在校护理本科生对临终关怀认知的调查研究
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摘要
目的:通过调查,了解在校护理专业本科生临终关怀认知现状,分析其认知度差异,并对可能的影响因素进行分析;根据调查结果,探讨适合我国护理本科生的临终关怀教育内容、方法及手段等,为相关教学提供佐证。
方法:对吉林省三所护理本科院校的护理本科生采用一般资料评估表、临终关怀知识问卷和临终关怀态度问卷进行调查。
结果:在校护理本科生临终关怀知识问卷所有项目的均分0.5953±0.14937,其中临终关怀心理社会精神方面知识得分最高,而临终关怀哲理与原则方面的知识得分较低;调查对象在不同学校、实习经历、双亲健康状况方面得分有显著性差异(P<0.05)。临终关怀态度问卷所有项目的均分为3.0754±0.37181,其中临终关怀服务对象需求评估与个人死亡态度得分较高,临终关怀态度评估得分较低;调查对象在不同实习经历、宗教信仰、临终病人接触经验及接触死亡经验情况下得分有显著性差异(P<0.05)。
结论:护理本科生临终关怀基本知识了解不够深入;普遍缺乏临终关怀哲理和原则方面的知识;疼痛控制相关知识相对薄弱。其临终关怀知识受多种因素影响,与学校、实习经历、父母亲健康状况有关。护理本科生在临终关怀态度评估方面不够乐观,但在临终关怀服务对象需求评估与个人死亡态度方面更为积极。其实习经历、宗教信仰、临终病人接触经验及接触死亡经验对临终关怀态度有影响,而年龄、民族、家庭型态等因素对临终关怀态度得分无显著性差异。
Objective: With the population aging, the change of disease spectrum, and the change of rank order of causes of death, hospice care has become the urgent needs of our society. Compared to more mature mode of hospice care education in foreign countries, there are many problems both in the content and means of teaching in China. The topic based on the present situation of hospice care education in nursing undergraduates, to understand the situation of konwledge and attitude towards hospice care in the students by the investigate on the cognition of hospice care in Undergraduate nursing students in JiLin Province; analyzing the difference of congnition of hospice care, to find the influencing factors; discussing the content, methods and means in hospice care which is situable for China, in order to provide evidence related to teaching.
Methods:
1. Investigation Method We use the non-probability sampling method to extract three school which has nursing undergraduates in Jilin province, and extracting different grades of nursing undergraduates from three schools as participants in the survey by stratified random sampling method from April 2008 to July 2008. The investigation object should express their understanding and support of the research, and participate the study voluntary; everyone should correctly understand the meaning of each entry. 460 copies of questionnaires were distributed, 430 valid questionnaires were received.
2. The design and selection of the questionnaire The questionnaire contain three parts: the general assessment of the survey form, including sex, age, nation, native place, education, grades, internship experience, family model, religion, parental age and health status, the experiences of the contact with dying patients and death, the sources of hospice care knowledge; hospice care knowledge questionnaire, self-designed, according to the relevant research of hospice care theory and knowledge, and according to palliative care knowledge questionnaire (PCQN) Chinese version of Scale which translated and revised by the ZOU Min (2007), including four dimensions, basic knowledge of hospice care, hospice philosophy and principles of pain control, psycho-social and spiritual support; hospice care attitude questionnaire, referring to the relevant literature both at home and abroad, self-designed, including three dimensions, hospice care attitude assessment, hospice services needs assessment, and personal attitudes toward death.
3. Pre-investigation As a result of the use of self-designed questionnaire in this study, selectting 45 cases of nursing undergraduates to answer the questionaire, in order to test the reliability and validity of the questionnaire. The Cronbach'Alpha for hospice care knowledge questionnaire in nursing undergraduates is 0.702, and the Cronbach'Alpha for hospice attitude questionnaire is 0.674, showed that the content of questionnaires has good internal consistency. 23 of them were selected after 28 days to test again in order to check the test-retest reliability of questionnaire, test-retest results showed the correlation coefficient is 0.703,explained that the questionaire has good stability.
