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The Transformation: Power in Persistence and Perspective 转型:坚持与展望的力量
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1353/nib.2023.0003
Tyler R Bendrick
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引用次数: 0
An Epidemic of Difficult Patients 难缠病人的流行
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1353/nib.2023.0012
Keva Southwell
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引用次数: 0
I Had Never Heard Someone Use That Word Before 我从来没听人说过这个词
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1353/nib.2023.0021
Adrienne Feller Novick
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引用次数: 0
Positive Change in Perception and Care for a Difficult Patient 对困难病人的认知和护理的积极改变
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1353/nib.2023.0019
Melissa Cavanaugh
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引用次数: 0
It Is Going to Be a Long Clinic Day 今天将是漫长的门诊日
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1353/nib.2023.0013
S. Cruz-Flores
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引用次数: 0
The Right to Be Childfree 没有孩子的权利
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1353/nib.2023.0018
Andrea Eisenberg, Abram L. Brummett
In this manuscript, we start with a real life account of an Ob/Gyn experience with a young patient from the childfree movement requesting permanent sterilization. A narrative ethics approach invites the reader to experience the encounter in an immersive way for this growing issue. This approach allows readers to reflect on their reaction to the patient and consider how that can affect other patient encounters. Additionally, it explores the stigma these young patients encounter making a permanent decision to never have children. In the commentary, we explore the ethical issues in this case including why we question the permanent decision to refrain from having children. We also discuss informed consent and patient education along with the various approaches to physician-patient relationships with an emphasis on shared decision making, which allows space for both patient and physician to question and reason through their health decisions.
在这份手稿中,我们从一个真实的生活开始,一个来自无子女运动的年轻病人要求永久绝育的妇产科经验。叙事伦理方法邀请读者以身临其境的方式体验这个日益增长的问题。这种方法允许读者反思他们对病人的反应,并考虑如何影响其他病人的遭遇。此外,它还探讨了这些年轻患者在做出永远不要孩子的决定时所遇到的耻辱。在评论中,我们探讨了这种情况下的伦理问题,包括为什么我们质疑永久不生孩子的决定。我们还讨论了知情同意和患者教育,以及医患关系的各种方法,重点是共同决策,这使得患者和医生都有空间通过他们的健康决策来质疑和推理。
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引用次数: 0
Editors' Note 编者注
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1353/nib.2023.0000
James M. DuBois, Ana S. Iltis, Heidi A. Walsh
Editors' Note James M. DuBois, Ana S. Iltis, and Heidi A. Walsh Approximately 15% of adult patient encounters are with patients described as "difficult" by healthcare providers. These encounters often evoke feelings of dread, frustration, and anger in healthcare professionals. Verbal or physical abuse of staff, repeat hospital admissions due to self-injurious behaviors, and unusual beliefs about health may make care difficult. In other cases, patients may lack the resources or social support to follow treatment protocols. Additionally, healthcare providers may bring biases, personal triggers, or inaccurate assumptions to patient encounters. David Vilanova, a cardiac and intensive care nurse, writes: No guidelines truly exist when it comes to the management of a patient that you simply do not like. The result can be a near-instantaneous dread each time you must answer that patient's bed alarm, call light, or most basic needs. A negative bias takes over, and it would be an understatement to say that this affects the quality of care. Patients in situations like this—with providers who judge them as I have been guilty of—can easily become subject to derogatory remarks, health inequities, and biased labeling in charting that follows them from one hospital visit to another. […] We often cannot control our initial thoughts. The knee-jerk reactions we have toward people, places, and things or the judgments we make about the patients that cross our paths, but what we choose to think and do beyond that is up to us. Through self-care before work and active reflection throughout my shift, especially in times of stress, I can ensure I am doing my best to provide high-quality care to my patients regardless of their circumstances. In this issue of NIB, 12 healthcare professionals including physicians, nurses, and social workers who have cared for "difficult" patients describe their experiences and offer constructive responses to these challenging situations. Eight additional stories are available in the online supplement. The symposium editor, Autumn Fiester is an Associate Professor and Associate Chair for Education in the Division of Medical Ethics at the Perelman School of Medicine at the University of Pennsylvania. She is the Executive Director of the Penn Program in Clinical Conflict Management. Much of her work focuses on the "difficult" patient. Fiester also provided a commentary article for the symposium. Aliza M. Narva & Erin T. Marturano and Yolonda Y. Wilson provided two additional commentaries. The commentary authors have expertise in conflict management, building ethical competence among clinical teams, ethics consultation, nursing, and racial justice. All three commentaries offer important insights into the authors' stories. Reflecting on how healthcare providers can change their approach to working with so-called "difficult" patients, Narva and Marturano surmise, "Good care may not mean recovery, healing, or a patient's return to a former, health
编者按James M. DuBois, Ana S. Iltis和Heidi A. Walsh大约15%的成年患者遭遇的患者被医疗保健提供者描述为“困难”。这些遭遇通常会引起医疗保健专业人员的恐惧、沮丧和愤怒。对工作人员的言语或身体虐待,因自残行为而多次入院,以及对健康的不同寻常的信念,都可能使护理变得困难。在其他情况下,患者可能缺乏资源或社会支持来遵循治疗方案。此外,医疗保健提供者可能会给患者带来偏见、个人触发因素或不准确的假设。心脏和重症监护护士大卫·维拉诺瓦(David Vilanova)写道:当涉及到你不喜欢的病人的管理时,没有真正存在的指导方针。结果是,每次你必须回答病人的床上警报、呼叫灯或最基本的需求时,你都会有一种近乎瞬间的恐惧。一种消极的偏见占据了上风,说它影响了护理的质量是保守的。在这种情况下,病人很容易受到贬损的言论、健康不公平的对待,并且在他们从一家医院到另一家医院的病历中被贴上带有偏见的标签。我们常常无法控制自己最初的想法。我们对人、地方和事物的下意识反应,或者我们对遇到的病人的判断,但我们选择思考和做什么,取决于我们自己。通过工作前的自我护理和在轮班期间的积极反思,特别是在压力大的时候,我可以确保我尽我所能,为我的病人提供高质量的护理,无论他们的情况如何。在这一期的NIB中,包括医生、护士和社会工作者在内的12名医疗保健专业人员描述了他们的经历,并对这些具有挑战性的情况提供了建设性的回应。在线增刊中还提供了另外八个故事。本次研讨会的编辑Autumn Fiester是宾夕法尼亚大学佩雷尔曼医学院医学伦理学部的副教授和副主席。她是宾夕法尼亚大学临床冲突管理项目的执行主任。她的大部分工作都集中在“难相处”的病人身上。费斯特还为研讨会提供了一篇评论文章。Aliza M. Narva、Erin T. Marturano和Yolonda Y. Wilson提供了另外两篇评论。评论作者在冲突管理、在临床团队中建立伦理能力、伦理咨询、护理和种族正义方面具有专业知识。这三篇评论都对作者的故事提供了重要的见解。在反思医疗服务提供者如何改变他们与所谓的“困难”患者打交道的方法时,纳尔瓦和马图拉诺推测,“良好的护理可能并不意味着康复、治愈或患者回到以前更健康的自我。这可能意味着放弃控制,关注病人的故事,而不是临床结果,或者道歉,联系和学习。”本期NIB包括两个案例研究。在《无子女的权利》一书中,Andrea Eisenberg和Abram L. Brummett描述了这样一种情况:Eisenberg的23岁病人要求永久绝育。“我知道我很年轻,但我知道我不想要孩子。我从没想过要孩子。我这辈子都没想过要孩子。”这位艾森伯格以前从未治疗过的病人解释说:“我一生都在与精神疾病作斗争。我知道我永远照顾不了一个孩子。我读过一些关于后悔风险的文章,但我永远不会后悔。”越来越多的人认为自己是无儿童运动的成员。他们希望或已经接受了永久性绝育,没有亲生孩子,也永远不想要孩子。但艾森伯格了解到,许多这样的人都经历过“暴食症”——这是那些没有孩子的人用来形容医生试图说服他们的决定是错误的,并驳回他们的选择。作者指出,这是一种过时的医患关系模式,相反,医生和病人应该交换他们选择的理由,并参与共同决策。“提出……
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引用次数: 0
Working with Patience: An Insight into Dealing with Difficult Emotions 耐心工作:处理困难情绪的洞见
Q4 Medicine Pub Date : 2023-03-01 DOI: 10.1353/nib.2023.0004
David Vilanova
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引用次数: 0
Editors' Note 编者注
Q4 Medicine Pub Date : 2023-02-06 DOI: 10.1353/nib.2019.0033
James M. Dubois, A. Iltis, Heidi A Walsh
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引用次数: 0
What Do We Owe to Patients Who Leave Against Medical Advice? The Ethics of AMA Discharges 我们欠那些不遵医嘱离开的病人什么?美国医学协会的道德规范
Q4 Medicine Pub Date : 2023-01-21 DOI: 10.1353/nib.0.0030
L. Hendizadeh, Paula Goodman-Crews, Jeannette Martin, Eli Weber
Discharges against medical advice (AMA) make up a significant number of hospital discharges in the United States, and often involve vulnerable patients who struggle to obtain adequate medical care. Unfortunately, much of the AMA discharge process focuses on absolving the medical center of liability for what happens to these patients once they leave the acute setting. Comparatively little attention is paid to the ethical obligations of the medical team once an informed decision to leave the acute care setting AMA has been made. Via a case narrative, we offer an ethical framework that we believe can help guide an ethically defensible AMA discharge process. By emphasizing our duty to provide the best care possible under the circumstances, we contend, our ethical obligations to promote the patient’s best interests can still be met despite their decision to leave the acute setting against medical advice.
不遵医嘱出院(AMA)在美国医院出院中占相当大的比例,通常涉及那些难以获得充分医疗护理的弱势患者。不幸的是,美国医学协会的出院流程大多侧重于免除医疗中心对这些病人离开急性环境后发生的事情的责任。相对而言,很少有人注意到医疗团队的道德义务,一旦知情决定离开急性护理设置AMA已作出。通过案例叙述,我们提供了一个道德框架,我们相信可以帮助指导道德上可辩护的AMA出院过程。我们认为,通过强调我们有责任在这种情况下尽可能提供最好的护理,我们仍然可以履行促进患者最大利益的道德义务,尽管他们决定不顾医疗建议离开急性环境。
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Narrative inquiry in bioethics
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