【生死教育第三講】
講題 Title:預設醫療指示與預設照顧計劃 Advance Directive and Advance Care Planning
報名鏈接Registration Link: https://bit.ly/3tE9RgE
日期 Date:12/6/2021(Sat)
時間 Time:3:00-4:30pm
地點 Venue:沙田澤祥街12號香港中文大學鄭裕彤樓地下演講廳1A (LT1A)
Lecture Theatre 1A, Level 1, Cheng Yu Tung Building, The Chinese University of Hong Kong, 12 Chak Cheung Street, Shatin, N.T.
講者 Speaker:陳裕麗教授 Prof Helen Chan / 鍾一諾教授 Prof Roger Chung
主持 Moderator:伍桂麟先生 Mr Pasu Ng
講座內容 Synopsis:
現今醫療科技發達,很多疾病均可治癒或受控制。當疾病到了末期,醫療科技有時只能提供維持生命治療,但延長死亡過程對病人可能沒有意義,甚至增加痛楚。面對這情況,病人、家屬和醫護人員可以商討是否中止對生活質素沒有幫助的維持生命治療,讓病人安詳離世。香港中文大學醫學院那打素護理學院副教授陳裕麗博士和香港中文大學公共衛生及基層醫療學院助理教授鍾一諾博士會在由中大公共衞生及基層醫療學院主辦的公眾「生死教育」四講系列的第三講和大家分享『預設醫療指示』 (Advance Directive)和『預設照顧計劃』(Advance Care Planning)的概念與應用。這兩種健康護理選擇不但可以免卻家屬決定病者死時所受到的困難和壓力,減少作出決定後感到矛盾和內疚的機會,亦體現對病者生命和意願的尊重。
Thanks to the advancement of medical technology, most diseases can be cured or subsided. However, there are times that medical technology could only prolong one’s life but could not cure the terminal illness. Facing such situation, patients, family members, and medical staff can discuss whether to withhold or withdraw from life-sustaining treatments that may not help improve patients’ quality of life so that they can die peacefully. Professor Helen Chan, Associate Professor from The Nethersole School of Nursing and Professor Roger Chung, Assistant Professor of the School of Public Health and Primary Care of the Chinese University of Hong Kong, will share with us the concepts and values behind Advance Directive and Advance Care Planning in the third public seminar of the four-lecture series on life and death education organized by the School of Public Health and Primary Care, CUHK. These two health care options aim not only to reduce the pressure faced by patients’ family when making end-of-life healthcare decision, but also show respect to patients’ will.
講者介紹:
Professor Helen Chan’s research interests focus on end-of-life care, gerontology as well as care ethics. She has conducted a number of research projects on promoting palliative and end-of-life care, especially advance care planning, among older adults and people with advanced progressive diseases.
陳裕麗教授的主要研究範疇集中在臨終護理、老年病學和護理倫理學上。她的研究項目包括推廣有關老人和晚期疾病患者的紓緩照顧和臨終護理服務,尤其是預設照顧計劃。
Professor Roger Chung’s research aims to empirically inquire into the social determinants of health inequalities, as well as aging‐related issues on multimorbidity and long‐term/end‐of‐life care, and to utilize such evidence to inform health services and policy, domestically and beyond.
鍾一諾教授的主要研究範疇為健康不平等的社會決定因素,與老年有關的多重疾病,和晚期與臨終護理政策,並運用研究成果為本地及國際公共衛生服務和政策提供意見。
生死教育 X 伍桂麟
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今早為Asian Medical Students Association Hong Kong (AMSAHK)的新一屆執行委員會就職典禮作致詞分享嘉賓,題目為「疫情中的健康不公平」。
感謝他們的熱情款待以及為整段致詞拍了影片。以下我附上致詞的英文原稿:
It's been my honor to be invited to give the closing remarks for the Inauguration Ceremony for the incoming executive committee of the Asian Medical Students' Association Hong Kong (AMSAHK) this morning. A video has been taken for the remarks I made regarding health inequalities during the COVID-19 pandemic (big thanks to the student who withstood the soreness of her arm for holding the camera up for 15 minutes straight), and here's the transcript of the main body of the speech that goes with this video:
//The coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, continues to be rampant around the world since early 2020, resulting in more than 55 million cases and 1.3 million deaths worldwide as of today. (So no! It’s not a hoax for those conspiracy theorists out there!) A higher rate of incidence and deaths, as well as worse health-related quality of life have been widely observed in the socially disadvantaged groups, including people of lower socioeconomic position, older persons, migrants, ethnic minority and communities of color, etc. While epidemiologists and scientists around the world are dedicated in gathering scientific evidence on the specific causes and determinants of the health inequalities observed in different countries and regions, we can apply the Social Determinants of Health Conceptual Framework developed by the World Health Organization team led by the eminent Prof Sir Michael Marmot, world’s leading social epidemiologist, to understand and delineate these social determinants of health inequalities related to the COVID-19 pandemic.