4. Statistics treatment We use the statistical analysis software SPSS15.0 to describe and analyze the result, describing of measurement data with mean±standard deviation, the comparison between two groups data use t tests, multiple comparison of the data use analysis of variance, two variables related use the Pearson correlation analysis. P≤0.05 considered to have statistically significant.
Results:
1. The average evaluation scores of hospice care knowledge questionnaire is 10.71±2.69, and the average accuracy rate is 61.6%. The average evaluation scores of all subjects is 0.5953±0.14937, compared in four dimensions of the hospice care knowledge questionnaire, t test shows that has statistical significance(P<0.05), the highest score is the score of psycho-social spiritual knowledge, but the score of hospice care philosophy and principles of knowledge is lower than others. The scores of people who being investigated of different schools, internship experience and health status of parents has significant difference(P<0.05), but the scores of hospice care knowledge in different age, nation, family patterns, religious beliefs has no significant difference.
2. The aggregate score of hospice care attitude questionnaire is 58.42±7.06. The average evaluation scores of all subjects is 3.0754±0.37181, compared in three dimensions, t test shows that has statistical significance(P<0.05), the scores of needs assessment of hospice care clients(NO.2 dimension)and personal attitudes toward death(NO.3 dimension) are higher , but the score of attitude assessment of hospice care(NO.1 dimension)is lower than other areas obviously. Internship experience, religious belief ,experience of contact with terminal patients and experience of contact with death all have influence on hospice care attitude(P<0.05), but different age, nation and family patterns effect on hospice care attitude has no significant difference.
Conclusion: The survey results showed that nursing students understand the basic knowledge of hospice care is not deep enough, most of them lack of hospice philosophy and principles of knowledge, knowledge of pain control is relatively weak; their hospice knowledge is related with the facts of schools, internship experience,and parents factors such as health status. Nursing undergraduates in attitude assessment of hospice care are also not optimistic, but the dimensions of hospice services needs assessment and personal attitudes toward death are more positive; their internship experience, religious belief ,experience of contact with terminal patients and death experience have influence on hospice care attitude(P<0.05).
China has entered the aging society, there has a major social benefits to promote the progress of hospice care. Compared with foreign countries, hospice care in China have a lot of deficiency no matter on the aspect of teaching or evaluation tools, there has a urgent needs for hospice care education, the education can be done from the following aspects: asked for the national policies’support; Strengthen the hospice care education; improved the attitude toward hospice care through Death Education.
方法:对吉林省三所护理本科院校的护理本科生采用一般资料评估表、临终关怀知识问卷和临终关怀态度问卷进行调查。
结果:在校护理本科生临终关怀知识问卷所有项目的均分0.5953±0.14937,其中临终关怀心理社会精神方面知识得分最高,而临终关怀哲理与原则方面的知识得分较低;调查对象在不同学校、实习经历、双亲健康状况方面得分有显著性差异(P<0.05)。临终关怀态度问卷所有项目的均分为3.0754±0.37181,其中临终关怀服务对象需求评估与个人死亡态度得分较高,临终关怀态度评估得分较低;调查对象在不同实习经历、宗教信仰、临终病人接触经验及接触死亡经验情况下得分有显著性差异(P<0.05)。
结论:护理本科生临终关怀基本知识了解不够深入;普遍缺乏临终关怀哲理和原则方面的知识;疼痛控制相关知识相对薄弱。其临终关怀知识受多种因素影响,与学校、实习经历、父母亲健康状况有关。护理本科生在临终关怀态度评估方面不够乐观,但在临终关怀服务对象需求评估与个人死亡态度方面更为积极。其实习经历、宗教信仰、临终病人接触经验及接触死亡经验对临终关怀态度有影响,而年龄、民族、家庭型态等因素对临终关怀态度得分无显著性差异。
Objective: With the population aging, the change of disease spectrum, and the change of rank order of causes of death, hospice care has become the urgent needs of our society. Compared to more mature mode of hospice care education in foreign countries, there are many problems both in the content and means of teaching in China. The topic based on the present situation of hospice care education in nursing undergraduates, to understand the situation of konwledge and attitude towards hospice care in the students by the investigate on the cognition of hospice care in Undergraduate nursing students in JiLin Province; analyzing the difference of congnition of hospice care, to find the influencing factors; discussing the content, methods and means in hospice care which is situable for China, in order to provide evidence related to teaching.
