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Objective:To explore the experience of self-management dilemma ofadults with emerging ankylosing spondylitis, and to provide reference for the construction of self-management intervention strategies for emerging adults with ankylosing spondylitis.Methods:Descriptive phenomenology was used to conduct in-depth interviews with 14 adults with emerging ankylosing spondylitis in the Rheumatology and Immunology Department of Drum Tower Hospital Affiliated to Medical College of Nanjing University from August 2022 to March 2023. The interview data were analyzed by Colaizzi′s seven-step analysis method.Results:A total of 14 patients completed the interview,10 males, 4 females, aged 21-30 years. In adults with emerging ankylosing spondylitis, there were dilemmas of role maladjustment and disease management disorder, including role maladjustment of disease management and social role maladjustment. Barriers to disease management included weak self-management awareness, insufficient support for self-management information, inadequate self-management skills, and poor compliance with self-management behaviors.Conclusions:The role adaptation and self-management ability of adults with emerging ankylosing spondylitis are seriously inadequate. It is urgent to construct health management strategies for adults with emerging ankylosing spondylitis to help them improve the level of role adaptation and disease management.
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Objective Further optimize and improve the path of China's technological governance system,solve the diffi-culties of technological governance,and provide specific ideas for innovative technological governance and optimization of techno-logical autonomy.Methods Elaborate on the dilemma of medical technology governance in China,as simple de administration has not fully activated the conscious and autonomous vitality of medical institution technology governance;Analyze the possible reasons behind the dilemma.Results The main difficulties in governance include difficulty in autonomy,weak supervision,and limited innovation;Analyze the corresponding reasons for insufficient awareness,professional barriers,and structural tension.Conclusion Exploring the path of medical technology governance system from three aspects:activating autonomy,promoting technological innovation through technological governance,and establishing a governance system with multiple entities.The ideal form of technological governance is to shift the focus of technological governance to grassroots medical institutions at all levels and respond to the medical needs of the masses.
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In view of the current norms and demands of human gene editing technology at home and abroad, the paper explained that the regulatory difficulties faced by human gene editing technology were due to the conflict between economic interests and moral bottom line by constructing a game model in a hypothetical way. On this basis, the ideas of the supervision mode of human gene editing technology were put forward: establish unified international standards based on the country as the main body, enact more stringent and effective laws, to jointly deal with the behavior of genetic manipulation of human gametes, zygotes and embryos for the purpose of reproductive, and ensure the normalization and legalization of gene editing technology to avoid technology abuse.
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【Objective:】 To understand the moral dilemma, coping style of frontline nurses and their correlation during the COVID -19. 【Methods:】 From March to April, 2021, 651 nurses working in designated hospitals for COVID -19 were selected by convenient sampling, and the Chinese version of Moral Distress Scale-Revised (MDS-R) and Chinese version of Coping Style Questionnaire (CSQ) were used for investigation. 【Results:】 Frontline nurses’ MDS-R score was 91.0, "value conflicts" was the moral dilemma with the highest frequency and intensity, more than half (51.0%) of the respondents had considered leaving their position because of moral dilemma. "Problem solving" and "seeking for help" were the major coping strategies adopted by the nurses. Nurses who directly provide medical services for COVID -19 patients, dissatisfied with hospital-related training and adopted negative coping strategies had higher moral dilemmas than other nurses. 【Conclusion:】 The moral dilemma of frontline nurses is at a high level during the period of epidemic prevention and control. Nursing managers should pay attention to guiding and helping nurses to establish positive coping styles and improve their ability to respond to major public health emergencies.
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【Objective:】 To understand the true experience and feelings of nurses in the intensive care unit on the clinical experience of moral dilemmas, and to provide strategies for reducing the impact of moral dilemmas. 【Methods:】 Thirteen nurses in the intensive care unit were interviewed face to face by descriptive nature research method. The traditional content analysis method were used to compute the data, and the coding, categorization and topic extraction were carried out cyclically until the data were saturated and the interview was stopped. 【Results:】 The moral dilemma experience of nurses in the intensive care unit had the following three themes: negative psychological experience, negative behavior experience, and life and death cognitive experience. 【Conclusion:】 Nurses in the intensive care unit will have complex negative experiences after experiencing moral dilemmas. This negative experience threatens nurses’ mental health. Nursing managers should pay attention to the impact of moral dilemmas on nurses and formulate effective measures, thereby ensure nursing safety and maintain the healthy development of the nursing team.
