癌症照護者之心理調適胡文郁

癌症照護者之心理調適台大醫學院護理學系所教授台大醫院護理部兼任督導長 101-9-2 胡文郁確定診斷期癌症治療期復健期治療無效瀕死期癌症之‘三段五級’觀念五級三段預防治癒性治療安寧緩和醫療癌症預防與早期偵測死亡空間軸（健康照顧場所）醫學中心時間軸（人生各發展階段）出生居家療護安寧緩和醫療健康軸（醫護專業服務) 健康促進人身靈心【醫療的本質】癌症患者連續性照護之模式癌症病人之持續性需要出院計畫中不同科別成組之介入社區中之護理機構連續性照護病患之預後預防及早期發現諮商因應舒適營養保衛機轉免疫造血皮膚感覺運動活動排泄性換氣循環護理專家護理人員醫師社工人員物理治療師職能治療師神職人員家屬社區醫院專業護理機構復健機構護理之家安寧之家門診照護居家健康照護家庭單獨照護增進生活品質生理狀況良好社會功能症狀控制癌症照護者緩和醫療學專論存活死亡整體性痛苦生活品質癌症病人之整體性痛苦與家屬之照顧負荷生命存活期生活品質熟輕熟重？癌症末期

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Transcript of 癌症照護者之心理調適胡文郁

1. 101-9-2 )

2. (Model of Family Members Perceptions of Death, Family Grief and Coping) (Nuclear Family (Family Grief Functioning)Reactions) (Death(Family (Family Member(Family CopingEvent)History)Perceptions Strategies) of the Death) (Cultural (Family (bereavement care)(grief work) Constraints) InteractionPatterns) Individual Filter From: Moos N.L., (1995)(1) (3) (Wider Society) (Reference Group) (Law enforcement system) (Communications (Welfare system) system) (Educational(Family) (Health care system) system) (Political system)(Religious system)From Lytton, 1980 - / - - - - - 3. (Pain)()(Spiritual concerns)(Physical symptoms)-- (Total suffering)Anger, Guilt, , Depression, Uncertainty, Anxiety, Fear (physical distresslonelinesshelplessnessloss of workand death) (Psychological problems) (Cultural factors) (Social difficulties) From: Woodruff, R.: Palliative Medicine. 4th ed. Oxford University Press, UK. 2004. : Family distress Patient autonomy From: Dr. Carl Rogers ( Taiwan: nationwide guidelines for truth tellingAssess and preparation()Communication with family (), ACTSTruth telling process (Donnelly & Walsh , 1996)()Support and follow up() http://health99.doh.gov.tw/educZone/edu_detail.aspx?Catid=21568&Type=SEARCH ) 4. () ( Bereavement care ) - / 14(The Tasks of Mourning) To accept the realiry of the loss To experience the pain of grief To adjust to an environment in which the deceased is missing Videka-Sherman - To withdraw emotional energy and reinvest Worden - in another relationship From: Dr. WordenSt. Christopher, Bohnet, 1984; Parkes & Weiss, 1 , , , A. B. , 1.()1. , 2. 2. 3. 3. 4. 4.() ,5. , , 5. (Art therapy) A.71.3 B.7.01.3.71. 37.5 1 23 4 5 2. 15.92. 12.5 3.9.83. 12.5 1 101 004. 36.64. 12.52200 0 0 5. 12.53001 0 05. 19.56. 12.54011 2 1,, C.21.75 402 9 146. 14.6NTUH Hospice 6. ( Staff support ) DNR (Spirituality)The incorporation of a transcendentdimension in life (Kemp, 1999). ; ,2004) Philosophy () Belief () (Spiritual) Faith () - The acceptance without objective proof of (Philosophy or belief) (Religion) something. Religion () An organized effort, usually involving ritual and devotion, to manifest spirituality. 7. - . ., . . . . . . . .(wholeness) Robert Assagioli, 1888-1974 8. . , () Sharing Your Wishes Advance Care Planning Aging with Dignity? ?? ? ? 2012/8/28 9. Freedomof spiritual !