Methods:
1. Investigation Method We use the non-probability sampling method to extract three school which has nursing undergraduates in Jilin province, and extracting different grades of nursing undergraduates from three schools as participants in the survey by stratified random sampling method from April 2008 to July 2008. The investigation object should express their understanding and support of the research, and participate the study voluntary; everyone should correctly understand the meaning of each entry. 460 copies of questionnaires were distributed, 430 valid questionnaires were received.
2. The design and selection of the questionnaire The questionnaire contain three parts: the general assessment of the survey form, including sex, age, nation, native place, education, grades, internship experience, family model, religion, parental age and health status, the experiences of the contact with dying patients and death, the sources of hospice care knowledge; hospice care knowledge questionnaire, self-designed, according to the relevant research of hospice care theory and knowledge, and according to palliative care knowledge questionnaire (PCQN) Chinese version of Scale which translated and revised by the ZOU Min (2007), including four dimensions, basic knowledge of hospice care, hospice philosophy and principles of pain control, psycho-social and spiritual support; hospice care attitude questionnaire, referring to the relevant literature both at home and abroad, self-designed, including three dimensions, hospice care attitude assessment, hospice services needs assessment, and personal attitudes toward death.
3. Pre-investigation As a result of the use of self-designed questionnaire in this study, selectting 45 cases of nursing undergraduates to answer the questionaire, in order to test the reliability and validity of the questionnaire. The Cronbach'Alpha for hospice care knowledge questionnaire in nursing undergraduates is 0.702, and the Cronbach'Alpha for hospice attitude questionnaire is 0.674, showed that the content of questionnaires has good internal consistency. 23 of them were selected after 28 days to test again in order to check the test-retest reliability of questionnaire, test-retest results showed the correlation coefficient is 0.703,explained that the questionaire has good stability.
4. Statistics treatment We use the statistical analysis software SPSS15.0 to describe and analyze the result, describing of measurement data with mean±standard deviation, the comparison between two groups data use t tests, multiple comparison of the data use analysis of variance, two variables related use the Pearson correlation analysis. P≤0.05 considered to have statistically significant.
Results:
1. The average evaluation scores of hospice care knowledge questionnaire is 10.71±2.69, and the average accuracy rate is 61.6%. The average evaluation scores of all subjects is 0.5953±0.14937, compared in four dimensions of the hospice care knowledge questionnaire, t test shows that has statistical significance(P<0.05), the highest score is the score of psycho-social spiritual knowledge, but the score of hospice care philosophy and principles of knowledge is lower than others. The scores of people who being investigated of different schools, internship experience and health status of parents has significant difference(P<0.05), but the scores of hospice care knowledge in different age, nation, family patterns, religious beliefs has no significant difference.
2. The aggregate score of hospice care attitude questionnaire is 58.42±7.06. The average evaluation scores of all subjects is 3.0754±0.37181, compared in three dimensions, t test shows that has statistical significance(P<0.05), the scores of needs assessment of hospice care clients(NO.2 dimension)and personal attitudes toward death(NO.3 dimension) are higher , but the score of attitude assessment of hospice care(NO.1 dimension)is lower than other areas obviously. Internship experience, religious belief ,experience of contact with terminal patients and experience of contact with death all have influence on hospice care attitude(P<0.05), but different age, nation and family patterns effect on hospice care attitude has no significant difference.