According to this framework, social determinants of health can be largely categorized into two types – 1) the lower stream, intermediary determinants, and 2) the upper stream, structural and macro-environmental determinants. For the COVID-19 pandemic, we realized that the lower stream factors may include material circumstances, such as people’s living and working conditions. For instance, the nature of the occupations of these people of lower socioeconomic position tends to require them to travel outside to work, i.e., they cannot work from home, which is a luxury for people who can afford to do it. This lack of choice in the location of occupation may expose them to greater risk of infection through more transportation and interactions with strangers. We have also seen infection clusters among crowded places like elderly homes, public housing estates, and boarding houses for foreign domestic helpers. Moreover, these socially disadvantaged people tend to have lower financial and social capital – it can be observed that they were more likely to be deprived of personal protective equipment like face masks and hand sanitizers, especially during the earlier days of the pandemic. On the other hand, the upper stream, structural determinants of health may include policies related to public health, education, macroeconomics, social protection and welfare, as well as our governance… and last, but not least, our culture and values. If the socioeconomic and political contexts are not favorable to the socially disadvantaged, their health and well-being will be disproportionately affected by the pandemic. Therefore, if we, as a society, espouse to address and reduce the problem of health inequalities, social determinants of health cannot be overlooked in devising and designing any public health-related strategies, measures and policies.
Although a higher rate of incidence and deaths have been widely observed in the socially disadvantaged groups, especially in countries with severe COVID-19 outbreaks, this phenomenon seems to be less discussed and less covered by media in Hong Kong, where the disease incidence is relatively low when compared with other countries around the world. Before the resurgence of local cases in early July, local spread of COVID-19 was sporadic and most cases were imported. In the earlier days of the pandemic, most cases were primarily imported by travelers and return-students studying overseas, leading to a minor surge between mid-March and mid-April of 874 new cases. Most of these cases during Spring were people who could afford to travel and study abroad, and thus tended to be more well-off. Therefore, some would say the expected social gradient in health impact did not seem to exist in Hong Kong, but may I remind you that, it is only the case when we focus on COVID-19-specific incidence and mortality alone. But can we really deduce from this that COVID-19-related health inequality does not exist in Hong Kong? According to the Social Determinants of Health Framework mentioned earlier, the obvious answer is “No, of course not.” And here’s why…
In addition to the direct disease burden, the COVID-19 outbreak and its associated containment measures (such as economic lockdown, mandatory social distancing, and change of work arrangements) could have unequal wider socioeconomic impacts on the general population, especially in regions with pervasive existing social inequalities. Given the limited resources and capacity of the socioeconomically disadvantaged to respond to emergency and adverse events, their general health and well-being are likely to be unduly and inordinately affected by the abrupt changes in their daily economic and social conditions, like job loss and insecurity, brought about by the COVID-19 outbreak and the corresponding containment and mitigation measures of which the main purpose was supposedly disease prevention and health protection at the first place. As such, focusing only on COVID-19 incidence or mortality as the outcomes of concern to address health inequalities may leave out important aspects of life that contributes significantly to people’s health. Recently, my research team and I collaborated with Sir Michael Marmot in a Hong Kong study, and found that the poor people in Hong Kong fared worse in every aspects of life than their richer counterparts in terms of economic activity, personal protective equipment, personal hygiene practice, as well as well-being and health after the COVID-19 outbreak. We also found that part of the observed health inequality can be attributed to the pandemic and its related containment measures via people’s concerns over their own and their families’ livelihood and economic activity. In other words, health inequalities were contributed by the pandemic even in a city where incidence is relatively low through other social determinants of health that directly concerned the livelihood and economic activity of the people. So in this study, we confirmed that focusing only on the incident and death cases as the outcomes of concern to address health inequalities is like a story half-told, and would severely truncate and distort the reality.
