Article(id=1322924448659157039, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.17.023, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1762963200000, receivedDateStr=2025-11-13, revisedDate=1783872000000, revisedDateStr=2026-07-13, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339367308, onlineDateStr=2026-10-30, pubDate=1788969600000, pubDateStr=2026-09-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339367308, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339367308, creator=13701087609, updateTime=1793339367308, updator=13701087609, issue=Issue{id=1322924415817757501, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='17', pageStart='2961', pageEnd='3152', issueExtLink='null', onlineDate='null', pubDate='1788969600000', pubDateStr='2026-09-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793339359478, creator='13701087609', updateTime=1793343089343, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940060072542250, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940060072542251, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3110, endPage=3114, ext={EN=ArticleExt(id=1322924448856289328, articleId=1322924448659157039, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Palliative care social support system based on the interaction ritual chain: coupling effects, practical dilemmas, and mitigation strategies, columnId=1220689488284668633, journalTitle=Chinese Nursing Research, columnName=Comprehensive Study, runingTitle=null, highlight=null, articleAbstract=

From the perspective of the interaction ritual chain theory,this paper proposed that the interaction ritual chain exerts five types of coupling effects within the palliative care social support system.Through physical co-presence,it alleviated the stress of elderly individuals,clarified the boundaries between subjects and content,strengthened family emotional energy connections,precisely matched needs through shared focus,and fostered member identity recognition.Furthermore,the study analyzed five major practical dilemmas encountered by the interaction ritual chain:ritual chain fragmentation caused by fragmented interactions,absence of the subject due to a lack of participant engagement among the elderly,boundary ambiguity resulting from role transgression,defocusing caused by a reduction in shared focal points,and content distortion due to excessive artistic processing.Based on the two core elements of "shared focus+emotional resonance,"strategies are proposed,including increasing ritual feedback intensity,stimulating the emotional energy market,expanding the material product market,providing symbolic carriers,and returning to genuine needs while avoiding excessive processing.

, authors=Haixia QIAO, Zhizhong WANG, Jiaming ZHENG, authorsList=Haixia QIAO, Zhizhong WANG, Jiaming ZHENG, authorCompany=null, correspAuthors=Zhizhong WANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322924451268014134, articleId=1322924448659157039, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=基于互动仪式链的安宁疗护社会支持系统:耦合作用、实践困境及纾解策略, columnId=1220689488938980091, journalTitle=护理研究, columnName=综合研究, runingTitle=null, highlight=null, articleAbstract=

从互动仪式链视角提出,互动仪式链在安宁疗护社会支持系统中发挥着5种耦合作用,通过身体在场的方式,缓解老年人的压力、明确主体与内容的界限、强化家庭情感能量联结、通过共同关注精准契合需求,达成成员身份认同。此外,研究还分析了互动仪式链在实践中面临的五大困境,即互动碎片化导致的仪式链断裂、老年人缺乏参与感导致的主体缺位、角色越位导致的边界不清、共同关注点减少导致的失焦、过度艺术化处理导致内容失真。依据“共同关注+情感共鸣”两大核心,提出加大仪式回馈力度、激发情感能量市场、拓展物质产品市场、提供符号象征载体、回归真实需求避免过度加工等策略。

, authors=乔海霞, 王志中*, *, 郑佳明, authorsList=乔海霞, 王志中, 郑佳明, authorCompany=null, correspAuthors=王志中, authorNote=

乔海霞,博士研究生

, correspAuthorsNote=
王志中,E-mail:
WANG Zhizhong, E-mail:
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postcode=null, companyName=null, departmentName=null, remark=1山西医科大学人文社会科学学院,山西 030001)])], figs=[ArticleFig(id=1322924453193199700, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924448659157039, language=EN, label=Figure 1, caption=Flowchart of Collins' interaction ritual chain, figureFileSmall=VK6vgIYJpUDN8PbMYnMGMw==, figureFileBig=4gp/+hruLMFynjAGx2HoGQ==, tableContent=null), ArticleFig(id=1322924453264502869, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924448659157039, language=CN, label=图1, caption=柯林斯的互动仪式链流程图

(资料来源:兰德尔·柯林斯.互动仪式链[M].北京:商务印书馆,2012)

