床旁疗愈师：一种在住院周边环境中增加人文实践的方法

and compassion, patients can feel connected to trainees and caretakers. These trustful relationships can further foster resilience and transform patient care, clinical education, and inpatient culture [3], [4]. The significance of compassion in medicine is by no means a new concept [5]. Research from the 1980s has underscored the importance of the biopsychosocial model and transpersonal patient-doctor relationships in healing [5]. Contemporary research continues to show that compassionate behaviors and improvements in patient communication increase patient satisfaction. Mutually satisfying discussions have the potential to make caretakers aware of patient preferences and enable them to adapt to the patients’ states of mind. This allows for better delivery of care [6], [7], [8].

2. Implementing an initiative to increase humanistic practices in hospitals

Beginning in July 2020, we established a Bedside Healers program at Allegheny General Hospital in Pittsburgh, Pennsylvania to alleviate isolation experienced by patients in the hospital. Through this program, third year medical students from Drexel University College of Medicine (DUCOM) on their Internal Medicine rotations are provided with protected time to spend and engage with COVID-negative patients during the afternoon hours. Students ask patients about their home lives, provide activities such as Sudoku worksheets or coloring pages, and connect patients with their families. They then write weekly journal entries reflecting on their experiences which are reviewed by the team leading this project.

3. Patients are people

One DUCOM student wrote about a meaningful interaction with her patient: “Her life had been turned upside down a few months ago. She went to the doctor because she had some trouble swallowing, and they found a tumor in her lung compressing her esophagus. I got the sense that she really wanted us to see that this is all new to her, that the hospital bed was not her natural habitat, that she was a real person and not just another body in a hospital gown. She is very polite, says thank you a lot, apologizes for spitting into napkins or needing time to pull herself together after a gagging spell. I'm sure it feels dehumanizing to lose all the accoutrements that provide the context wherein we can comfortably feel like ourselves. No personal decor in the room, no style expressed through clothes, even everyday activities and habits are demolished. This is part of why it is so important to talk to our patients; it helps them hold on to who they are, express their personality, feel seen and heard, and it helps us to see that too.”

The hospital often becomes a place where people are insidiously converted into patients, dehumanized in subtle ways: remembered for their conditions rather than names, subjected to examinations they often do not understand. Now more than ever, there is a need to recognize that people have multiple dimensions – character, personality, family ties, life roles, and past experiences [9]. Awareness of these dimensions and how they relate to illness and suffering is paramount in alleviating suffering [9].

4. Staying connected during the pandemic

The students helped patients remain engaged with family members and friends outside of the hospital. One student from DUCOM wrote about her experience connecting to family members: “This week I helped my patient reach out to his wife and updated her on my patient's hospital course. My patient has been altered and had been asking to speak with his wife. Unfortunately, my patient was from out of town and his wife had been unable to come to the hospital. I was able to reach out to the wife to update her on my patient's status. The following day, I was able to help them connect via telephone in the room. My patient's wife was very happy to be updated and to be able to have a moment to speak with her husband.”

Families play an important role in medical decision making. With visitor restrictions in current times, we prioritized family input for patients to ensure the best care possible. Another medical student wrote about communicating with a patient’s family member who was recently diagnosed with cancer during a time when visitors were not permitted in the hospital. He wrote, “My patient was hard of hearing and had difficulty using the phone, so I was able to act as a mediator between him and his nephew (his POA) as they discussed the news of his recent cancer diagnosis. The emphasis was on prioritizing comfort over being aggressive in terms of treatment given the patients age and lack of clear benefit from aggressive treatment. I reflected on my own thoughts about end of life care and feelings about dying with dignity.” Medical decision-making can be an overwhelming task for patients. By helping connect patients to individuals who they want involved in these decisions, healthcare professionals can better accomplish their sacred duty of taking care of their patients, executing realistic therapeutic steps, and establishing lifelong goals.

