目的 分析临终患者家庭的"社会-心理"困扰,为困扰解决的方法 策略设计提供现实依据.方法 2018 年 7－12 月,2019 年 9 月至 2020 年 6 月,对上海某社区医院安宁疗护科入住的4 个临终患者家庭行参与式观察,2018 年 7 月,对该科 8 名护士行叙事访谈,采用分析叙事法对两个视角的资料进行分析.结果 临终患者家庭"社会-心理"困扰可归纳为 10 个类型,即:缺乏情感支持、不接受临终结局、遗愿实现受阻、担忧家庭发展、恐惧死亡过程、病情沟通不畅、不舍亲人分离、情感交流不畅、人生价值迷惘与家属身心疲乏.结论 临终患者家庭"社会-心理"困扰具有普遍性、重要性、独特性、多样性、复杂性、紧迫性、反复性的特点;叙事方法 可成为理解、分析、解决临终患者家庭"社会-心理"困扰的有效方法 途径.

介绍社交媒体定义及种类,总结肿瘤患者目前常用社交媒体类型及其具体发挥的社会支持、信息支持、叙事治疗和心理干预等方面的作用,建议未来研究着重于建设兼顾整体性和个性化、功能性和吸引性,并能提供权威医疗信息的社交媒体平台为肿瘤患者提供心理支持.

我国护理科学研究的真正开展和兴起与我国高等护理教育的发展密不可分.在此之前,护理学术期刊发表的论文大多是经验总结、工作体会,少有护理人员掌握科学的研究方法.自护理研究生教育开展以来,护理学科研究者队伍逐步形成,具有研究生学历,特别是博士学位的高层次护理人才已成为我国护理研究领域的中坚力量.2011年,护理学成为一级学科后,政府部门、卫生机构、院校以及企业对于护理领域的科学研究认可度不断提高,且支持力度逐渐加大,涌现了一批代表性的护理科研工作者,广大护理人员的科研意识不断提高,科研选题日趋专业化,注重解决专业核心问题,学科研究领域不断拓展,研究深度不断加强,研究项目的科学性越来越高,研究方法和手段越来越多样,助推了护理学科的良好发展态势.本文所提供的数据资料来源于由国务院学位委员会办公室授权,第七届护理学科评议组为撰写《一级学科发展报告》所开展的全国学位点学科发展调研资料[1]以及国家自然科学基金委员会网站(http://www.nsfc.gov.cn/.)资料和全国哲学社会科学工作办公室网站(http://www.nopss.gov.cn/GB/219469/index.html.)资料.

目的 探究叙事护理策略在解决临终患者家庭的"社会-心理"困扰中的应用及效果.方法 2018年7-12月,2019年9月至2020年6月,采用目的抽样法选取上海市某社区卫生服务中心安宁疗护科4个临终患者家庭,通过鼓励患者家庭叙事、解构分析叙事、建构新意义叙事的叙事护理策略解决其"社会-心理"困扰,对研究过程中产生的语音、观察记录、实物文本资料行叙事分析,提炼困扰主题并对解决效果进行描述.结果 研究中4个临终患者家庭共涉及10个方面的"社会-心理"困扰,通过新意义叙事的重构,有效促进了各个家庭"社会-心理"困扰的解决.结论 临终患者家庭的"社会-心理"困扰亟需得到重视与针对性解决;叙事护理策略为临终患者家庭"社会-心理"困扰的积极解决提供了人文的新方法.

为进一步完善护理学科人文知识体系,增强护理人文教育的实践指导性,本研究借鉴"叙事医学"领域的研究成果,采用Walker和Avant提出的理论派生策略,构建了包括核心概念群、跨学科理论基础、研究对象、主要研究内容、特色研究方法5部分的叙事护理学理论,并在此基础上设置相关课程的内容体系.