Conclusion: The survey results showed that nursing students understand the basic knowledge of hospice care is not deep enough, most of them lack of hospice philosophy and principles of knowledge, knowledge of pain control is relatively weak; their hospice knowledge is related with the facts of schools, internship experience,and parents factors such as health status. Nursing undergraduates in attitude assessment of hospice care are also not optimistic, but the dimensions of hospice services needs assessment and personal attitudes toward death are more positive; their internship experience, religious belief ,experience of contact with terminal patients and death experience have influence on hospice care attitude(P<0.05).
China has entered the aging society, there has a major social benefits to promote the progress of hospice care. Compared with foreign countries, hospice care in China have a lot of deficiency no matter on the aspect of teaching or evaluation tools, there has a urgent needs for hospice care education, the education can be done from the following aspects: asked for the national policies’support; Strengthen the hospice care education; improved the attitude toward hospice care through Death Education.
引文
[1]廖春玲.高职生临终关怀教育课程设置初探[J].卫生职业教育, 2004,22(1):29-30.
[2]孟宪武,崔以泰.临终关怀[M].天津:天津科学技术出版社,2002.
[3]李义庭,李伟,刘芳,等.临终关怀学[M].北京:中国科学技术出版社,2000.
[4]殷磊.护理学基础[M].第3版.北京:人民卫生出版社,2004.
[5]许婷婷.临终关怀中的人文护理模式研究[D].山东:山东大学,2007.
[6]黄天中.临终关怀理论与发展[M].台北:强业出版社,1988:9
[7] Marian A. and Theovan A.The content and effects of palliative care courses for nurses: A literature review [J]. International Journal of Nursing Studies,2008, 45(3):471-485.
[8]金河严,朴泰洙.心理学[M].北京:中央民族大学出版社,2000
[9]陈四光.心理健康视野下大学生死亡态度及生命教育研究[D].江西:江西师范大学教育学院,2006.
[10]马国亮.护理学校学生死亡态度现状研究[D].郑州:郑州大学教育学院,2006.
[11]卞燕,何仲.我国的临终关怀事业发展[J].南方护理学报,2004,11(7):26.
[12]余悦,周绿林.关于我国临终关怀发展策略的思考[J].医学与哲学, 2006,27(1):65.
[13]徐勤.美国临终关怀的发展及普及http://www.ocan.cn
[14]陈真奋.临终关怀对晚期恶性肿瘤病人生命质量的影响[J].当代护士, 2004,4:50-52.
[15]余春华,付岚,向秋芬,等.临终关怀对癌症病人家属生活质量的影响[J].现代护理,2006,12(21):1961-1963.
[16]黄海珊,张静平,邓小梅.刍议建设有中国特色的临终关怀[J].医学与社会, 2006,19(9):36-38.
[17]路雪芹,白琴.开展本土化临终关怀面临的问题与挑战[J].中国老年学杂志,2007,3(27):299-300.
[18]王琳,梁椰林.护理专业增设“临终关怀”的教学实践与思考[J].白求恩军医学院学报,2005,3(3):183
[19]傅静,谭道玉.护理学本科开设《临终关怀学》课程的必要性[J].现代护理,2007,13(33):3220-3221
[20]张杰,平川仁尚,吴锦屏.全国医科大学医学专业临终关怀教育的调查[J].云南医药,2008,29(5):508-509.
[21]赵梅,高标.医护本科学生对待死亡及临终关怀态度的调查[J].安徽医科大学学报,2003,38(3):237-239.
[22]曾凡,曾铁英.护生对待死亡的态度及其影响因素调查[J].护理学杂志,2007,22(20):6-8.
[23] Judy L. M. The impact of a palliative care educational component on attitudes toward care of the dying in undergraduate nursing students [J]. Journal of Professional Nursing, 2003,19(5):305-312.
