Model essay on psychological care of dying patients: On psychological care of family members of patients who died in heart surgery; To explore psychological changes and psychological care of family members of patients who died in heart surgery. In clinical nursing work, we should not only care about patients, but also care about the psychological problems of patients' families, especially those of deceased patients.
Keywords psychological care of family members of patients with accidental death
The death of a patient who is unable to receive medical treatment due to an accident or is too ill will produce a series of physiological and psychological reactions to his family members and relatives, showing psychological changes such as fear, tension, anxiety, sadness and insomnia [1], which is an important content that cannot be ignored in modern nursing. Since 200 1? In 2006, more than 39 dead patients were rescued. While actively rescuing patients, we pay attention to the psychological care of dying patients and their families, winning the support of patients' families for medical care and avoiding medical conflicts or attacks. The report reads as follows:
1 psychological impact of patient's death on family members Observing the psychological changes of family members of patients who died unexpectedly, people think that it can be roughly divided into the following four periods [2]: (1) negative period: when the family members of patients know this sudden bad news, they express strong denial and doubt and dare not face up to reality; (2) Deliberation period: Family members feel anxious when they see their loved ones dying, and strongly hope that medical staff will give them the best rescue treatment and place hope on their loved ones' survival; (3) Anger period: when a relative dies suddenly, too strong environmental stimulus will cause strong emotional reaction, and the accompanying physiological changes are also extremely intense, with unpredictable, unbearable suddenness and super strength; (4) Sad period: Faced with the fact of the death of a loved one, the patient's family members are psychologically unbearable, sad and emotional, and may even lose their minds. Don't listen to other people's persuasion, don't believe in the fact of death, and even beg the doctor to continue the rescue. Some of them cried loudly, unable to control themselves. Some even take it out on others, reprimand others loudly, and project their worries and sadness on people related to the incident; Or blame the hospital for poor rescue, and the hospital can't understand how to actively rescue it, complaining that doctors and nurses have no power to save the sky. Therefore, it is an important aspect of disease prevention, treatment and nursing to help the families and relatives of the deceased adapt to the pressure and cope with the crisis, so that they can maintain the internal balance of body and mind in an extremely painful external environment.
2. Psychological care for the families of deceased patients.
2. 1 Nurses actively communicate with patients' families and give psychological support. Different medical records will have many different reactions. Nurses should actively communicate with patients' families and introduce patients' condition and rescue process. For those with poor psychological endurance, the immediate family members, elders and the elderly and infirm of the deceased should temporarily evacuate the scene, stabilize their loved ones' emotions and make psychological preparations. At the same time, we should pay attention to listen to their questions, answer them appropriately and ask them what other requirements they have. The tone should be euphemistic, the attitude should be sincere and compassionate, and their psychological endurance should be enhanced, and they should not be stiff and indifferent.
2.2 Pay attention to the spiritual communication between patients' families and their loved ones, and provide time and space for the families of the deceased to pour out their voices. Medical staff should fully consider the psychological needs of patients' families, and try to keep them with their relatives when they are allowed to be present when rescuing patients. According to relevant data, some foreign hospitals have formed a system of allowing family members to be present when patients are rescued or dying. This can not only reduce the anxiety of the patient's family members when they wait blindly, but also reduce the regret that the family members have been waiting for their loved ones. At the same time, family members witnessed the whole rescue process and were psychologically prepared for the death outcome of their loved ones, thus reducing the grief after the death of their loved ones. After the death of a patient, family members often vent their emotions by crying loudly, which helps to alleviate their sadness, while suppressing these behaviors will prolong their sadness. Therefore, medical staff should not only stop it, but also actively provide them with appropriate space; Listen to them patiently, or express sympathy and comfort with body language, such as patting them on the shoulder and guiding them to pour out their psychological grief.
