华人生死学
医疗情境死亡话语素养:疼痛科门诊生命关怀谈话“观点展示三步法”
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1.北京大学医学部;2.清华大学长庚医院

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国家社科基金重点项目“当代中国‘死亡话语’及发展考察”( 19AYY001);北京大学医学部教育教学研究课题成果(2020YB25);中华医学会医学教育分会和全国医学教育发展中心2023年医学教育研究立项重点课题 (2023A03);中国外语战略研究中心-外教社“世界语言与文化研究”项目(WYZL2023BJ002)。


Death Discourse Literacy in Clinical SettingsThe Three-step Perspective Display Device in Life Care Talk at the Clinic of Pain Management
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School of Health Humanities, Peking University,Beijing Tsinghua Changgung Hospital

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    摘要:

    近年来,随着老龄化社会的到来,安宁疗护、缓和医疗等新兴理念逐渐在国内得到重视和推广。“死亡”这一传统禁忌话题正在经历着从被暗示到被言说的变化,死亡话语相关研究逐渐兴起。本研究聚焦安宁疗护医疗情境中医护人员的死亡话语素养,选取北京市某安宁疗护示范基地所在医院为研究场景,通过社会语言学民族志研究方法,观察和收集疼痛科门诊医生与癌痛、老年患者之间的会话录音和录像。按照会话分析传统对数据进行转写和系统分析。研究发现医护人员的死亡话语素养主要表现为出诊时与患者开展生命关怀谈话。语料分析进一步显示,医生通过实施“观点展示三步法”来开展生命关怀谈话,践行死亡话语素养。该模式呈现了在医患互动中由医生发出的三个行为序列:邀请患者展示观点、医生给出回应和评价,以及医生展示生命关怀观点。鉴于“邀请患者展示观点”是三步法中最重要、最基础,也最具有挑战性的行为,本文进一步重点论述了邀请患者展示观点的具体实施途径,详细阐述了直接邀请和间接邀请的实施过程与效果。研究对探索医护人员死亡话语素养的提高、改进安宁疗护门诊医患沟通质量,以及从整体上推进生命关怀与教育的开展有直接的借鉴意义。

    Abstract:

    In response to the challenges posed by an aging society, palliative care and hospice have been introduced and promoted as crucial components in constructing a comprehensive Health Care System for the Elderly. There has been a notable shift in the discourse surrounding "death", transitioning from a traditional taboo to an openly discussed topic. This trend has sparked increased scholarly interests in death discourse.Our study focuses on the death discourse literacy of medical professionals, exploring how doctors communicate end-of-life care and life care issues with patients and their families in a Pain Management Clinic. The research was conducted at a public hospital in Beijing, recognized as a model base for hospice. Ethnographic methods were used to observe and collect data on doctor-patient communication in everyday clinical practices. Audio and video recordings of doctor-patient conversations were collected and transcribed for systematic analysis. The study found that doctors' death discourse literacy is primarily demonstrated through life care conversations with patients and their families. Experienced doctors typically employ a "Three-step Perspective Display Method" to facilitate these discussions. The method was illustrated with concrete instances taken from the data. The paper then discusses in detail the implementation of the first step, inviting patients to display their perspectives, from two aspects: direct invitation and indirect invitation. Through the analysis, this paper offers practical patterns and models for clinical practitioners to improve the quality and effectiveness of communicating end-of-life issues and conducting life care and education, particularly in clinical settings.

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李芳,路桂军.医疗情境死亡话语素养:疼痛科门诊生命关怀谈话“观点展示三步法”[J].华人生死学,2024,(1):92-105

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  • 收稿日期:2024-06-17
  • 最后修改日期:2024-06-17
  • 录用日期:2024-06-18
  • 在线发布日期: 2024-07-11
  • 出版日期: 2024-07-05
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