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基于互动仪式链的安宁疗护社会支持系统:耦合作用、实践困境及纾解策略
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乔海霞 , 王志中 *, * , 郑佳明
护理研究 | 综合研究 2026,40(17): 3110-3114
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护理研究 |综合研究 2026 , 40 (17) : 3110 -3114
基于互动仪式链的安宁疗护社会支持系统:耦合作用、实践困境及纾解策略
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乔海霞, 王志中*, * , 郑佳明
作者信息
  • 1山西医科大学人文社会科学学院,山西 030001
通讯作者:
王志中,E-mail:
WANG Zhizhong, E-mail:
作者简介:

乔海霞,博士研究生

Palliative care social support system based on the interaction ritual chain: coupling effects, practical dilemmas, and mitigation strategies
Haixia QIAO, Zhizhong WANG , Jiaming ZHENG
Affiliations
  • 1School of Humanities and Social Sciences, Shanxi Medical University, Shanxi 030001 China
出版时间: 2026-09-10 doi: 10.12102/j.issn.1009-6493.2026.17.023
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从互动仪式链视角提出,互动仪式链在安宁疗护社会支持系统中发挥着5种耦合作用,通过身体在场的方式,缓解老年人的压力、明确主体与内容的界限、强化家庭情感能量联结、通过共同关注精准契合需求,达成成员身份认同。此外,研究还分析了互动仪式链在实践中面临的五大困境,即互动碎片化导致的仪式链断裂、老年人缺乏参与感导致的主体缺位、角色越位导致的边界不清、共同关注点减少导致的失焦、过度艺术化处理导致内容失真。依据“共同关注+情感共鸣”两大核心,提出加大仪式回馈力度、激发情感能量市场、拓展物质产品市场、提供符号象征载体、回归真实需求避免过度加工等策略。

老年人  /  互动仪式链  /  安宁疗护  /  支持系统  /  耦合作用

From the perspective of the interaction ritual chain theory,this paper proposed that the interaction ritual chain exerts five types of coupling effects within the palliative care social support system.Through physical co-presence,it alleviated the stress of elderly individuals,clarified the boundaries between subjects and content,strengthened family emotional energy connections,precisely matched needs through shared focus,and fostered member identity recognition.Furthermore,the study analyzed five major practical dilemmas encountered by the interaction ritual chain:ritual chain fragmentation caused by fragmented interactions,absence of the subject due to a lack of participant engagement among the elderly,boundary ambiguity resulting from role transgression,defocusing caused by a reduction in shared focal points,and content distortion due to excessive artistic processing.Based on the two core elements of "shared focus+emotional resonance,"strategies are proposed,including increasing ritual feedback intensity,stimulating the emotional energy market,expanding the material product market,providing symbolic carriers,and returning to genuine needs while avoiding excessive processing.