5. Outcomes of the Bedside Healers program

“Having never been in a hospital other than to shadow physicians, I was unaware of how busy things are on the Internal Medicine floor and, as a result, how little time most physicians and residents get to spend with patients. During the "Bedside Healers" conversation, learning about the patient's life was the goal rather than a means to another goal [such as obtaining relevant information to produce a differential diagnosis]. I thought that this changed the conversation significantly and allowed me to relax during the talk; the patient could dictate the conversation and I could remain a listener without having to direct them in one way or another. I really enjoyed the Bedside Healers program and look forward to continuing for the coming weeks; I think it helps to break up the day and also serves as a reminder for why we are doing this in the first place: to learn more about people and to help them in whatever way that they require.”

These are the words of one of numerous DUCOM medical students who found Bedside Healers to be an empowering and eye opening experience. From their entries, it is evident that dedicating time to bedside discussions with patients improves both patient and physician wellness, increases empathy in care for patients, and enables patients to feel more connected with their health care providers. By highlighting our approach of devoted time with patients during the COVID-19 outbreak, we hope to encourage more patient-centric humanistic practices within the medical student body.

Declaration of Competing Interest

We have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. We have no other conflicts of interest to declare.

下卷翻译（仅供参考）

“恶同理、疲倦、痉挛、嘴唇干旱、咳嗽、肚子裂开，当她得知我她的四个夫妻俩和她的男朋友们时，她的天性仍然闪闪发光。鞋无需换了，她更为焦虑。当牙医不够换胶带时，我抬起了她的握。我不确定它到底有为了让，但它让我觉得很有用。我在此之前没有想到像这样被先用的胸部。伤口看紧紧如此平易近人，几乎不真实，就像星星从前面的裂痕。我不喜欢无法解决这些问题。我只是决同理我的访问能为了让我消除孤独感。” −3 年德雷波尔所大学的所大学学校。2019 年 7 同月 27 日。

1 . COVID-19一时期的人文主义

COVID-19 大流行是学自始最大的挑战之一。这些极大的一时期凸显了所医院对病征的险恶和非人性化环境。驱使给医疗保障各个领域管理人员的人际交往能意志力正受到自我必要措施供给的考验[1]。随着这两项的感染建议、自已防盗装备以及对截图技术的日趋依赖，病征多年来在经历与伺候者分离和险恶的冲动[1]. 在大流行之前，触摸是一种毋庸置疑的非第二语言社交方式，值得注意，它可以在医疗保障间的关系从前面创设人性化感和信任感。观察性研究成果说明了，触摸对于以病征为从前面同理的护理管理人员至关关键性，并直接影响病征对这种护理管理人员的看法。正如 Pype 在 3 同月份的《病征教学和咨询》的一篇篇名从前面所争辩的那样，大流行以及随之而来的医疗保障政策的巨大变化受到限制了护理管理人员管理人员的保持联系，因此无需找到方法来弥补牙医和咨询管理人员一落千丈的人际保持联系。以另一种治疗方式将与病征重新创设直接联系[2]。

人文主义是病征护理管理人员和牙医健康的关键性自由软件。通过套用同理同理和幽默感的行为，病征可以感受到与受训者和伺候人的直接联系。这些信任间的关系可以进一步培养复原意志力并忽略病征护理管理人员、病理教学和住院治疗文化[3]、[4]。慈悲在性疾病的含意绝不是一个新概念[5]。1980 世纪末的研究成果合理化了生物学同理理社会假设和超自已医患间的关系在康复从前面的关键性性[5]. 当代研究成果继续说明了，富有幽默感的行为和病征社交的改进可以大幅提高病征的满意度。相互满意的争辩有可能使护理管理人员管理人员了解病征的偏好，并使他们需要适应病征的同理理状态。这允许很好地缺少护理管理人员[6]、[7]、[8]。

2 . 试行增加所医院人文倡导的举措

从 2020 年 7 同月开始，我们在宾夕法尼亚州底特律的新罕布什尔州综合所医院创设了床边精神科计划书，以缓解所医院病征的险恶感。通过该计划书，哈德森波尔所大学的所大学 (DUCOM) 神经内科轮转的三年级女学校在上午有受必要措施的星期与 COVID 比如说病征独自度过和保持联系。学校向病征告诉他们的中产阶级贫困，缺少数独工作表或图例页等户外活动，并将病征与亲人直接联系紧紧。然后，他们每周撰写出反映他们经历的日记列出，并由拥护该项目的团队开展审查。

