Culture, Communication and Safety_ Lessons from the Airline Industry

SPECIAL ARTICLE

Culture,Communication and Safety: Lessons from the Airline Industry

Lori G.d’Agincourt-Canning&Niranjan Kissoon&

Mona Singal&Alexander F.Pitfield

Received:24September2010/Accepted:23November2010

#Dr.K C Chaudhuri Foundation2010

Abstract

Background Communication is a critical component of effective teamwork and both are essential elements in providing high quality of care to patients.Yet,communi-cation is not an innate skill but a process influenced by internal(personal/cultural values)as well as external (professional roles and hierarchies)factors.

Objective To provide illustrative cases,themes and tools for improving communication.

Methods Literature review and consensus opinion based on extensive experience.

Results Professional autonomy should be de-emphasized. Tools such as SBAR and simulation are important in communication and teamwork.

Conclusion Tools designed to improve communication and safety in the aviation industry may have applicability to the pediatric intensive care unit.

Keywords https://www.wendangku.net/doc/dd4550154.html,munication.Cultural values. Medical errors.Safety.Team training

Introduction

In his book“Outliers,”Gladwell[1]presents some interesting data on“the ethnic theory of plane crashes.”He states:“the kind of errors that cause plane crashes are invariably errors of team work and communication.”This sentence holds considerable import when“medical mis-haps”are substituted for“plane crashes.”According to Gladwell and others[2],lapses in communication and teamwork may be due to the personal values and attributes each individual brings into their professional position. These,in turn,are shaped by the traditions and assumptions embedded within the communities from which they came. Similarly,Helmreich,Merritt and Sherman[3]argue that behaviors are affected by national,organizational and professional cultures.

What is particularly relevant to medicine is that values, such as respect for and deference to authority,can vary widely across cultures and affect interpersonal communi-cation.Hofstede[4]conducted a comprehensive study of how values are influenced by culture and developed a model(Power Distance Index-PDI)that quantifies the degree to which members of organizations and institutions accept and expect unequal distribution of power.In a comparison of40countries,Hofstede found that low PDI countries placed greater value on individuality and equality than did high PDI countries,where respect for authority and paternalism were the social norm.His subsequent research on commercial airline pilots showed that the degree to which first officers were willing to assert themselves(i.e. express a safety concern)and challenge authority depended to a large extent on their national culture and PDI rating. Helmreich[5]has also examined the influence of culture on pilot behaviour and argues that respect for authority,and accordingly,lack of assertiveness may play a role in airline crashes.

It has long been recognized that effective communica-tion and interpersonal skills are critical to patient safety and the delivery of quality health care.Further,evidence shows that the pressure of high stress work areas such as

surgical L.G.d’Agincourt-Canning

:N.Kissoon(*):M.Singal:

A.F.Pitfield

Department of Pediatrics and Ethics Services,

British Columbia Children’s Hospital,

4500Oak Street,Room B245,

Vancouver,BC V6H3N1,Canada

e-mail:nkissoon@cw.bc.ca

Indian J Pediatr

DOI10.1007/s12098-010-0311-y

theatres and critical care units present particular challenges to communication[6–10].As a result,the Institute of Medicine[11]highly recommends that emergency and critical care teams who work together should train together. This has led to an increase in simulation team training for surgical and trauma resuscitation teams[12–14].While simulation plays a critical role in acquiring and maintaining technical expertise,the impact of personal aspects of performance,communication skills and team culture on outcomes is often underplayed.

The objectives of this manuscript are three fold:

1)To evaluate evidence about the critical relationship

between culture,communication,teamwork and safety;

2)To review methods for improving communication and

teamwork based on standardized communication tools, simulation and teaching of nontechnical skills,and management of disruptive behaviour

3)To examine the impact of team training on communication

and quality care.

In order to frame the discussion and address the issues above,we start with three illustrative cases.