20 世纪以来,医学界的高新技术革命在延长人类寿命、改善医疗结局方面取得了巨大成就,但同时也出现了技术至上、人文缺乏的现代性困境[1].2001 年Rita Charon在《内科学年报》上首次提出对患者饱含同情、怜悯的"叙事医学"概念[2],并引起了医学界的关注与思考.随着以患者"身体-心理-社会-精神"为核心的整体护理观在临床工作思维与护理服务意识中的不断深入,众多国外临床护理研究者将"叙事"理念融入疾病照护,在改善服务质量、促进人文关怀等方面发挥了重要作用.本综述旨在总结叙事在国外疾病照护中应用的有益经验,以期为国内研究与实践提供借鉴.

Background In recent years, narrative practice has been applied in clinical settings to address the relational and psychological concerns that occur in tandem with physical illness. It is an emerging strategy to treat patients as individuals with their own stories, rather than purely based on symptoms. Objective To synthesize the experience of patients with cancer using narrative practice. Methods Following a systematic search strategy, a literature search was conducted to identify qualitative studies on the experience of patients with cancer using narrative practice. Nine databases were searched up to April 2018, which included six English databases and three Chinese databases. A meta-synthesis was conducted to synthesize the findings of the included studies. Main Results Seven studies out of 2894 studies were included in this review. Patients with cancer had different preferences on narrative practices. In terms of the impacts of narrative practice on patients with cancer, six themes were identified, which included '(a) reducing the gap between patients and clinicians; (b) healing effect; (c) social connection; (d) facilitating self-reflection, self-recognition and self-realization; (e) risk of negative impacts; and (f) Patients' preference on different approaches of narrative practice'. Conclusions Patients with cancer experienced positive effects regarding narrative practice. Although some patients may experience negative effects, narrative practice is a humanized way to provide care for patients with cancer in the clinical settings.

目的·了解上海市某城乡结合社区老年人的健康促进生活方式的现状,并探讨其与社会支持、自我效能感的相关性。方法·采用整群抽样法,对上海市闵行区浦江镇某社区符合条件的984名老年人进行一般情况、社会支持评定量表、一般自我效能感量表和健康促进生活方式量表（Health Promotion Lifestyle ProfileⅡ,HPLPⅡ）的问卷调查。结果·该社区老年人社会支持总分为40.51±5.92,一般自我效能感总分为2.35±0.58,健康促进生活方式总分为120.44±22.75;社会支持评定量表总分及主观支持、对支持的利用度2项维度的得分,一般自我效能感量表总分均与HPLPⅡ量表各维度得分及总分呈正相关（P＜0.01）;对老年人HPLPⅡ量表总分预测能力较强的因素依次为一般自我效能感量表总分＞社会支持评定量表总分＞子女数＞对支持的利用度得分。结论·城乡结合社区老年人健康促进生活方式水平有待提高,其中营养维度的得分最高,运动锻炼维度得分最低;可以通过改善社会支持以及加强自我效能感的方式来提高社区老年人健康促进行为及健康水平。

Whether metabolically healthy obesity (MHO) is associated with longitudinal changes in high-density lipoprotein cholesterol (HDL-C) remains unclear. MHO was defined as participants with overweight and obesity (BMI ≥ 24.0 kg/m2, n = 2921), free of history of metabolic diseases, and without abnormalities of blood pressure, fasting blood glucose, hemoglobin A1c, lipid profile, carotid artery and liver ultrasonographic findings at baseline. Metabolically healthy normal weight (MHN) was defined as participants with normal weight (BMI < 24.0 kg/m2, n = 9578) and without above-mentioned abnormalities. HDL-C, fasting blood glucose, hemoglobin A1c, and blood pressure were assessed annually. Glucose abnormality was considered if either FBG ≥ 5.6 mmol/L or HbA1c ≥ 5.7%; while, high blood pressure (HBP) was considered if either systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 80 mmHg during 5 years of follow-up. Compared with the MHN group, the adjusted mean difference in HDL-C change rate was − 0.005 mmol/L per year [95% confidence interval (CI) − 0.007, − 0.003] for MHO after adjustment for a series of potential confounders. Furthermore, transiting to abnormality of blood glucose, but not high blood pressure, was associated with lower cumulative average of HDL-C in MHN group, compared with those remained in metabolically healthy status. MHO and transiting from metabolically healthy to abnormality of blood glucose were associated with HDL-C in Chinese adults. III, cohort study.