[24] Kwekkeboom K,Vahl C, Eland J. Education: professional and lay: Student companion program improves knowledge and attitudes toward palliative care [J]. The Journal of Pain,2004,5(3):s136.
[25]Arolker M.S, Johnson M.J.Palliative care in non-malignant disease [J]. Medicine, 2008,36(2):96-99.
[26] Saori H.Support required for palliative care teams in university hospitals: survey of movements and attitudes of cancer patients at hospital discharge [J]. European Journal of Pain Supplements,2007,1(1):84.
[27] Shujun L, Lijun D, Gouhong S.Survey of the attitude of 428 clinicians to palliative care of cancer patients [J]. European Journal of Pain, 2001,5(1):129.
[28] Liz S, Lindsey B. Palliative care in the community for children with cancer in South East England [J]. European Journal of Oncology Nursing,2001,5(3):190-197.
[29] Gelene T. Effects of End-of-Life Education on Baccalaureate Nursing Students [J]. AORN,2005,82(3):434-440.
[30]陈刚. 592名欧洲医生对医学教育中“临终关怀”教育的评价[J].国外医学.护理学分册,2000,21(4):20,31.
[31] George E, David C. Palliative care and end of life issues in UK pre-registration, undergraduate nursing programmes [J]. Nurse Education Today,2008,28(2):163-170.
[32] Natalie S, Jeanne K. The impact of a distance learning death and dying course: An analysis of student self-reported changes [J]. Nurse Education Today,2005,25(7):509-518.
[33] Joakim E, Erik B, Birgitta H,et al. Palliative sedation at end of life-A systematicliterature review [J]. European Journal of Oncology Nursing. 2007,11(1):26-35.
[34] Michael J Y. Transforming Doctor-Patient Relationships to Promote Patient-Centered Care: Lessons from Palliative Care [J]. Journal of Pain and Symptom Management,2007, 33(1):40-57.
[35]郑悦萍.医护人员临终关怀照护知识、态度及相关因素研究[D]湖南:中南大学护理学院,2008.
[36]茅竞伟,乔丽枝.谁来关怀临终关怀[J].世界医学杂志。2005,(3).
[37]孟宪武.中国临终关怀工作的开展及其前景展望[J].肿瘤防治杂志, 2003,10(1):17-20.
[38]王平,李海燕.死亡与医学伦理[M].武汉.武汉大学出版社,2005.
[39]胡苏珍,卢慧娟.护理本科教育设立临终关怀课程的必要性及建议[J].护理学杂志,2008,23(4)(外科版):22-23.
[40] Reginald D, Jan L. B, Robert V S,et al. Truth-telling at the end of life: A pilot study on the perspective of patients and professional caregivers [J]. Patient Education and Counseling,2008,71(1):52-56.
[41] Peretti W, Bendiane M K, and Moatti J P. Attitudes toward palliative care, conceptions of euthanasia and opinions about its legalization among French physicians [J]. Social Science & Medicine, 2005,60(8):1781-1793.
[42] David E W, Linda B. Education in Palliative Care [J]. Clinics in Geriatric Medicine,2005,21(1):165-175.
[43] Colleen S M, Barry R, William B. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients [J]. The Lancet, 2003, 361(9369):1603-1607.
[44]陈雅雪,韩跃红.从临终关怀看死亡教育[J].昆明理工大学学报, 2006,6(4): 15-18.
[45] Debra P O, Denise B. Nursing Home Experience with Hospice [J]. Journal of the American Medical Directors Association, 2002,3(2):46-50.
[46] Raymond V, Akira A,Carol R, et al. End-of-Life Decisions and Advance Directives in Palliative Care: A Cross-Cultural Survey of Patients and Health-Care Professionals [J]. Journal of Pain and Symptom Management,1998,16(3):153-162.