Illustrative Cases

Case1

An ICU team,composed of an attending intensivist,ICU fellow,two pediatric residents,bedside nurse,pharmacist, respiratory therapist and nutritionist are conducting their morning round on a14year who was admitted for sepsis.A decision was made to change his antibiotics to a more appropriate regime.The pharmacist,who is new to the team,reviews the chart and realizes the boy has multiple drug allergies.The pharmacist informs the attending physician,but in an oblique way.The physician did not address the multiple drug allergies and says later he did not hear the pharmacist raise any concerns.The child goes into anaphylactic shock.

Case2

An ICU bedside nurse has a‘bad feeling’about a heart rate pattern for a newborn recovering from cardiac surgery.She tells the covering intensivist that she is concerned,but he says he“will get around to it when he has time”.The nurse has often worked with the attending and is not comfortable asserting herself.Additionally,she did not tell the super-vising nurse about her concerns.Thirty minutes later,the child went into cardiac arrest and although resuscitated, suffered brain damage.Case3

A first year resident,for whom English is her second language,is reluctant to tell the attending physician that a patient with hemophilia who is being treated for an intracranial hemorrhage has a younger brother who needs prophylaxis.

Common Themes in Medicine and the Aviation Industry While tremendous strides have been made in the technical aspects of critical care medicine,scenarios such as these are not https://www.wendangku.net/doc/dd4550154.html,mon to these and similar cases are: discomfort in communication;a perceived lack of safety in asserting and expressing a concern;disrespect or disregard for team member’s opinions and vague or incomplete communication.Researchers and medical professionals agree that patient care is improved through interdisciplinary teamwork[15].The reality is,however,that medical culture and traditional hierarchies can make it difficult for team members to raise an issue or voice a concern.As seen above,the lack of psychological safety,uncertainty about the plan of care,power distances and cultural norms can further pose barriers to communication[16].

Similar findings have been observed in the airline industry.It is well recognized that the typical airline crash does not occur because of one mishap,but as a result of several consecutive errors,the combination of which leads to the disaster.Moreover,these errors are not due to technical knowledge or flying skill but rather are caused by failures in teamwork,communication and social skills[17]. Experience in medicine is remarkably similar to that of the airline industry[18,19].There is a large body of evidence illustrating that75–80%of medical errors are linked to systemic issues regarding miscommunication in teams[20–23].The ICU environment is more conducive to miscom-munication because it relies on a larger team than a couple of pilots communicating with an air traffic controller.The typical ICU team includes clinical pharmacists,nurses, physiotherapists,respiratory therapists,social workers, junior and senior residents and a consultant.Frequently other specialists are involved as well(cardiologists, oncologists,radiologists,internists etc.).In addition,with increased globalization in the training environment,indi-viduals participating in these teams come from very diverse backgrounds.Effective communication among all of these individuals is necessary in order to exchange pertinent information.However,it is apparent that the discomfort of speaking up and lack of assertion played a critical role in the mishaps of the earlier case study scenarios.

As in the aviation industry,calls have been made for better communication,collaboration and teamwork in

Indian J Pediatr

healthcare.Yet,in many ICU environments,communica-tion and team performance evolve unsystematically,rather than being developed and taught in a more coordinated manner.ICU teams are similar to surgical teams and tend to function as discrete and separate collections of individuals where conventional hierarchical practices and intra-professional cohesion dominate over intentional collabora-tive practices[18,24].Indeed,a study by Lingard et al.

[25]depicts interprofessional collaboration in a Canadian ICU as rooted in ownership and‘trade of commodities,’rather than one of shared goals.A symptom of this behaviour is the stereotyping of the“other”professional, whether it be nurses,surgeons,cardiologists,oncologists, respiratory therapists,social workers or psychologists. Yet,notions of‘them and‘us,together with hierarchical modes of practice,do little to foster teamwork and safe operating or communication practices.For example, studies of physician-nurse interactions in the ICU describe divergent views of communication,with more nurses than physicians reporting difficulty in speaking up and a lack of collaboration[26,27].Other research shows that communication failures are caused by junior team members being reluctant to communicate openly with senior member because of fear of appearing as incompe-tent[9].Issues related to relationship and personalities of superior have also been shown to affect the willingness of resident to question or challenge authority with respect to safety concerns[28].Cultural factors may confound these problems further and compromise significantly the quality and safety of patient care.