目的 探索叙事护理培训课程对院校护理教师和临床护理人员的适用性及实施效果.方法 基于前期课程及学员反馈,设计叙事护理培训课程,并对院校护理教师和临床护理人员38人实施该课程,叙事护理培训课程包括师资队伍、学习目标、内容结构、教学方法、教学资源和考核方法6个基本组成部分.培训前后使用叙事护理知识-态度-行为调查问卷、医护人员医学叙事能力量表、中文修订版关怀能力量表调查学员叙事护理相关知识与能力变化,培训后调查学员对课程的评价.结果 培训后学员的叙事护理知识、态度、行为得分,叙事能力各维度得分,以及关怀能力认知和耐心维度得分显著高于培训前(均P＜0.01).超过90％的学员对课程内容、教学方法、授课计划、编写讲义表示满意,全体学员认为经过培训后收获大.结论 叙事护理培训课程以患者疾病故事为载体,能够帮助院校护理教师和临床护理人员实现专业提高及个人成长,具有较好的普适性及推广性.

本研究在实证研究的基础上,理论分析并概括了情境教学在护理人文关怀教学中的应用及应用机制,重点讨论了创设审美情境和体验情境在护理人文关怀教学中的应用注意事项及其发挥的促进审美及移情的心理场效应.

数字故事 (digital storytelling) 是指将叙事与多媒体技术 (如图像、音乐、动画) 相结合, 制作成短视频, 并通过网站或社交媒体传播给更多的群体, 以分享个体的经历[1].故事的种类繁多, 包括生活故事、情感故事、成长故事等.所有的故事都包含着个体的生活经历和人生阅历.目前, 数字故事在教育领域的应用较为广泛[2,3], 在医疗卫生领域中也在不断发展[4].Hardy和Sumner是医疗卫生保健领域中数字故事的推动者, 他们发起了多个项目帮助医护人员和患者研发与他们的经历相关的数字故事.数字故事提供了一个新的平台, 传递患者和医护人员的声音, 提倡医护教育的新方式, 强调同情与移情在临床实践中的重要性[5].因此, 本文就数字故事的概念、历史发展和应用进行综述, 以期为今后的研究提供参考.

Objective: To investigate the current status quo of health self-help behavior of elderly in a community and its influencing factors using a semi-structured interview in a qualitative study. Methods: A phenomenological method is employed for purposive sampling and snowball sampling methods. The elderly (>60 years old), who had lived in the Minhang District of Shanghai for >5 years, with an annual residence duration ≥10 months, were selected. Data were collected in person by a semi-structured and an in-depth interview; the topics were identified according to data arrangement, analysis, and coding. Results: A total of 10 subjects were enrolled, from Pujiang Town, Minhang District of Shanghai. The cohort constituted of 7 males and 3 females, aged 60-68 years, with an average of (63.40±9.19) years. After data arrangement and analysis, the following topics were obtained: (1) various forms of health self-help behaviors existed among elderly in the community; (2) some factors influenced the health self-help behavior among the elderly in the community; (3) a deviation was observed in the health self-help behavior among the elderly in the community. Conclusion: The health self-help behaviors of the elderly in the community should be rectified to carry out self and the environmental establishment of the health self-help behaviors of the elderly in the community, as well as, to guide and develop the personalized health self-help behavior program.

目的:分析国外护理学博士研究生课程设置现状,为优化我国护理学博士研究生课程设置提供参考.方法:通过网络资源调查和实地调查法,收集并分析北美地区8所院校的护理学博士研究生课程设置资料.结果:国外护理学博士研究生课程设置重视护理哲学与理论及高级研究方法,课程主要包括专业基本能力、科研素养、研究方法、跨学科前沿和科研论文写作5大类,灵活使用多种教学及评价方法,重视科研能力、多学科合作能力及创新能力的培养.结论:我国护理学博士研究生教育可以借鉴国外课程设置经验,更新课程设置理念,细化培养能力要求,明确护理专业核心课程设置,优化教学及评价方法,并深化研究领域,以进一步提高护理学博士研究生的培养质量.

