellness‐focused interventions are helpful in improving participants' level of wellness; implications for practice are provided.     

Social validity assessment of behavior data recording among human services care providers

Care providers within human services organizations have many job responsibilities and performance expectations. In the present study, we conducted social validity assessment with 78 care providers concerning their attitudes and opinions about behavior data recording with adults who had intellectual disability and lived in community group homes. Specifically, the care providers responded to a written questionnaire that inquired about the practicality, training/supervision, and value of behavior data recording in the context of service delivery. Results indicated generally high approval of behavior data recording practices, purposes, and approaches to training. We discuss implications of these findings for implementing data recording by care providers and the contribution of social validity assessment to training and performance management within human services organizations.     

Care and Justice Moral Orientation Among African American College Students

The current study assessed the moral orientation of African American college students. In addition, we examined whether or not they exhibit the gender difference in moral orientation hypothesized by Gilligan. One hundred sixty-six African American undergraduates at an historically Black university completed the Moral Orientation Scale, which measures care versus justice moral orientation. The students selected an average of 4.39 care-oriented responses (out of 12). In contrast to predictions that African American culture would lead to the development of a care focus, most participants had a justice focus. In fact, these students were significantly more justice oriented than male law students, who were the most justice oriented of the groups studied by N. Yacker and S. L. Weinberg (1990). There was no evidence of a gender difference in moral orientation. If future research replicates this finding, then Gilligan's theory may need to be modified with regard to African Americans.     

健康公平--概念、影响因素与政策

长期以来健康不平等和不公平一直是卫生改革与发展所关注的重点,并已经成为了国际卫生政策的主要方向.在国家之间健康不平等和不公平也存在不同的理解.发达国家主要集中在产生疾病和导致死亡率差异的社会经济阶层的形成机制,将健康不平等作为疾病病原学的一个函数,关键措施是加强初级卫生保健;在中低收入国家,人们却趋向于通过提供基本的医疗保健服务来解决这一问题.     

家属对脑卒中患者设立预先指示的态度研究

通过方便取样法,抽取海口市某三级老年病专科医院脑卒中患者家属249名,使用问卷调查法调查家属对脑卒中患者设立预先指示(advance directives,AD)的态度并分析其影响因素。结果显示,在生命终末期治疗的选择上,家属为自己选择的治疗与为患者选择的治疗一致性较差(Kappa=0.249,P<0.01)。家属的代理决策结果受多种因素影响。是否有过住院经历、家属代理决策的结果、家属对AD的态度是影响家属对患者设立AD态度的主要因素。     

慢性心衰患者姑息照护的挑战和策略

慢性心衰患者往往经历呼吸困难、乏力、液体潴留、焦虑抑郁、对生活失去兴趣等身体心理症状,是实施姑息照护的主要对象。但由于其疾病轨迹的不确定性、人们对姑息照护认识不足、缺乏有效工作模式等原因,导致姑息照护使用比例很低,通过系统回顾国内外慢性心衰姑息照护实施现况,建议我国一方面可以加强姑息照护的宣传教育、积极探索慢性心衰患者姑息照护实施的最佳模式和最佳时机,并注重对整个家庭进行需求评估;另一方面,国家应该制定相关的政策和法律以推动姑息照护在慢性心衰患者中的使用。     

Protection of Life and Human Dignity: The German Debate between Christian Norms and Secular Expectations

The German debate on bioethics and medical ethics turns on achange in the meaning of human dignity. Such dignity is increasinglyrendered contingent upon a person's empirically assessable qualityof life. In contrast to such dignity-endowed human life, a merelybiological human life is taken to disqualify its bearer fromsuch dignity, depriving his life of the protection "respectfor human dignity" would otherwise guarantee. The idea of a"life not worth living" or "undignified life" evokes categories,which were developed at the beginning of the 20th century, andlater informed the crimes of National Socialist medicine inGermany. Against this secular development, this article analysesthe theological and church-based discussion of basic bioethicalquestions in Germany, especially the controversy among Protestants:once Protestant ethicists abandon an explicitly theologicalbasis for their arguments, their conclusions come to closelyresemble those of the secular participants in the debate. Asa result, such Protestants relativize fundamental ethical norms.They subordinate, along with their secular environment, theprotection of life to respect for autonomy. They thus preparethe ground for a revival of the risky concepts of the past.     

The Financial Dimension of Integrated Behavioral/Primary Care

There are two reasons why mental health, now more appropriately termed behavioral healthcare, is declining: (a) a lack of understanding among psychotherapists of healthcare economics, particularly the intricacies of medical cost offset, and (b) our failure as a profession to see the importance of behavioral interventions as an integral part of the healthcare system inasmuch as the nation pays for healthcare, not psychosocial care. This paper will briefly describe the rapid changes in the economics of healthcare during the past 75 years, including the post World War II enthusiastic espousal of psychotherapy by the American public which was followed by a precipitous decline as our outcomes research in behavioral care remained ignorant of financial outcomes, leaving it to the government and managed care to arbitrarily curtail escalating mental health costs. At the present time psychology is on the cusp of becoming part of the healthcare system through integrated behavioral/primary care, renewing the primacy of financial considerations such as return on investment (ROI) and medical cost offset, as well as an urgency that we avoid the mistakes that are emerging in some flawed implementations of integrated care.     

Models of Psychotherapy: Implications for Pastoral Care Practice

Pastoral care givers are called to provide care and counseling to parishioners that are suffering in many ways. A core question is what does a pastor rely on to provide this care? Pastors usually call on models of psychotherapy to inform their care giving. A framework of theological anthropology, cosmology, soteriology and harmatiology is developed for analyzing the worldviews inherent in models of psychotherapy. The specific models of Adler’s Individual Psychology, Narrative therapy, Horney’s personality theory, and Intersubjective theory are used to demonstrate the application of this framework. Several pastoral care implications are developed following the application of the framework.