2.3 Let the family members participate in the hospice care of the deceased, and improve their understanding of death. Old age, natural disasters and man-made disasters are natural laws, and death due to ineffective rescue is an inevitable reality. No matter how medicine develops, no matter how clever doctors are, there are always some people who can't come back to life because of injuries. It is necessary to explain the seriousness and irreversibility of the disease to family members and explain the occurrence and development results of the disease to family members. While actively rescuing, we should be psychologically prepared for death, correctly understand the seriousness and irreversibility of the disease, adjust our emotions, and actively cooperate with the aftermath. Nurses should be gentle and steady in hospice care, show respect for patients everywhere, and at the same time respect the wishes of patients' families, let them participate in hospice care of patients, teach them the skills of life care, enable them to take better care of patients, fulfill their final obligations, get psychological comfort from them, and reduce anxiety and self-blame. In addition, after the death of patients, if circumstances permit, it is not necessary to transfer them to the morgue immediately, leaving appropriate time for them to stay with their loved ones. Family members should be encouraged, not forced to spend more time with their loved ones. Many family members feel that holding the hand of the deceased or kissing the deceased and expressing their feelings in words can reduce excessive sadness. Therefore, we should take care of the psychological needs of family members as much as possible, give them some psychological comfort, let them adapt to the pressure, cope with the crisis and guide them to face the reality. We should not lose the courage to live because of sadness, but should encourage them to shoulder the heavy responsibility of family. In addition, nurses should pay attention to the cooking of corpses. Boiling corpses is an important part of hospice care. Doing a good job in corpse care is not only a respect for the personality of the deceased, but also the best psychological comfort for family members. Nurses should respect the customs of their family members, for example, some family members propose to change clothes for their loved ones in person and try their best to meet their reasonable requirements.
2.4 Do a good job in appeasing the families of the deceased. The sudden death of a loved one is the peak of family members' grief. In the face of the death of a loved one, family members feel shocked, sad and desperate, and may even have a series of physical and mental reactions such as headache, increased heart rate, elevated blood pressure, insomnia, fatigue, memory loss and depression. Therefore, it is very important to do a good job in comforting the families of the deceased. For a long time, we often only pay attention to the cultivation of nurses' professional ethics, while ignoring the training of soothing knowledge and skills. When facing the grieving families of the deceased, it is not enough to have sympathy. We should give them favorable psychological support when necessary to help them avoid the sad scene of life and death parting. After the death of the patient, the nurse should actively give comfort and guidance to the family members of the deceased, guide them to treat them correctly, help them accept the fact of death, reduce their sadness, promote their physical and mental balance and start a new life. In addition, nurses can contact them by follow-up and telephone. But be careful not to do it in the first few days after the patient dies.
refer to
Thomas lee Xi Shu Hua 1. Experience of hospice care service in Hong Kong hospitals. PLA Nursing Journal, 2000, 46 (4): 54 ~ 55.
Xi Shu Hua, thomas lee. Experience of hospice care service in Hong Kong hospitals. PLA Nursing Journal, 2000, 46 (4): 54 ~ 55.
Model essay on psychological care of dying patients: how to do well in hospice care of elderly patients?
Death is an important part of life, a special kind of life, and a reality that no one can escape. Hospice care is a new interdisciplinary subject, which takes the physiological and psychological characteristics of dying patients and related social and ethical issues as the research object and combines the professional and scientific knowledge of medical care with each other.
1 discussion on the connotation of hospice care model for elderly patients
Hospice care for elderly patients should not only stay at the medical level, but also involve medicine, psychology, sociology, nursing, ethics and other disciplines, covering all physiological, psychological, social and spiritual needs. This requires us to change the nursing mode from the simple biological mode in the past to the modern biological-psychological-social mode, from the simple diagnosis, treatment and nursing in the past to caring for patients from the physiological point of view, alleviating their mental and physical pain, so that they can live comfortably and meaningfully in limited days; Relieve and alleviate patients' fear and anxiety about death from the psychological point of view, so that they can face death calmly; Guide patients to understand the meaning of survival on their deathbed from the perspective of sociology; From the perspective of bioethics, when patients are dying, they can realize the value of life and that they are concerned by society and their relatives.
2. The main measures that should be taken in hospice care of elderly patients.
For people, death is inevitable. It is generally believed that after active treatment, elderly patients still have no hope of survival until the end of their lives. This time is called. Dying? . The dying elderly patients will generally go through denial period, anger period, consent period, depression period and acceptance period, which will inevitably lead to longing for life and fear of death, and will inevitably lead to great sadness and pain. In order to make them optimistic, as nursing workers, they should do the following.
2. 1 Provide a comfortable environment. The dying elderly patients should be arranged in a single room. The room should be clean and quiet, with sufficient light, moderate temperature and humidity, fresh air and noise avoidance. The layout of the room should meet the psychological characteristics and needs of elderly patients. At the same time, there should not be too many restrictions on the indoor things of elderly patients. The purpose is to let the elderly patients have a quiet and comfortable rest, create a good rest and treatment environment for the elderly patients to the maximum extent, and let the elderly patients spend their last time in a comfortable environment.