the aged  /  interaction ritual chain  /  palliative care  /  support system  /  coupling effects
乔海霞, 王志中, 郑佳明. 基于互动仪式链的安宁疗护社会支持系统:耦合作用、实践困境及纾解策略. 护理研究, 2026 , 40 (17) : 3110 -3114 . DOI: 10.12102/j.issn.1009-6493.2026.17.023
Haixia QIAO, Zhizhong WANG, Jiaming ZHENG. Palliative care social support system based on the interaction ritual chain: coupling effects, practical dilemmas, and mitigation strategies[J]. Chinese Nursing Research, 2026 , 40 (17) : 3110 -3114 . DOI: 10.12102/j.issn.1009-6493.2026.17.023
伴随经济的快速发展,我国安宁疗护需求越来越多。《2023年度国家老龄事业发展公报》显示,到2023年末,中国60岁及以上老年人口接近3亿人,这一数据占总人口的21.1%[1]。临终老年人群体逐渐增多,安宁疗护的重要性愈加凸显。国家政策的支持为安宁疗护的发展提供保障。2016年,国务院发布《“健康中国2030”规划纲要》[2],提出为老年人提供治疗期住院服务、康复期护理服务、稳定期生活照料服务及临终期安宁疗护服务的健康养老服务。2025年,国家卫生健康委发布了《安宁疗护实践指南(2025年版)》[3]等相关文件,提出安宁疗护中心准入、服务、操作等方面的具体规定。2019年,国家卫生健康委员会发布《关于加强老年护理服务工作的通知》[4],提出将护理服务从机构延伸至社区和家庭,为老年人提供全面的安宁疗护服务。《“十四五”健康老龄化规划》[5]中提到要逐步扩大全国安宁疗护试点。因此,发展安宁疗护的理论与社会实践,提高我国临终老年人的生命质量与死亡质量,让病人安然离世是值得研究的命题。
柯林斯在《互动仪式链》这本书中提出互动仪式(interaction ritual),其主要的组成要素:1)身体在场,2个或2个以上的人聚集在同一场所,因此,不管他们是否会特别有意识地关注对方,都能通过其身体在场而相互影响;2)有明确的边界,对局外人设定了界限,因此参与者知道谁在参加,而谁被排除在外;3)有共同的关注焦点,将注意力集中在共同的对象或活动上,并通过相互传达和沟通关注该焦点;4)共同的情绪或情感体验;5)产生互动仪式的结果,形成成员身份,具有了群体符号。
以往的研究大多从社会结构、社会身份的宏观视角探讨安宁疗护支持体系,而互动仪式链理论则依托情境社会学,从微观角度剖析老年人的需求及人际互动。本研究将柯林斯的互动仪式链模型引入,将安宁疗护老年人的支持系统视作一场大家共同参与的仪式互动,深入探讨这一互动过程及其在安宁疗护支持系统中的耦合作用,为改进策略提供理论支撑,丰富安宁疗护老年人社会支持系统的内涵。柯林斯的互动仪式链流程图见图1。
社会支持是影响安宁疗护病人生存质量的因素[6]。老年病人在安宁疗护过程中存在生理疼痛控制需求,而且需要心理疏导、精神安慰和社会援助[7]。互动仪式链的5个要素耦合于安宁疗护社会支持系统,发挥了缓解安宁疗护老年人压力、加强家庭情感能量链连结和满足安宁疗护病人需求的作用。
跨学科团队与安宁疗护老年人、子女与老年人,都是先从身体在场开始。身体在场是互动仪式的先决条件,是仪式本质上一个身体经历的过程,身体在场是建立彼此主体性的过程[8]。人们在同一个地方聚在一起产生一种情绪交流的感觉[9]。身体在场通过共同的情绪体验产生情感能量,以减少安宁疗护老年人的压力。随着电子媒介的发展,虚拟空间中的互动仪式逐渐消解身体在场的限制[10]。安宁疗护老年人的子女即便身处异地,也可经由视频通话做到“虚拟在场”,从而达到纾解压力的目的。无论是亲自到场还是通过其他方式,最重要的是老年人心中有一个可以倾诉的地方。
仪式主体边界是划定好参与者与局外人的界限,使安宁疗护老年人周围的众人产生较强的互动,满足安宁疗护老年人的身心需求。虽然确定了边界,但这只是个必要的条件,不是成功的保证。仪式内容边界是情感的尺度与主题的把握,把仪式做成老年人的情感表达。邀请不同科室的人去老年人的家中举行生前告别会,让家人能够抒发他们的悲伤情绪。社会工作服务人员将告别仪式制作成“生命的礼物”的音像视频时,这样的情形就会成为一种特别的符号象征仪式。通过设置内容边界,跨学科团队更好地为安宁疗护老年人提供情感服务。