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This paper analyzes the main obstacles in the process of promoting the integration of medicine and prevention in China,including the mindset of prioritizing medical care over prevention,fragmented system architecture,conflicting direction of funding and incentives,and inherent contradictions in the division of labor and cooperation in service provision.Furthermore,this article attempts to present the current status and constraints of medical and health integration in China from the perspectives of management mechanisms and service mechanisms,highlighting the mismatch between these two aspects as the root cause.It proposes that the reform logic of current medical and health integration practices should prioritize the service mechanism.This involves clarifying the service interface of medicine and prevention integration and establishing patient-centered service pathways for integration.In the establishment of the service mechanism,a balance should be struck between efficiency and quality,while also integrating based on division of labor.Subsequently,adjustments to the management mechanism should be made in accordance with the medicine and prevention integration service mechanism.In the reform of the management mechanism,various stakeholders'interests should be coordinated and the costs of reform should be controlled.
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The role and function of nurses in the application of assisted reproductive technology were sorted out.Addressing potential ethical dilemmas,this paper analyzed the restrictive factors in dealing with difficulties in nursing practice and proposed the construction of a nursing ethics literacy system.It is suggested to improve ethical rules and education systems,strengthen case education,enhance risk prevention capabilities,and cultivate a healthy ethical culture,so as to effectively enhance nurses'ethical literacy.
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Due to the particularity of the Intensive Care Unit(ICU)environment,the visiting time of family members is strictly limited,resulting in family members being unable to communicate with patients in time to understand their wishes and preferences.Moreover,the sudden onset of the diseases and clinical uncertainty can easily lead to ambivalence among family members in decision-making,leading to decision-making dilemmas.This paper reviewed the concepts,assessment tools,causes,effects,and coping strategies of decision-making dilemmas for family members of ICU patients,with a view to providing a theoretical basis for future intervention in decision-making dilemmas for family members of ICU patients,improving their quality of agency decision-making,shortening patient hospitalization time,improving the health outcomes of patients,and ultimately increasing the satisfaction of medical and nursing.
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Medical internship is a yearlong experience that is physically, mentally, and emotionally exhausting. After five years as students, the interns finally get close to achieving what they have always dreamt of. Most of the fundamental clinical knowledge and skills that a student learns are acquired during their internship. For the first time, students gain financial freedom, recognise the importance of a white coat, and are recognised as doctors. Internship helps a student to realise the mechanics of how a hospital operates, how patients are treated, how crises are managed, and most crucially, how to think and work productively in a chaotic yet effective atmosphere. Each obstacle encountered serves as a training ground. The key dilemmas are whether to prioritise learning clinical skills or study for the post-graduation entrance examinations, and which specialty to opt for. Conscientious mentors are vital to this whole process.
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The solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is a relatively uncommon entity. The aim of the present study was to summarize our experiences with regard to diagnostic dilemma, surgery, postoperative follow-up, and management. This retrospective data were collected during the period from January 1, 2018 to December 31, 2020. A total of four patients (three females and one male) were identified within an age range of 13 to 25 years. All the patients were presented with nonspecific symptoms such as abdomen lumps, swelling in the abdomen, and abdominal pain. To reach a definite diagnosis, imaging studies were conducted along with endoscopic ultrasound fine-needle aspiration (EUS-FNA) and biopsy. After confirmation of SPEN on biopsy, all the patients underwent surgery without any complications. Patients are on follow-up, and to date, no metastasis has been detected. SPEN is a rare pancreatic tumor with unusual pathological features leading to a diagnostic dilemma. The pathologist should be familiar with SPEN and its salient histological characteristics that differentiate it from other look-alike pancreatic tumors and can help in timely surgery and management.
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Objective:To systematically evaluate the qualitative studies on the decision dilemma of blood glucose management during pregnancy in patients with gestational diabetes mellitus, so as to provide reference for the subsequent formulation of intervention strategies.Methods:The qualitative studies on the decision dilemma of blood glucose management during pregnancy in patients with gestational diabetes mellitus in the Cochrane Library, CINAHL, EMbase, PubMed, PsycINFO, ProQuest, Web of Science, China National Knowledge Internet, Wanfang, VIP and Chinese Biomedical Database were searched from inception to May 2022. The JBI Critical Appraisal Tool for qualitative studies in Australia (2016) was used to evaluate the literature quality, and research results were summarized and integrated by integrating methods.Results:A total of 13 studies were included, 56 themes were extracted, and they were summarized into 9 categories, forming 3 integrated results as following, lack of personalized and professional information on blood glucose management, worring about the influence of blood glucose management on the health of mothers and children, conflict between daily life and blood glucose management plan.Conclusions:Health care workers should provide gestational diabetes mellitus patients with adequate personalized professional information support on blood glucose management to facilitate scientific decision-making during pregnancy, and also analyze the benefits and risks of different decisions for patients to help them make the best decision and strengthen their external support system to help them implement blood glucose management decisions.