2.2 Do basic nursing. Besides routine basic nursing, we should turn over frequently and pat the back more to help the elderly patients do their best to prevent bedsore, pneumonia and other complications. Cooperate closely with medical treatment, timely and accurately complete various treatment and nursing tasks such as infusion, sputum aspiration, oxygen inhalation and collection of various laboratory specimens, and do not terminate various life-sustaining measures at will. Nurses should work out the diet of elderly patients together with their families and nutritionists according to the characteristics of patients' loss of appetite to ensure the nutritional supply of patients. For those elderly patients who cannot expectorate due to weakened gastrointestinal function, such as dysphagia, dry mouth or sputum accumulation in the mouth, they should be cleaned up in time and oral care should be strengthened. Sober patients should be allowed to gargle, and those with dentures should be removed. For constipation patients, massage can be done with both hands in the abdomen according to the direction of colon, laxatives or kaisai dew can also be used, and gloves can be worn to dig out the stool when necessary to keep the patient's stool unobstructed.
2.3 The implementation of psychological counseling for dying elderly patients is extremely sensitive and complicated, and psychological care is the focus of nursing care for dying elderly patients. Nurses should know the real thoughts of elderly patients in time, grasp their psychological changes at any time, and provide targeted psychological comfort and counseling according to their different occupations, psychological reactions and social and cultural backgrounds, so as to help elderly patients correctly understand and treat life and diseases, get rid of their fear and anxiety about death, face the upcoming death with a calm mood and spend all stages of the dying process comfortably. If so, in? Denial period? Elderly patients should listen carefully to the conversation and often appear around the patient, so that he can feel people's care; Yes, are you there? Anger period? For elderly patients, we should understand, tolerate, comfort and guide; Yes, are you there? Term of the agreement? Elderly patients should meet the needs of patients as much as possible, even if it is difficult to achieve, they should work hard; Yes, are you there? Melancholy Elderly patients should be allowed to express their grief, and encouraged and supported to increase their confidence and courage in fighting diseases; Yes, are you there? Acceptance period? Some elderly patients should respect their beliefs and extend the nursing time, so that elderly patients can complete their life journey with a peaceful and comfortable attitude.
2.4 Do a good job in the ideological work of the families of dying elderly patients. Family members are the relatives of elderly patients and the spiritual pillar of elderly patients. The mental pain of family members will affect the emotional changes of elderly patients and aggravate the symptoms. Therefore, it is necessary to do a good job of the family members of elderly patients and promote their psychological adaptation. It is necessary to understand the psychological activities of the families of elderly patients, help them get rid of their pain, and make them actively cooperate with the nursing work of dying elderly patients. It is necessary to mobilize family members and social members to visit the elderly patients more, promote communication and understanding between them, eliminate past grievances, alleviate excessive guilt and sadness, let them support each other and understand each other in this precious and limited time, and let the elderly patients live in warmth and hope.
2.5 Establishing a good nurse-patient relationship and a harmonious nurse-patient relationship will help alleviate the psychological pressure and pain of elderly patients. Nurses should stand in the perspective of elderly patients, observe their needs, properly reflect their inner feelings with keen insight, and make them feel understood and accepted. We should help the elderly patients at any time according to their needs, so that they can feel care and care, so as to establish a harmonious nurse-patient relationship, so that the elderly patients can be in the best treatment state and happily walk through the last stage of their lives. The dying elderly patient still enjoys the same rights as others before his death. Because he is about to say goodbye to life, many demands are only the last time for him. Therefore, we should respect the rights of dying elderly patients, make them feel that they are still concerned, help them establish a new psychological balance and leave this world safely.
2.6 To improve the comprehensive quality of nursing staff, hospice care needs to apply the theoretical and practical knowledge of medicine, nursing, sociology, psychology and other disciplines. Therefore, nurses should persist in learning and constantly improve their comprehensive quality. Must have a certain professional theoretical level and operational skills, and master multidisciplinary knowledge; Must have the ability to relieve the physical and mental pain of dying elderly patients and their families; Good communication skills, able to establish good relations with patients and their families; Accept death education, have a low degree of avoidance and fear of death and near-death, and can honestly discuss the meaning of life and death with patients and their families; By improving the quality of nursing staff, the quality of hospice care can be fundamentally improved.
In a word, it is an important topic worth discussing to do a good job in nursing the dying elderly patients. Only the cooperation and support of doctors, nurses, family members and all walks of life can truly let every elderly patient live a quiet, comfortable and dignified life at the last stop.
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