兰德尔·柯林斯认为短期的情感只是人际互动仪式中的一个要素,通过互动仪式链的累积和沉淀,最终产生的结果就是长期的情感[11]。通过营造情境的互动仪式[12],互动仪式就会有源源不断的能量。情感连带是情感的集体展现形式,是仪式成员在一定的感情运作策略之下,产生情感被激发、情绪被点燃,甚至产生情感共鸣的交融状态[13]。不同个体间相互发生的单个互动仪式,在链条中是独立的一环,但是也可以通过传递的情感能量叠加之后,再发生新的互动仪式而产生因果关联[14]。
情感能量的节奏合作、情感连带是互动仪式中很重要的成分,正负情绪感受都会对人产生重要的影响[15]。情感能量是互动的真正驱动力[16]。情感能量分为高端积极能量、中端平淡能量和低端消极能量[17]。子女、医生、护士、社工、志愿者与安宁疗护老年人之间的互动仪式带有不同的情感能量,高能量的互动能让老年人的情感需求得到强化,家庭情感能量最为显著且持久,能够帮助安宁疗护老年人填满精神空白,完成自我价值,达成人生意义。
多方互动的共同关注点可以是老年人的生理需求(身体少痛)、老年人的心理需求(归属和爱的需求)、老年人的社会需求(临终前的社交需求)、老年人的灵性需求(临终前的愿望清单)。多主体互动只有在彼此共同致力于保持相互关注时,才能获得团结的回报,更高层次的精神回报需要多个主体以相同的时间长度维持这种关注。如果一方关注的焦点不集中,关注的时间不持久,那么情感能量的获得就受阻,互动效果会变差,安宁疗护老年人的支持系统将受到破坏。
仪式结果是互动仪式链的一部分,安宁疗护老年人和家属之间的互动仪式产生的结果不同之处,在于成员的身份被对方所承认[18]。如果仪式虚假,会阻碍群体符号生成[19]。安宁疗护老年人和家属主题小组要有身份在场,成员身份被认可,有共同的情感和关注[20]。成功的主题小组,会因为大家唱一首歌、经历一件事而产生很高的情感能量,成员之间产生情感联结。反之,互动仪式的消极结果是情感能量流动不畅,造成成员退出。家属舒缓心灵主题小组通过共同的情感体验来舒缓家属们的心灵,只有互动成功才能达到舒缓的效果,否则小组解散。
在老年人安宁疗护社会支持中的互动仪式链面临5个实践困境:1)互动碎片化,导致仪式链断链耦合不连贯;2)安宁疗护的老年人没有存在感,主体缺位,导致耦合失效;3)其他主体角色越位,导致耦合不清;4)共同关注点变弱,导致耦合失焦;5)艺术化处理,导致耦合偏离。厘清实践困境有助于找到针对性解决方案,从而更好地指导安宁疗护实践。
互动碎片化就会造成群体仪式的破裂,情感能量不能稳定地累积起来,从而造成互动仪式链的断裂。安宁疗护老年人与跨学科团队、老年人之间、亲人之间的互动因为离职、死亡或者亲人工作忙碌无法参与而被切断,于是缺少了情感能量,仪式链变得不稳定。互动连续性较差,跨学科团队成员因各种原因退出,安宁疗护老年人因离世退出,亲人因工作繁忙不能持续参与,互动仪式链不能持续,整体支持效果受影响。
安宁疗护老年人没有参与感,主体在互动仪式链中消失。理想状态下老年人应该参与到仪式中来,但因为身体或者心理的原因,老年人的参与度低,精神不集中,无法全身心参与仪式中。缺乏足够的参与感导致系统失灵,社会支持系统无法正常运作。老年人主体缺位,互动仪式链的耦合作用失效,不能很好地满足老年人的情感需求,给予老年人必要的精神慰藉。
安宁疗护支持系统中,其他角色越位会导致边界不清,从而破坏互动仪式的稳定状态。跨学科团队成员、家属、临终老年人同伴由于权威因素或者情感因素代替老年人做出决定,使老年人主体角色受到压抑或者忽视。缺乏明确的边界感使互动仪式失去焦点与秩序,安宁疗护效果也会受到影响。其他角色越过应有的界限,安宁疗护老年人社会支持体系被扰乱,仪式链效能遭受削减。
跨学科合作不平等,共关心点减少,互动仪式失灵。大家都围着老年人转,可是各自为政,缺乏学科之间的协作,只有短暂的互动。医生、护士、社会工作者等各自关注自己的专业领域,忽视整体,最终导致安宁疗护老年人无法从多方参与者获得系统性的支持,造成社会支持系统不稳定。
过度艺术化的仪式处理导致内容失真,老年人的真实需求没有被体现出来。跨学科团队可能为了美化仪式内容,采取一些老年人不喜欢或者不适用的方式,老年人可能会感到抗拒。生命视频中出现的说话声音和情感表达与老年人自己的想法不同,过度夸大感情的表达。艺术化处理未能激起情感共鸣,导致老年人对仪式内容产生抵触情绪,从而使得互动仪式未能发挥情感支撑的作用。
互动仪式链在老年人安宁疗护社会支持中的优化策略,可从以下5个方面着手。重点在“共同关注+情感共鸣”这两个核心上做加法,让群体有参与感和获得感。互动仪式链视角下安宁疗护支持系统见图2。
通过仪式团结情感嵌入的瞬间共有,链接“关注与连带”的认知状态、情感状态与意志状态,从而产生心理认同的共在感、伙伴感、共情感[21]。人们倾向于参与当前情感能量回报最大、强度最高的互动仪式。成员的文化资本与一些互动不太相配时,互动仪式未能达到高强度,成员就会自动慢慢离开这个互动仪式;当成员的文化资本与互动非常相配时,互动仪式达到高强度,互动仪式是成功的,高情感能量回报吸引成员加入互动情境。增强仪式反馈,增强子女、医生、护士、社工及老年人的仪式反馈,通过仪式反馈增强老年人的社会支持的可持续性。
