叙事医学视域下以患者家庭为中心的重症监护室分诊治疗体系构建  

Construction of patient family-centered triage and treatment system in the intensive care unit from the perspective of narrative medicine

作　　者：赵辰茜 褚宏蕊 崔翔宇 ZHAO Chenxi;CHU Hongrui;CUI Xiangyu(School of Clinical Medicine,Jining Medical University,Jining 272067,China;School of Foreign Studies,Jining Medical University,Jining 272067,China)

机构地区：[1]济宁医学院临床医学院,山东济宁272067 [2]济宁医学院外国语学院,山东济宁272067

出　　处：《医学教育研究与实践》2023年第1期99-103,113,共6页Medical Education Research and Practice

基　　金：山东省教育科学“十三五”规划课题(BYGY201925);济宁医学院2018年校级教育科学研究项目(18012);济宁医学院2019年大学生创新训练项目(cx2019119)。

摘　　要：叙事医学是具有叙事能力的医生对患者的困境共情、反思并行动的医疗实践,但完全照搬国外的叙事医学体系不符合中国国情。ICU患者多昏迷、无意识,救与不救的决定权更掌握在家属手里。患者家属和患者缺乏交流、接触,往往不了解患者的真实情况,很难与其共情,心理防线往往先崩溃,进而放弃治疗。要构建符合中国国情的、符合医院院情的、符合科室科情的、以家庭为中心的“叙事-临床医学体系”才能将叙事医学彻底融入我国现行的医疗体系,让医学更有温度、助力医生与疾病之间的博弈。笔者在叙事医学视域下从ICU接诊、分诊到以家庭为中心的诊疗体系以及平行病历书写形式的改进进行了系统的构建,并提出了医患共建平行病历这一观点,以期为今后叙事医学融入我国ICU医疗体系提供参考依据。Narrative medicine is a medical practice in which doctors with narrative ability empathize, reflect and act on the plight of patients, but it is not in line with China’s national conditions to completely copy the foreign narrative medicine system.Most ICU patients are comatose and unconscious, and the decision to save or not to save is in the hands of their families.The patient’s family members and first, and then gives up treatment.To build afamily-centered “narrative-clinical medicine system” that is in line with China’s national hospital conditions, department conditions, and family-centered, narrative medicine can be thoroughly integrated into the current domestic medical system, making medicine more warm and helpful.The game between the doctor and the disease.From the perspective of narrative medicine, the author constructed a system from ICU admission and triage to family-centered diagnosis and treatment system and the improvement of parallel medical record writing, which filled the gap in domestic ICU family-centered ward rounds.This paper puts forward the view that doctors and patients jointly build parallel medical records, in order to provide a reference for the integration of narrative medicine into the domestic ICU medical system in the future.

关 键 词：叙事医学 重症监护室 亚ICU病房 以家庭为中心的查房 家属探视 平行病历 

分 类 号：G642[文化科学—高等教育学]