3 . 患者是人

一位 DUCOM 学校所述，她与病征开展了一次有含意的社交：“几个同月前，她的贫困发生了翻天覆地的巨大变化。她因为吞咽困难去看了牙医，他们推断出她的肺部有一个骨髓压迫了她的鼻腔。我冲动到她实在决同理我们看到这对她来说是全新的，所医院病床不是她的人为栖息地，她是一个真实的人，而比如说是穿着病号服的另一个身体。她非常有礼貌，说了很多谢谢，为呼到餐巾纸上或在呕呼咒语后无需星期振作紧紧而道歉。我敢肯定，一落千丈所有缺少我们可以人性化地冲动自己的环境的装备会让人感到残酷。地下室从前没有自已装饰，没有通过鞋表达的风格，甚至日常户外活动和习惯都被毁损了。这就是为什么与我们的病征问候如此关键性的部分原因；它为了让他们坚持自己的身份，表达自己的天性，冲动被看到和听到，它也为了让我们看到了这一点。”

所医院经常变成一自已们阴险地变成患者的；也，以微妙的方式将非人性化：讲出他们的状况而不是人名，接受他们经常不理解的检查。现在比即使如此任何时候都不够无需预见人们不具多个一维——性格、天性、中产阶级间的关系、贫困角色和过去的经历[9]。了解这些一维以及它们与疾病和恐惧的间的关系对于缓解恐惧至关关键性[9]。

4 . 在大流行之前保持直接联系

学校们为了让病征与所医院外的亲人和朋友们保持直接联系。来自 DUCOM 的一名学校写出下了她与亲人直接联系的经历：“本周，我为了让我的患者直接联系了他的前夫，并让她了解了我患者的所医院授课。我的患者已经忽略并多年来要求与他的前夫问候。不幸的是，我的患者来自外地，他的前夫无法来所医院。我需要直接联系到前夫，让她了解我患者的最新情况。第二天，我需要通过地下室从前的电话机为了让他们直接联系。我患者的前夫很高兴得到最新立即，并且需要有星期与她的太太问候。”

中产阶级在医疗对政府从前面起到着关键性作用。由于当前的参观受到限制，我们优先考虑为病征缺少中产阶级异议，以尽可能获得最佳护理管理人员。另一位女学校写出了一篇关于在不允许病重者转至所医院之前与不太可能被检验显现出患有帕金森氏症的病征亲人开展交流的篇名。他所述：“我的患者听意志力不好，来电机也有困难，所以当他们争辩他不太可能被检验显现出帕金森氏症的立即时，我需要都是他和他的侄子（他的 POA）之间的调解人。考虑到病征年龄和鼓励治疗缺乏明显好处，重点是在治疗方面优先考虑人性化而不是鼓励治疗。我反思了自己对临终关怀的想法和对有尊严地病倒的感受。” 医疗对政府对病征来说可能是一项迫切的任务。通过为了让将病征与他们决同理加入这些对政府的自已直接联系紧紧，医疗保障各个领域管理人员可以很好地收尾他们的神圣职责，即照顾他们的病征、执行本质的治疗步骤和创设终生目的。

5 . 床边精神科计划书的结果

“除了影子牙医，我在此之前没有去过所医院，我不知道神经内科的事情有多忙，因此，大多数牙医和住院治疗医师与患者朝夕相处的星期是多么少。在“床边精神科”的谈及从前面，了解病征的贫困是目的，而不是实现另一个目的的伎俩（例如获取相关文档以开展识别检验）。我认为这不小地忽略了谈及，让我在谈及从前面放松了；患者可以口授谈及，我可以保持倾听者的身份，而不须以一种或另一种方式将指导他们。我实在很喜欢床边精神科计划书，并期待在接下来的几周内继续下去；

这些是众多 DUCOM 女学校之一的话，他们推断出床边精神科是一种自发性和大开眼自始的体验。从他们的列出来看，很明显，红豆星期与病征开展床边争辩可以改善病征和牙医的健康状况，增加对病征护理管理人员的同理同理，并使病征冲动与他们的医疗保障缺少者有不够多的直接联系。通过合理化我们在 COVID-19 爆发之前与病征朝夕相处的方法，我们决同理在女学校的组织从前面鼓励不够多以病征为从前面同理的人文倡导。

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