情感能量市场是互动仪式的核心,互动过程中投入情感能量以获得回报,平衡情感能量的预算[22]。安宁疗护的老年人之间情感能量市场就是把疼痛倾诉出来,把生命的故事讲出来,倾诉自己走过的漫长路程,倾诉自己对这个世界的思考。互动中如果可以吸收等量或更多的情感能量,则仪式继续,否则仪式中断。情感既能团结也能引发冲突[23]。情感唤起随着时间的推移逐渐稳定,过分激动便会衰退,恰当的激动有益于维系稳定。安宁疗护老年人的情感需求包括对生命意义的需求、被尊重与被爱的需求,唤起的任何情感都需要和老年人的身体情况相适应,不能太激动,以利于老年人安然离世。
物质市场包括商品市场和服务市场,柯林斯的《互动仪式链》书中提到物质市场提供了一些条件和物质基础,这些成为互动仪式发生的要素。互动仪式的主导因素是产生足够的感情和符号,但没有物质条件,再好的互动仪式也会走到尽头。物质产品市场内容丰富,需要安宁疗护团队与老年人及家庭共同丰富产品与服务内容。
文化是一种象征符号的能量[24]。生命意义的符号象征是过去人生的具体表达,跨学科团队帮助安宁疗护老年人完成旅行笔记、生命旅行视频等承载生命意义的符号载体。还有一些自然意象符号(如蝉鸣、雨声、风声等),都有老年人的一些情感寄托在里面,让老年人充实自己的晚年生活,使生命变得更有意义。老年人通过仪式行为类符号掌握生活,就像叠被子、唱歌、散步就是生活的延续;相册、笔记等纪念品也是仪式符号,它并不仅仅是一个物件,会有带感情的能量一直存在,也是一连串的过去的记忆。
跨学科团队需要不断挖掘符号象征载体,涵盖生命意义、自然意象、仪式行为等符号。新的符号可以通过小组互动创造,源自成功互动仪式中的情感连带与关注点。新符号成为新的象征,帮助老年人面对临终时的情感需求,促进心灵的平静。团队需依据特定场景赋予每个符号以意义,逐步实现老年人优逝的目标,妥善处理身心痛苦,构建基于德行而非自主性的临终尊严[25]。
安宁疗护跨学科团队以童年、青年、中年、老年为具体的时间轴制作旅行笔记、旅行视频。社会工作者与老年人进行了大量的深度访谈,了解老年人的语言习惯、逻辑习惯、人生经历和情感经历,在视频的制作过程中不采用太多的艺术化处理,尽可能保留安宁疗护老年人的真声音、真影像,在视频制作完成后邀请老年人进行审核,他是视频的创作者而不是一个被动的参与者。只有做到这些才可以让安宁疗护老年人社会支持系统耦合,让安宁疗护老年人可以有尊严地完成自己人生最后一程。
本研究以互动仪式链理论为依据,从安宁疗护社会支持系统耦合机制、实践困境、优化策略3个方面进行研究。研究表明,互动仪式链依靠身体在场、边界清晰、情感能量、共同关注、身份认同这些要素,可以很好地缓解临终老人的心理压力,加强家庭情感联系,精准对接各种需求。但实践中存在着互动碎片化、主体缺位、角色越位、关注失焦、内容失真的问题,影响到支持系统整体效能的发挥。为此提出强化仪式反馈、激活情感能量市场、丰富物质产品供给、挖掘符号象征载体、回归真实需求等策略,把共同关注、情感共鸣作为核心来推进安宁疗护社会支持系统的可持续发展。未来还要加强跨学科合作,尊重老年人的主体地位和真实的表达,在政策引导和人文关怀并重的基础上,创建更加有温度、有效果的安宁疗护支持体系,帮助临终老年人度过尊严、安然的生命终程。

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2026年第40卷第17期
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doi: 10.12102/j.issn.1009-6493.2026.17.023
  • 接收时间:2025-11-13
  • 首发时间:2026-10-30
  • 出版时间:2026-09-10
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  • 收稿日期:2025-11-13
  • 修回日期:2026-07-13
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    1山西医科大学人文社会科学学院,山西 030001

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王志中,E-mail:
WANG Zhizhong, E-mail:
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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