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Objective:To explore the correlation between nurses′ workplace adaptability, moral dilemma and resilience after suffering workplace violence in emergency department, in order to provide reference about improving the workplace adaptability and formulating intervention.Methods:A cross-section survey was conducted, we selected 248 nurses who had suffered workplace violence in the emergency department of five tertiary hospitals in Qingdao from January 2022 to January 2023 by convenient sampling method, and used self-designed general information questionnaire, moral dilemma scale, resilience evaluation scale for medical staff and nurses′ workplace adaptability scale to conduct a questionnaire survey on nurses who had suffered workplace violence, and found out the factors affecting their workplace adaptability.Results:The score of workplace adaptability of 248 nurses who had suffered workplace violence was (39.37 ± 12.77) points. Univariate analysis showed that education, length of emergency service, department or social part-time job, professional title, number of night shifts and sleep condition were the influencing factors of workplace fitness for emergency nurses ( t/ F values were -12.72 to 132.15, all P<0.05). The correlation analysis showed that the nurses′ workplace adaptability after workplace violence was negatively correlated with the scores and total scores of all dimensions of moral dilemma ( r values were -0.725 to -0.194, P<0.05), and positively correlated with the scores and total scores of all dimensions of resilience ( r values were 0.135 to 0.732, P<0.05). Multi-factor results showed that education background, department/social part-time job, working years, professional title, sleep status, moral dilemma and resilience were the influencing factors of nurses′ workplace adaptability after workplace violence ( t values were -9.25 to 15.25, P<0.05). Conclusions:Nurses with specialized education, emergency service for 1-3 years, no department/social part-time job, primary professional title, sleep disorder, higher degree of moral dilemma and low level of resilience have low occupational adaptability. Nursing managers should focus on such nurses and improve their occupational adaptability.
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High-quality hospital development calls for high-quality hospital culture.Hospital culture is the core of hospi-tal management,which deeply affects the development direction and operation mode of the hospital,throughout the whole process of high-quality development of the hospital,but also an indispensable component of social culture.This paper discusses and con-siders the definition and value of hospital culture,the dilemma of the ideological level and management level of hospital culture construction,and countermeasures,which provides a reference for hospital management and promotes the high-quality develop-ment of hospitals.
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Objective Based on"timing it right"framework,this study explored the dynamic changes of care dilemma in caregivers of adolescents with mood disorder and non-suicidal self-injury at different stages of disease development,and provided support for the construction of intervention programs.Methods This study adopted phenomenological research and purposive sampling method to select 11 caregivers of adolescents with mood disorders and non-suicidal self-injury behavior who were treated and hospitalized in a tertiary A psychiatric hospital in Henan Province from May 2022 to February 2023 as research subjects.According to the"timing it right"theory,5 semi-structured interviews were conducted with caregivers during the adolescent diagnostic period,hospitalization period,discharge preparation period,adjustment period,and adaptation period.The data was analyzed by the Colaizzi 7-step analysis method.Results The following themes were summarized.①Diagnostic period:complex emotional reactions,facing a dilemma at a loss.②Hospitalization period:lack of knowledge of disease and childcare,self-conscious care difficulties.③Discharge preparation period:lack of confidence in home care and lower expectations for the future of adolescents.④Adjustment period:lack of care skills and desire professional care support.⑤Adaptation period:negatively coping with diseases,with persistent care difficulties.Conclusion The care dilemma of caregivers of adolescents with mood disorders and non-suicidal self-injury behavior in different stages of disease development is dynamic.Medical staff should provide personalized professional support in a planned and continuous manner based on their different stages of care experience and needs,in order to improve the quality of their care and promote adolescent rehabilitation.
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Promoting medical preventive integration and improving its collaborative mechanism is an inevitable requirement for achieving the transformation of China′s medical and health care system from " disease centered" to " people′s health centered" and providing comprehensive and comprehensive health services for the people.This study established a research framework based on the SFIC model on the basis of clarifying the collaborative subjects of medical preventive integration, sorted out the dilemma of medical preventive integration collaborative governance in China from five aspects, including external environment, starting conditions, facilitative leadership, institutional design and collaborative process.In order to break the dilemma of medical preventive integration and promote collaborative governance among multiple subjects, the authors proposed such optimization strategies, including further improving relevant laws, regulations, and policy systems, filling resource gaps, attracting multiple entities to participate, providing reference for promoting China′s medical preventive integration work.