[47] Mary P, Mary E C. Palliative care: Past, present, and future perspectives [J].Seminars in Oncology Nursing, 1998,14(2):86-94.
[48] Fiona G, David C. The changing model of palliative care [J]. Medicine, 2008,36(2): 64-66.
[49] Evelyn W, George K W. The palliative care education needs of nursing home staff [J]. Nurse Education Today,2006,26(6):501-510.
[50] Claire H, Tony L, Linda S,et al.An evaluation of educational preparation for cancer and palliative care nursing for children and adolescents: Issues in the assessment of practice arising from this study [J]. Nurse Education Today, 2006,26(7):528-537.
[2]孟宪武,崔以泰.临终关怀[M].天津:天津科学技术出版社,2002.
[3]李义庭,李伟,刘芳,等.临终关怀学[M].北京:中国科学技术出版社,2000.
[4]殷磊.护理学基础[M].第3版.北京:人民卫生出版社,2004.
[5]许婷婷.临终关怀中的人文护理模式研究[D].山东:山东大学,2007.
[6]黄天中.临终关怀理论与发展[M].台北:强业出版社,1988:9
[7] Marian A. and Theovan A.The content and effects of palliative care courses for nurses: A literature review [J]. International Journal of Nursing Studies,2008, 45(3):471-485.
[8]金河严,朴泰洙.心理学[M].北京:中央民族大学出版社,2000
[9]陈四光.心理健康视野下大学生死亡态度及生命教育研究[D].江西:江西师范大学教育学院,2006.
[10]马国亮.护理学校学生死亡态度现状研究[D].郑州:郑州大学教育学院,2006.
[11]卞燕,何仲.我国的临终关怀事业发展[J].南方护理学报,2004,11(7):26.
[12]余悦,周绿林.关于我国临终关怀发展策略的思考[J].医学与哲学, 2006,27(1):65.
[13]徐勤.美国临终关怀的发展及普及http://www.ocan.cn
[14]陈真奋.临终关怀对晚期恶性肿瘤病人生命质量的影响[J].当代护士, 2004,4:50-52.
[15]余春华,付岚,向秋芬,等.临终关怀对癌症病人家属生活质量的影响[J].现代护理,2006,12(21):1961-1963.
[16]黄海珊,张静平,邓小梅.刍议建设有中国特色的临终关怀[J].医学与社会, 2006,19(9):36-38.
[17]路雪芹,白琴.开展本土化临终关怀面临的问题与挑战[J].中国老年学杂志,2007,3(27):299-300.
[18]王琳,梁椰林.护理专业增设“临终关怀”的教学实践与思考[J].白求恩军医学院学报,2005,3(3):183
[19]傅静,谭道玉.护理学本科开设《临终关怀学》课程的必要性[J].现代护理,2007,13(33):3220-3221
[20]张杰,平川仁尚,吴锦屏.全国医科大学医学专业临终关怀教育的调查[J].云南医药,2008,29(5):508-509.
[21]赵梅,高标.医护本科学生对待死亡及临终关怀态度的调查[J].安徽医科大学学报,2003,38(3):237-239.
[22]曾凡,曾铁英.护生对待死亡的态度及其影响因素调查[J].护理学杂志,2007,22(20):6-8.
[23] Judy L. M. The impact of a palliative care educational component on attitudes toward care of the dying in undergraduate nursing students [J]. Journal of Professional Nursing, 2003,19(5):305-312.
[24] Kwekkeboom K,Vahl C, Eland J. Education: professional and lay: Student companion program improves knowledge and attitudes toward palliative care [J]. The Journal of Pain,2004,5(3):s136.
[25]Arolker M.S, Johnson M.J.Palliative care in non-malignant disease [J]. Medicine, 2008,36(2):96-99.
[26] Saori H.Support required for palliative care teams in university hospitals: survey of movements and attitudes of cancer patients at hospital discharge [J]. European Journal of Pain Supplements,2007,1(1):84.