Truth be told, health inequality does not only appear after the pandemic outbreak of COVID-19, it is a pre-existing condition in countries and regions around the world, including Hong Kong. My research over the years have consistently shown that people in lower socioeconomic position tend to have worse physical and mental health status. Nevertheless, precisely because health inequality is nothing new, there are always voices in our society trying to dismiss the problem, arguing that it is only natural to have wealth inequality in any capitalistic society. However, in reckoning with health inequalities, we need to go beyond just figuring out the disparities or differences in health status between the poor and the rich, and we need to raise an ethically relevant question: are these inequalities, disparities and differences remediable? Can they be fixed? Can we do something about them? If they are remediable, and we can do something about them but we haven’t, then we’d say these inequalities are ultimately unjust and unfair. In other words, a society that prides itself in pursuing justice must, and I say must, strive to address and reduce these unfair health inequalities. Borrowing the words from famed sociologist Judith Butler, “the virus alone does not discriminate,” but “social and economic inequality will make sure that it does.” With COVID-19, we learn that it is not only the individuals who are sick, but our society. And it’s time we do something about it.
Thank you very much!//
Please join me in congratulating the incoming executive committee of AMSAHK and giving them the best wishes for their future endeavor!
Roger Chung, PhD
Assistant Professor, CUHK JC School of Public Health and Primary Care, @CUHK Medicine, The Chinese University of Hong Kong 香港中文大學 - CUHK
Associate Director, CUHK Institute of Health Equity
medical school中文 在 虎紋姑娘 Facebook 的最佳貼文
【在香港如何做護士】(2020年7月更新版)
誰想到十多年後的今天香港醫護要再一次面對疫症,過去半年我們多次吶喊,當權者都視而不見。而在大家默默地盡心盡力抗疫之際,醫管局卻以「凍薪」作答謝... 做醫護並沒有特別偉大,在香港更可說是「賤過地底泥」;但我們知道 #如果可磊落做人你會更吸引 。入行者,敬請勿忘初心。
▶敬告文字小偷,請自重。◀
一、大學學位課程
- 五年制
- 畢業後會得到護理學學士及註冊護士資格
- 於大學上課,到醫院實習
1. 理工大學(護理學理學士 / 精神健康護理學理學士)
- 最低收生要求3322+33 (只限甲類科目) ,有修生物科優先
護理學:
https://sn.polyu.edu.hk/…/bachelor_of_science_…/index_m.html
精神健康護理學:
https://sn.polyu.edu.hk/…/bachelor_of_science_…/index_m.html
2. 中文大學(護理學士)
- 最低收生要求3322+33 (考獲3級的其一必須為理科)
http://www.nur.cuhk.edu.hk/…/undergrad…/bachelor-of-nursing/
3. 香港大學(護理學學士)
- 最低收生要求3322+33
https://nursing.hku.hk/educat…/bachelor-of-nursing-full-time
(非理科生入學後需額外上生命科學課程 Life Science Enrichment Programme)
4. 公開大學(護理學學士普通科 / 護理學學士精神科)
- 最低收生要求3322+2,有修理科或「健康管理與社會關懷」優先
http://www.ouhk.edu.hk/wcsprd/Satellite…
5. 東華學院(護理學健康科學學士)
- 最低收生要求3322+2 (只限甲類科目),英文達4級或以上優先
https://www.twc.edu.hk/en/Programmes/bhsn
6. 明愛專上學院(護理學學士)
- 最低收生要求3322+2 (只限甲類科目),有修生物科優先
https://www.cihe.edu.hk/…/bachelor-…/introduction/index.html
7. 浸會大學持續教育學院(護理學學士)
- 最低收生要求3322+33 (兩科甲類科目或一科甲類科目加「健康護理實務」 / 「中醫藥學基礎」,有修理科優先)
