居丧关怀课件.ppt

居 丧 关 怀Bereavement Care John L. Shuster, Jr., MD Tuscaloosa VA Medical Center University of Alabama Definitions定义 居丧:一个人丧失亲人时所处的状况 Bereavement: The situation of anyone who has lost a person to whom they are attached. 悲伤: 居丧的心理和情感反应. Grief: The psychological and emotional reactions to bereavement. 哀悼: 悲伤的社会表现. Mourning: The social face of grief.  背 景Background 居痛是一种普遍的经历 Bereavement is a universal experience. “正常的”时间过程不清楚,具有争议性 “Normal” time course is unclear, controversial. 寻证医学的证据缺乏 Limited evidence base. “正常”悲伤的过程The Course of “Normal” Grief 帕克斯的悲伤的三个组成部分 Parkes’ Three Components of Grief: 哭泣的欲望和对逝人的找寻 The urge to cry and search for the lost person. 控制或压抑哭泣的欲望和找寻 The urge to avoid or repress crying and searching. 重新审视和改变内心模型的欲望 The urge to review and revise internal models. “正常”悲伤的过程The Course of “Normal” Grief 麻木和情感变迟钝 Numbness and Blunting 渴望和怀念 Pining and Yearning 崩溃和绝望 Disorganization and Despair 重组和恢复 Reorganization and Recovery “正常”悲伤的过程The Course of “Normal” Grief “正常”悲伤的过程The Course of “Normal” Grief 差异性很大 Highly variable. 大多数人应对良好 Most people cope well. 恢复依赖于: -社会支持 -失去的种类 -失去的突然程度 -其它失去和压力 Recovery depends on: Social support Comorbidity Type of loss Suddenness of the loss Other losses or stressors 悲 痛 的 症 状Symptoms of Grief 躯体 -胃中的空虚感,胸腔紧缩,心悸 Physical: hollowness in stomach, tightness in chest, heart palpitations 情感: -麻木,忧患,哀伤,恐惧,负罪感 Emotional: numbness, relief, sadness, fear, anger, guilt 认知 Neurocognitive: -不置信,迷惑,无法集中注意力 -幻想/错觉(发生在刚刚失去之后) disbelief, confusion, inability to concentrate Illusions/hallucinations (early after the loss) 悲 伤 的 结 果Consequences of Grief 丧偶的人表现出: -加重的躯体不适;更多的使用卫生保健服务 -心脏病导致的死亡数量增加 -严重抑郁的高发生率(高达47%的人在失去的第一年内发生) -自杀率升高 Surviving spouses show: Increased physical distress; more healthcare service utilization. Increases in deaths from heart disease. High prevalence of major depression (up to 47