臨終病人和家屬的護理MedCMU課件

1、 Communication Models in Palliative Care/End of Life CarePing fen TangProfessor of NursingKunming Medical University, China 第1頁，共32頁。Role of Communication Skills Effective symptom control is impossible without effective communication. Communication as a major component of the delivery of all medical

2、, and particularly palliative care. Kaplan SH, Greenfield S, Ware JE: Impact of the doctor-patient relationship on the outcomes of chronic disease. In Stewart M, Roter D (eds): Communicating with Medical patients. Newbury Park, Sage Publication, 2001 第2頁，共32頁。PATIENT CAREQUALITY LIFEWith patientWith

3、 FamilyCommunicationAll health caretermEmpowerMoralReduce sufferingCommunication as a mediating variable in achieving the goal of palliative careInterventionOutcomeCommunication Ethics第3頁，共32頁。Overview of the COMFORT ModelWittenberg-Lyles and colleagues developed an evidence-based communication mode

4、l that elaborates seven principles of communication.Wittenberg-Lyles E, Goldsmith J, Ferrell B, Ragan S.Communication in Palliative Nursing. New York, NY: OxfordUn iversity Press; 2013.第4頁，共32頁。COMFORT ModelCommunication (Narrative clinical) Orientation & Options Mindful CommunicationFamily Caregive

5、rsOpening RelatingTerm CommunicationCOMFORT第5頁，共32頁。Communication (3Rs)Reflection on the patient before illnessRemember the patient as an individualRe-author the story第6頁，共32頁。Orientation and Options Question to determine family orientationUse plain language planner for palliative careQuestion to un

6、derstand patient/family culture第7頁，共32頁。Mindful CommunicationAwareness of emotionsAvoiding judgmentAdaptabilityNotice signs of stressIdentify positives for patient/familySilence as a strategy第8頁，共32頁。Family CaregiversCaregiver communication toolPatient & Family communication needConcern/response: Pa

7、inPrompt/response: Assessment第9頁，共32頁。OpeningsAddress the topicComment on topicIncorporating quality of lifeSpiritual review第10頁，共32頁。RelatingChecklistAMENQuestion第11頁，共32頁。Team CommunicationProfessional Group thinkTerm meetingMulti-DisciplinaryCollaborationRisk and SolutionSpecific communication第12

8、頁，共32頁。Giving bad news to patients/families need different communication skills because the cultural differently.第13頁，共32頁。In many countries, including most Asian countries and some southern Europe, decisions about what is told to a patient and the care received is made by the family. Johnson M.R.D.

9、 (2009). End of life care in ethnic minorities. Providers need to overcome their fear of dealing with people from different backgrounds. British Medical Journal 338, a2989第14頁，共32頁。第15頁，共32頁。Breaking Bad News Bad news can best be defined as any news that adversely affects the patients view of his or

10、 her future.Buckman R: Breaking bad news: Why is it still so difficult? BMJ 288:1597-1599, 1984 第16頁，共32頁。SPIKESWALTER F. BAILE, 2000ABCDERabow MW, Mcphee,1999 Breaking Bad News Mode 第17頁，共32頁。S: Setting Arrange for some privacy Involve significant others& Sit down Make connection and establish rapp

11、ort with the patient Manage time constraints and interruptionsP: Perception of condition/ seriousnessDetermine what the patient knows about the medical or what is suspected. “Before you tell, ask.”, Listen to the patients level of comprehension Accept denial but do not confront at this stageI: Invit

12、ation from patient to give informationAsk patient if wishes to know the medical and/or treatment Accept patients right not to know Offer to answer questions later if s/he wishesK: Knowledge give medical factor Consider educational level, socio-cultural background, current emotional Give information

13、in small chunks, warn the patient bout to give bad news Check whether the patient understood what you said & Respond reactions Give any positive aspects firstE: Explore emotions & sympathize Prepare to give an empathetic response: 1. Identify emotion expressed by the patient (sadness, silence, shock

14、 etc.) 2. Identify cause/source of emotion 3. Give the patient time express his or her feelingsStrategy & summary Patients who have a clear plan for the future are less likely to feel anxious and uncertain-so clarify their understanding Close the interview第18頁，共32頁。SPIKES ModePerceptionInvitationSum

15、mary第19頁，共32頁。The SPIKES protocol has been designed specifically for these purposes and will allow the physician to assess the patients expectations before going on to share the information. Curtin S, MCCONNELL M. Teaching dental student how to deliver bad news: SPIKES model J .J Dent Educ, 2012,76(

16、3): 360-365第20頁，共32頁。Case第21頁，共32頁。ABCDE Mode Advance PreparationBuild Environment/ RelationshipCommunicate WellDeal with Patient & Family Reactions Encourage and Validate Emotions Rabow MW, Mcphee SJ, Beyond Breaking the bad news: How to help patients that suffer West J Med 1999;171:261 第22頁，共32頁。A

17、dvance PreparationTopicTimingTo whomWho says第23頁，共32頁。Build a Therapeutic Environment/ RelationshipwherePrivacyComfortableHow MoodFeeling第24頁，共32頁。Communicate WellPerspective others Individuals different Step by step 第25頁，共32頁。Deal with Patient and Family ReactionsProcessObservationPerspective Empat

18、hyGuideSupporting 第26頁，共32頁。Encourage and Validate EmotionsValidate EmotionsExpectsCognitiveEncourage ManageAssist第27頁，共32頁。第28頁，共32頁。The so-called death caf movement started 2011 in London by Jon Underwood, who was inspired by the writings of Swiss sociologist Bernard Crettaz.第29頁，共32頁。Death Coffee of KunmingBritish Death Coffee GuideTraditional Chinese Cultural Multidisciplinary Teams Mon