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Modern medical model advocates holistic medical treatment and holistic care, which transforms the concern about diseases in traditional medicine into the concern about people in modern medicine. Narrative medicine, as a tool for practicing holistic medical treatment and holistic care, runs through the whole process of patients’ entering medical procedures. It not only meets the needs of patients’ disease-related narratives, but also provides a new and more comprehensive way of communication for both doctors and patients, which is helpful to promote the comprehensive recovery of patients and the healthy development of doctor-patient relationship. At present, narrative medicine is facing some difficulties in the process of local practice in China. Social work, as one of the main bodies of multi-disciplinary and inter-professional cooperation in the medical field, can give full play to its professional advantages to help the new exploration of narrative medicine practice in China.
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With the arrival of aging, various industries in society are facing great pressure, especially higher requirements for the medical and nursing industries. The integrated eldercare services with medical care breaks through the traditional endowment pattern and integrates medical treatment, elderly care, rehabilitation, and nursing. However, many factors hinder the development of this model at present, and it requires the cooperation of the country and various departments to improve. From the perspective of a Healthy China, based on the release and implementation of policies such as the "Healthy China 2030" Plan Outline and the "Healthy China Action (2019-2030)" , this paper briefly summarized the current status and existing problems of the development of integrated eldercare services with medical care in China, and put forward rectification suggestions, aiming to provide reference to build a new endowment pattern of integrated eldercare services with medical care with Chinese characteristics.
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Ethical dilemmas commonly exist among nurses during the epidemic prevention and control of major infectious diseases, which can affect their physical and mental health and nursing quality. This paper reviewed the ethical dilemmas of nurses in the epidemic prevention and control of major infectious diseases from four aspects, including concepts, current situation, evaluation tools, and influencing factors, with a view to raising the attention of nurses, nursing administrators, and health management organizations to the ethical dilemmas of nurses in the epidemic prevention and control of major infectious diseases, and providing theoretical references for further formulating strategies. In terms of ethical dilemmas research of nurses during the prevention and control of major infectious diseases, domestic and foreign studies mostly used scales and qualitative interviews to investigate. Research has found that the ethical dilemmas of nurses during the period include the ethical dilemma of visiting restrictions, the ethical dilemma of fair allocation of scarce resources, and the ethical dilemma of nurses’ rights and obligations. The main influencing factors include demographic factors, psychological factors, risk perception, and social support. It is recommended to develop suitable assessment tools from the perspective of ethical in the future, timely grasp the current situation of ethical dilemmas of nurses during the prevention and control of major infectious diseases, and deeply explore influencing factors.
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The positive role of hospice social work in responding to the needs of terminal cancer patients and their families has been highlighted, and has also triggered discussions on localized ethical issues. Taking the casework of terminal cancer patients as an example, this paper analyzed the specific manifestations and causes of ethical dilemmas in the practice of hospice social work, and then provided ideas for coping with them. It was found that hospice care casework workers face four ethical dilemmas, including quality of life dilemmas, emotional boundaries dilemmas, power relationship dilemmas, and cultural respect dilemmas. Service managers can enhance the ethical issue response ability of front-line workers by improving the collaborative service mechanism between medical and social institutions, constructing a whole-process professional supervision system, conducting skills training for caring social workers, and expanding patient and family life education services. The ethical dilemmas in hospice social work service are localized, and will affect the service effect. The response to these issues requires the joint participation of the government, society, universities, hospitals, and front-line social workers.
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The retention of emergency patients is a common problem faced by hospitals worldwide. In addition to medical problems, social, family, economic and other problems will also cause patients to stay in the emergency department. It not only brings challenges to patients’ own disease treatment and hospital operation and management, but also brings ethical dilemmas. Taking the service cases of medical social workers who involved in stranded patients in Shanghai E Hospital as an example, this paper analyzed 20 service records and interviews with social workers receiving cases, and combed the ethical dilemmas faced by medical social workers in the process of involving in emergency stranded patients. It was found that medical social workers faced many ethical dilemmas in the process of involving in emergency stranded patients, such as interpersonal relations and relevant legal regulations, the right to life and health and the right to informed consent, the self-determination of case owners and the allocation of medical resources. In this regard, it is suggested to solve the problem of patient retention by advocating the improvement of relevant systems and policies, building cooperative teams to smooth referral channels, strengthening education, and promoting family shared decision-making.