目的 了解当前我国护理学硕士学术学位研究生课程设置,拟为教育主管部门和护理院校优化课程设置提供参考.方法 采用问卷调查法,调查了国内66所护理学硕士学术学位研究生培养院校的课程设置情况.结果 护理学硕士学术学位研究生课程类型以公共必修课、专业必修课和选修课为主;66所院校平均设有23.44门课程,护理专业类课程资源不足;课程主要包括思想政治教育、医学专业知识、护理基础理论、研究方法等.院校间学分要求有所差异,64所院校平均总学分为32.07分.结论 我国护理学硕士学术学位研究生课程体系逐渐完善,但存在院校间学分要求差异较大,护理专业课程开设不足等问题.各院校需结合自身情况,从调整学分要求、加强护理专业课程建设、减少医学专业课程等方面优化护理学硕士学术学位研究生课程设置;教育主管部门应帮助各院校更加科学地设置护理专业核心课程.

目的 了解当前我国护理学博士研究生课程设置现状,为进一步优化博士研究生课程设置提供参考.方法 采用问卷调查法,对国内26所护理学博士研究生招生院校的课程设置情况进行调查.结果 我国护理学博士研究生课程类型多样,以公共课、专业课和选修课为主;26所院校平均设有15.42门课程,院校间学分要求差异较大,平均为21.29分;课程内容主要涵盖思想政治、基础理论、研究方法、研究方向、发展前沿和科研写作六大类,但护理专业类课程较少,平均仅为2.38门,有9所院校尚未开设此类课程.结论 我国护理学博士研究生教育尚未形成具有护理学科特色的课程体系,缺乏护理专业核心课程设置标准.各护理学博士学位点院校需加强护理专业课程建设,确定合理的学分数量与分配.同时相关教育主管部门应尽快明确护理专业核心课程,以进一步优化护理学博士研究生的课程设置.

Objective To understand the current situation of healthy self-help behavior among the elderly in the community, in order to provide reference for future intervention.Methods Under the guidance of phenomenological method, the elderly people aged 60 years and over who lived in a community of Minhang district of Shanghai for more than 5 years, and lived for more than 10 months each year were selected as the subjects of study by purposeful sampling and snowball sampling methods. Semi-structured interviews were conducted and Colaizzi's seven-step analysis method was used to analyze the data and refine the theme.Results The following three main themes were obtained: there were the various forms of healthy self-help behavior among the elderly in the community; healthy self-help behavior was related to socio-demographic factors and perceived disease factors; there were deviations of healthy self-help behavior in health understanding, dietary control and lack of exercise.Conclusion Under the guidance of the concept framework of active aging, it is suggested the professional guidance and environmental construction can improve and promote healthy self-help behavior of the elderly in the community.

To explore the inadequacies of health service and its impact on clinical outcomes of patients with systemic lupus erythematosus (SLE) in China. A total of 210 SLE patients were randomly recruited between January 2017 and January 2018. Each patient received self-report questionnaires to assess medication adherence [Compliance Questionnaire for Rheumatology (CQR)], beliefs about medicines [Beliefs about Medicines Questionnaire (BMQ)] and satisfaction about medicine information [the Satisfaction with Information about Medicines Scale (SIMS)]. Associations between SLE disease activity index (SLEDAI-2 K) and observed factors were analyzed by multiple logistic regression. Based on CQR, only 28.10% patients were adherent. The score of BMQ was 2.85 ± 5.42, and merely 32.38% patients were satisfied with the information about their prescribed medicines. Disease activity was associated with SIMS, EuroQol five-dimensions [EQ5D], Systemic Lupus International Collaborating Clinics (SLICC), depression, use of NSAID (P ≤ 0.05). Remission of disease was positively correlated with SIMS (OR = 0.16, 95% CI: [0.06, 0.40]), and BMQ (OR = 0.64, 95%CI: [0.43, 0.94]). In this study, the scores of BMQ and SIMS were low, implying defects in the patient education of health service system, which led to disease flare in Chinese SLE patients. ClinicalTrials.gov ID: NCT03024307 . Registered January 18, 2017.