The Individual Is the Core-And Key-To Person-Centered Care
The Individual Is the Core-And Key-To Person-Centered Care
复制标题
个人是以人为本的护理的核心和关键
DOI：
--
复制
发表时间：
2013
期刊：
影响因子：
--
通讯作者：
S. Fazio
中科院分区：
文献类型：
--
作者：
S. Fazio
我们如何照顾痴呆症患者应该考虑到研究表明，人类的自我意识可能与社会互动密切相关。据估计，有 5.2 名美国人患有某种形式的痴呆症，到 2050 年，这一数字可能会增加两倍，达到预计的 1380 万，除非出现预防、减缓或阻止痴呆症相关疾病的医学突破（阿尔茨海默氏症协会，2013 年）。阿尔茨海默病 (AD) 是痴呆症最常见的原因，是一种进行性的大脑退行性疾病，会破坏脑细胞，导致认知功能受损。其症状包括记忆丧失、语言和功能障碍以及行为障碍。随着时间的推移，大多数与痴呆症相关的疾病会逐渐破坏脑细胞，导致认知功能进行性下降。但痴呆症的进展速度因人而异。对于痴呆症患者来说，从发病到死亡的时间从三到二十年不等，平均持续时间为八年（阿尔茨海默病协会，2013）。尽管有共性，但痴呆症的表现方式也各不相同，这完全适合个体化护理。但 AD 患者接受此类护理的情况仍然很少。 阶段可能作为医疗框架有用，但不适用于护理许多专家已经开发了阶段框架来描述 AD 的进展，记录通常与神经细胞退化相对应的症状发展模式。阶段可以提供对疾病如何发展的理解，但由于疾病的进展是个体性的，因此这种理解方式在护理领域并不适用。如果阶段被用作给一个人贴上 AD 标签并对其行为施加期望的基准，这可能会限制或抑制该人的贡献和能力。这种阶段的使用可以创造一种只承认相似性而不是庆祝差异的文化。医生、家庭和护理人员通常认为需要阶段来确定可预测的病程和相关治疗。阶段通常侧重于损失和衰退，限制了个人的独特性格，为家庭和专业人士描绘了一幅悲惨的景象，并对护理和互动产生不利影响。家庭或专业人士可以预见到某些损害，并过早地将其分配给个人，或将正常的行为或行动视为某个阶段的特征或症状。这种限制性方法对于对基于优势的方法感兴趣的护理提供者或支持以人为本的护理的互动没有帮助。早期、中期、晚期，或轻度、中度和重度等广泛的阶段可能会更有帮助。超越阿尔茨海默病的医疗治疗严格的医疗护理模式不再适合许多疾病的护理，尤其是对于痴呆症或阿尔茨海默病。这种方法无法从人的角度来认识疾病，也无法支持完整的、终生的自我（Morris，1996）。Karen A. Lyman（1989）首先将痴呆症的观点描述为“异常医学化”的一个例子，她将其定义为将人及其社会问题视为医疗问题。她认为，医学模型包括许多疾病类别，这些类别限制了痴呆症患者的自我认同，并建议改变对 AD 的看法，包括社会因素和对个人的认可。 Christine Harrison (1993) 说，医疗重点只关注问题，还应该评估个人的剩余优势、积极功能和特征。哈里森建议我们研究是什么让一个人随着时间的推移而成为同一个人，并强化了这样的观念，即人格不仅仅是认知能力，还包括许多方面和背景，例如优势和个人特征。 ……
How we care for people with dementia should take into account research that shows humans' sense of self may be deeply tied to social interactions.It is estimated that 5.2 Americans have some form of dementia, and that number may arly triple to a projected 13.8 million by 2050, barring the development of medical breakthroughs to prevent, slow, or stop demen- tia-related disease (Alzheimer's Association, 2013). Alzheimer's Disease (AD) is the most common cause of dementia, and is a progres- sive, degenerative disease of the brain that destroys brain cells, resulting in impaired cognitive function. Its symptoms include memory loss, language and function impair- ment, and behavioral disturbances.Most conditions associated with dementia gradually destroy brain cells over time and lead to progressive decline in cognitive function. But the rate of progression of dementia varies from person to person. For people with dementia, the time from onset until death ranges from three to twenty years, with the average duration being eight years (Alzheimer's Association, 2013). And although there are commonalities, the way in which dementia manifests itself also varies, perfectly lending it to individualized care. But it is still rare that individuals with AD receive such care.Stages May Be Useful as a Medical Framework, but Not for CareMany experts have developed frameworks of stages to describe the progression of AD, docu- menting patterns of symptom development that generally correspond to the degeneration of nerve cells. Stages may provide an understand- ing of how the disease may play out, but because the progression of the disease is individual, this way of understanding it does not work well in the caregiving realm. If stages are used as benchmarks for labeling a person with AD and imposing expectations of their behavior, this can limit or inhibit that individual's contributions and abilities. Such use of stages can create a culture that merely recognizes similarities rather than celebrating differences.Physicians, families, and care staff often believe stages are needed to identify a predict- able disease course and associated treatments. Stages typically focus on loss and decline, limiting the individual's unique character, portraying a solely dismal picture for families and professionals, and adversely affecting care and interactions. Families or professionals can anticipate certain impairments and prematurely assign them to the individual, or refer to a nor- mal behavior or action as a characteristic or symptom of a stage. This restrictive approach is not helpful for care providers interested in a strengths-based approach, or for interactions supporting person-centered care. Broad stages such as early, middle, and late, or mild, moder- ate, and severe may be more helpful.Moving Beyond the Medicalization of Alzheimer's DiseaseA strict medical model of care is no longer appropriate for much disease care, but especially for dementia or Alzheimer's. Such an approach fails to appreciate the disease from the person's point of view and fails to support the complete and lifelong self (Morris, 1996).Karen A. Lyman (1989) first described the view of dementia as an example of the "medi- calization of deviance," which she defined as treating the person and their social troubles as medical problems. She argued that the medical model includes many disease categories that limit the self-identity of the person with demen- tia and suggested a shift in how AD is perceived to include social factors and a recognition of the individual. Christine Harrison (1993) said that a medical focus, which looks only at problems, should also assess the individual's remaining strengths, positive functions, and characteris- tics. Harrison suggested that we examine what makes a person the same person over time, and reinforced the notion that personhood is more than just cognitive abilities, but includes many facets and contexts such as strengths and personal characteristics. …