https://www.sce.hkbu.edu.hk/…/…/bachelor-of-nursing-honours/
二、醫院管理局護士學校
- 分兩年制登記護士課程及三年制註冊護士高級文憑課程
- 前者無需學費,但畢業後須於醫管局工作兩年;後者須繳交學費
- 前者只於葛量洪醫院開辦;後者分別於明愛醫院、屯門醫院及伊利沙伯醫院開辦
登記護士(普通科)訓練課程:
- 最低收生要求222 (中英數) + 22
- 中文教學
http://www.ha.org.hk/haho/ho/nursing/enrolled_nurse-b5.htm
(收生期間方有報名詳情)
註冊護士高級文憑課程:
- 最低收生要求3322+2 (必須為理科)
- 英文教學
http://www.ha.org.hk/…/nur…/higher_diploma_in_nursing-en.htm
(收生期間方有報名詳情)
三、私家醫院護士學校
- 兩年制登記護士課程
- 除養和醫院課程以及香港中文大學醫院(浸會醫院協辦)課程為免學費外,其他全須繳交學費
- 畢業後一般會獲聘於受訓醫院工作
1. 聖德肋撒醫院 (法國醫院) St. Teresa Hospital
- 最低收生要求222 (中英數) + 22
- 英文教學
http://www.sth.org.hk/nursing_school_info_1.asp?lang_code=en
2. 養和醫院 Hong Kong Sanatorium & Hospital
- 最低收生要求222 (中英數) + 22
- 英文教學
https://www.hksh.com/school-of-nursing/…/programme/index.php
3. 浸會醫院 Hong Kong Baptist Hospital
- 最低收生要求222 (中英數) + 22,英文科達3級或以上,有修生物科優先
- 英文教學
http://www.hkbhipe.com/…/the-school-of-nursing/higher-dip…/…
4. 仁安醫院 Union Hospital
- 最低收生要求222(中英數)+ 22
- 英文教學
http://www.union.org/nursingschool/prodetail.php
5. 香港中文大學醫院 CUHK Medical Centre
<浸會醫院護士學校協辦>
- 最低收生要求222 (中英數) + 22,英文科達3級或以上,有修生物科優先
- 英文教學
*暫無2020年度招生消息
http://www.cuhkmc.hk/zh-hant/about_us/background/
四、 其他兩年制登記護士高級文憑課程
1. 公開大學(普通科 / 精神科護理學高級文憑)
- 最低收生要求222 (中英數) + 22
- 中文教學
http://www.ouhk.edu.hk/wcsprd/Satellite…
2. 東華學院(護理學高級文憑)
- 最低收生要求22 (中英) + 222 (不多於兩科應用學習科目)
- 英文教學
https://www.twc.edu.hk/en/Programmes/hdn
五、社福界登記護士課程(普通科 / 精神科)
- 由社會福利署與公開大學合辦
- 無需學費,但畢業後須於社福界工作兩年
- 最低收生要求222 (中英數) + 22
- 中文教學
http://www.ouhk.edu.hk/wcsprd/Satellite…
附錄一:有機會銜接各護理學課程之副學位課程
1. HKUSPACE
護理學副學士
https://www1.hkuspace.hku.hk/…/associate-of-nursing-studies/
社康照顧高級文憑
https://hkuspace-plk.hku.hk/…/higher-diploma-in-health-and…/
2. 理工大學 HKCC(健康學副學士)
https://www.hkcc-polyu.edu.hk/…/assoc…/programmeDetails.php…
3. 中文大學 CUSCS(健康護理高級文憑)
http://scs-hd.scs.cuhk.edu.hk/…/health-social-…/health-care/
4. 東華學院(健康科學高級文憑)
https://www.twc.edu.hk/en/Programmes/hdhsc
5. 公開大學
醫療護理高級文憑
http://www.ouhk.edu.hk/wcsprd/Satellite…
健康學文憑 (社區健康護理)
*合資格升讀的課程為公開大學護理學高級文憑(登記護士)
http://www.ouhk.edu.hk/wcsprd/Satellite…
6. 明愛專上學院(健康護理高級文憑)
https://www.cihe.edu.hk/…/higher-d…/introduction-/index.html
附錄二:已考取非護理學大學學位者可報讀之「註冊前護理學碩士課程」
- 三年全日制
- 畢業後會得到護理學碩士及註冊護士資格
1. 理工大學( 護理學碩士(註冊前) )
- 最低收生要求
HKCEE 5科合格,包括英文 D (Level 3)、生物/化學/物理/數學 E 及 任何一科 C
或
HKDSE 3322+2 (只限甲類科目)
- 持有香港認可的大學學士學位
http://sn.polyu.edu.hk/…/postg…/master_of_nursing/index.html
2. 中文大學( 護理科學碩士(註冊前) )
- 最低收生要求
i. HKCEE 5科合格,包括英文 D (Level 3)、生物/化學/物理/數學 E 及 任何一科 C
或
HKDSE 4322+2 (只限甲類科目)
ii. HKALE 英文 E 或 HKDSE 英文 Level 4
- 持有香港認可的大學學士學位,並不低於二級榮譽
http://www.nur.cuhk.edu.hk/…/master-of-nursing-science-pre…/
☆ 延伸閱讀:
1.《註冊護士 VS 登記護士 & 大學課程 VS 護士學校》
https://www.facebook.com/…/a.100537296616…/999328873431497/…
2. 《護士的職責》
https://www.facebook.com/…/a.100535385616…/740958522601868/…
3. 《人手問題?護士荒、護士專業化、去護士化三者關係你要知》
https://www.facebook.com/…/a.60349541968…/1035928493104868/…
medical school中文 在 香港中文大學學生會醫學院院會Medical Society, CUSU 的推薦與評價
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