[27] Shujun L, Lijun D, Gouhong S.Survey of the attitude of 428 clinicians to palliative care of cancer patients [J]. European Journal of Pain, 2001,5(1):129.
[28] Liz S, Lindsey B. Palliative care in the community for children with cancer in South East England [J]. European Journal of Oncology Nursing,2001,5(3):190-197.
[29] Gelene T. Effects of End-of-Life Education on Baccalaureate Nursing Students [J]. AORN,2005,82(3):434-440.
[30]陈刚. 592名欧洲医生对医学教育中“临终关怀”教育的评价[J].国外医学.护理学分册,2000,21(4):20,31.
[31] George E, David C. Palliative care and end of life issues in UK pre-registration, undergraduate nursing programmes [J]. Nurse Education Today,2008,28(2):163-170.
[32] Natalie S, Jeanne K. The impact of a distance learning death and dying course: An analysis of student self-reported changes [J]. Nurse Education Today,2005,25(7):509-518.
[33] Joakim E, Erik B, Birgitta H,et al. Palliative sedation at end of life-A systematicliterature review [J]. European Journal of Oncology Nursing. 2007,11(1):26-35.
[34] Michael J Y. Transforming Doctor-Patient Relationships to Promote Patient-Centered Care: Lessons from Palliative Care [J]. Journal of Pain and Symptom Management,2007, 33(1):40-57.
[35]郑悦萍.医护人员临终关怀照护知识、态度及相关因素研究[D]湖南:中南大学护理学院,2008.
[36]茅竞伟,乔丽枝.谁来关怀临终关怀[J].世界医学杂志。2005,(3).
[37]孟宪武.中国临终关怀工作的开展及其前景展望[J].肿瘤防治杂志, 2003,10(1):17-20.
[38]王平,李海燕.死亡与医学伦理[M].武汉.武汉大学出版社,2005.
[39]胡苏珍,卢慧娟.护理本科教育设立临终关怀课程的必要性及建议[J].护理学杂志,2008,23(4)(外科版):22-23.
[40] Reginald D, Jan L. B, Robert V S,et al. Truth-telling at the end of life: A pilot study on the perspective of patients and professional caregivers [J]. Patient Education and Counseling,2008,71(1):52-56.
[41] Peretti W, Bendiane M K, and Moatti J P. Attitudes toward palliative care, conceptions of euthanasia and opinions about its legalization among French physicians [J]. Social Science & Medicine, 2005,60(8):1781-1793.
[42] David E W, Linda B. Education in Palliative Care [J]. Clinics in Geriatric Medicine,2005,21(1):165-175.
[43] Colleen S M, Barry R, William B. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients [J]. The Lancet, 2003, 361(9369):1603-1607.
[44]陈雅雪,韩跃红.从临终关怀看死亡教育[J].昆明理工大学学报, 2006,6(4): 15-18.
[45] Debra P O, Denise B. Nursing Home Experience with Hospice [J]. Journal of the American Medical Directors Association, 2002,3(2):46-50.
[46] Raymond V, Akira A,Carol R, et al. End-of-Life Decisions and Advance Directives in Palliative Care: A Cross-Cultural Survey of Patients and Health-Care Professionals [J]. Journal of Pain and Symptom Management,1998,16(3):153-162.
[47] Mary P, Mary E C. Palliative care: Past, present, and future perspectives [J].Seminars in Oncology Nursing, 1998,14(2):86-94.
[48] Fiona G, David C. The changing model of palliative care [J]. Medicine, 2008,36(2): 64-66.
[49] Evelyn W, George K W. The palliative care education needs of nursing home staff [J]. Nurse Education Today,2006,26(6):501-510.
[50] Claire H, Tony L, Linda S,et al.An evaluation of educational preparation for cancer and palliative care nursing for children and adolescents: Issues in the assessment of practice arising from this study [J]. Nurse Education Today, 2006,26(7):528-537.
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