肿瘤科护士需要考虑的新概念

2021
11/23

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NursingResearch护理研究前
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肿瘤科护士需要考虑的新概念


 



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In my various readings this past week, I was introduced to an idea that was new to me, although linked to ones with which I am familiar. It clearly has implications for oncology nursing and, therefore, is an idea I thought you might be interested in learning about.

The idea I learned about emerged during the preparation for a presentation I was doing on stigma in cancer care. I am sure you are all familiar with the notion of stigma that occurs when a person possesses, or is believed to possess, an attribute or characteristic that conveys a social identity that is devalued in a particular social context. In health-related situations, the exclusion, blame, or devaluation of another person arises from an individual having a particular health problem. It arises in situations when the individual is thought to be responsible for the health condition, there is disfigurement or disability, or the individual’s behaviour results in lack of control or disrupts social interactions. Stigma is heightened if a disease is seen as controllable.

Stigma frequently exists regarding lung cancer, but can also arise with cervical cancer. Individuals who experience stigma may also experience depression, increased symptom burden, decreased quality of life, poor provider-patient communication, and decreased adherence to treatment. Lower screening uptake, avoidance of healthcare and decreased help-seeking are all associated with stigmatization as individuals fear being blamed, censured, or labelled. (See references below.)

The new concept for me was one called ‘stacked stigma’ or ‘corrosive disadvantage’. This concept refers to the situation when one disadvantage leads to another or when an individual falls into two or more groupings that could, on their own, result in negative consequences from stigmatization. For example, stigmatization could arise from being grouped in any one of these groups: elderly, overweight, low education, low income, sexual minority, or new immigrant. Having a health condition and belonging to more than one of these groups could result in the disadvantages having a cumulative effect.

Stigma operates at both explicit and implicit levels. The explicit level is much easier to observe and identify, but it sometimes takes a concerted effort to bring the implicit level thinking into conscious awareness. Without bringing implicit ideas into conscious awareness, our behaviours could easily be based on our hidden thinking and result in patients and family members feeling stigmatized.

Learning about stacked stigma made me start thinking about oncology nursing practice and how this idea might influence how we interact with patients and family members. How do we phrase the question about smoking to a lung cancer patient? How do we inquire about sexual partners for women with cervical cancer? Are there some individuals we do not look in the eye or talk as much with as we would others? Are there some individuals we do not take the time to teach in as much detail, offer and discuss as many options, or engage in shared decision-making?

And what are the reasons driving such behaviour? Could our behaviours be happening because we have assigned attributes or characteristics to patients, either explicitly or implicitly, which we see as negative?

I believe it is important for us to think about our role and any behaviours that could be contributing to, or perpetuating, ‘stacked stigma’. I have added some references below to get you started! I encourage you to take a few minutes from your busy day to look up these articles, read them, and think about how your patients could benefit from what you learn.


全文翻译(仅供参考)

在过去一周的各种阅读中,我了解到一个对我来说很新的想法,尽管与我熟悉的想法有关。它显然对肿瘤学护理有影响,因此,我认为您可能有兴趣了解这个想法。

我了解到的这个想法是在准备我正在做的关于癌症治疗耻辱的演讲时出现的。我相信你们都熟悉污名的概念,当一个人拥有或被认为拥有传达在特定社会背景下贬值的社会身份的属性或特征时,就会出现污名化的概念。在与健康相关的情况下,对另一个人的排斥、责备或贬低源于一个人有特定的健康问题。它出现在个人被认为对健康状况负责、毁容或残疾,或者个人的行为导致缺乏控制或扰乱社交互动的情况下。如果疾病被认为是可以控制的,那么耻辱感就会加剧。

肺癌的病耻感经常存在,但宫颈癌也可能出现。遭受耻辱的个体也可能会经历抑郁、症状负担增加、生活质量下降、提供者与患者沟通不良以及对治疗的依从性下降。较低的筛查率、避免医疗保健和减少寻求帮助都与污名化有关,因为个人害怕被指责、谴责或贴上标签。(请参阅下面的参考资料。)

对我来说,新概念被称为“堆积污名”或“腐蚀性劣势”。这个概念是指一种劣势导致另一种劣势的情况,或者当一个人陷入两个或更多群体时,这些群体本身可能会因污名化而产生负面后果。例如,被归为以下任何一种群体都可能导致污名化:老年人、超重、低教育、低收入、性少数群体或新移民。拥有健康状况并属于多个这些群体可能会导致不利影响累积。

污名在显性和隐性层面都有作用。外显层次更容易观察和识别,但有时需要齐心协力将内隐层次思维带入有意识的意识中。如果不将隐含的想法带入有意识的意识中,我们的行为很容易基于我们隐藏的想法,并导致患者和家人感到被污名化。

了解叠加污名让我开始思考肿瘤学护理实践以及这个想法如何影响我们与患者和家庭成员的互动方式。我们如何向肺癌患者表达有关吸烟的问题?宫颈癌女性如何查询性伴侣?是否有一些人我们不像其他人那样直视或交谈?是否有一些人我们没有花时间详细教授、提供和讨论尽可能多的选项,或参与共同决策?

导致这种行为的原因是什么?我们的行为是否会因为我们明确或隐含地为患者分配属性或特征而发生,而我们认为这些属性或特征是负面的?

我相信对我们来说,思考我们的角色和任何可能导致或延续“堆积耻辱”的行为很重要。我在下面添加了一些参考资料以帮助您入门!我鼓励您在忙碌的一天中抽出几分钟时间查看这些文章,阅读它们,并思考您的患者如何从您学到的知识中受益。

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关键词:
患者,想法,我们,污名,导致

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