Methods for Improving Team Work

and Communication

Medical culture is one that has traditionally emphasized professional autonomy(e.g.individual ownership of the patient)and hierarchical practices.Yet,in its1999report entitled,To Err Is Human:Building a Safer Health System, the Institute of Medicine(IOM)advocated for translating concepts of aviation team training to the health-care sector as a means to improve patient safety.The IOM repeated this call in its follow-up report2years later.

Indeed,a critical lesson learned from aviation is that there needs to be a shift in thinking of collaboration as emerging spontaneously or through goodwill,to explicitly setting up structures to articulate and establish a teamwork culture,the focus of which is patient care and safety[29]. Integral to aviation training is a specialist training program called crew resource management(CRM).The aim of CRM is to develop shared non-technical behaviours,such as teamwork and communication skills,in order to improve safety on the flight https://www.wendangku.net/doc/dd4550154.html,nguage Tools-SBAR

There are several key components to enhancing communi-cation and building effective teams(see Table1).These include briefings and de-briefings,situational awareness, critical language to signal major safety concerns and appropriate assertion,by which team members are encour-aged to state their concerns in an environment of mutual https://www.wendangku.net/doc/dd4550154.html,nguage tools such as a situational briefing model (SBAR-situation,background,analysis,recommendation), and closed loop communication(team members must verify that information sent is received an interpreted correctly by the intended party)have also been found to improve information exchange safety[15,30].Teamwork does not mean that everyone has the same position and/or degree of responsibility.Indeed,the roles and responsibilities of different team members need to be made clear,and deference to member expertise acknowledged,but it also requires that all members of the team are empowered to speak freely.This means a nurse or a medical resident should feel confident in raising a safety concern to the attending physician without fear of reprimand even if the concern is found to be unwarranted[30].

Simulation

Medical simulation is a promising approach to communi-cation training for both physicians and allied health care professionals.Simulation studies have shown that errors in patient management are almost always related to break downs in team communication:nurses are overloaded with tasks,time and personnel at hand are mismanaged,and individuals fail to adequately communicate thought pro-cesses to the rest of the team[9].Simulation creates a non-threatening,realistic environment where a back and forth dialogue can occur until mastery of the particular CRM skill in question is attained[31].Literature to support the use of simulation in CRM training indicates that it has a positive impact on the acquisition of non-technical skills.

Studies have demonstrated participant perception of improved CRM skills after undertaking a simulation training course in those principles[32].A recent approach to a more objective method of evaluating effectiveness of team communication in simulation has been undertaken using“probes”[33].In this method,“probes”(pieces of information that are deemed vital to patient management during a simulated crisis)are inserted by a confederate and then the knowledge of the probe information by other team members is audited post-scenario.This provides a validated way of measuring the effectiveness of team communication in a scenario[33].Given that the medical community has become cognizant of the importance of non-technical skills

Indian J Pediatr

in the safe management of patients,particularly those in a crisis,one could argue that didactic training in CRM principles should be an integral part of the curriculum of any residency or fellowship training program.Subsequent use of simulation to enhance,solidify and master CRM skills may create the most effective combination in the training of medical staff [34,35],though further studies are required to provide definitive evidence for this combination method of training.

Addressing Disruptive Behaviour

One commonly encountered roadblock to effective communication by a team is the presence of a disruptive team member.Disruptive individuals can degrade a team atmosphere and pose a threat to patient safety [36–38].This disruption commonly takes the form of intimidation (condescending language,impatience with questions,refusal to answer questions or telephone calls,throwing objects)or bullying (profane or disrespectful language,outbursts of anger,berating,demeaning and/or criticizing other providers in front of patients or other staff,name-calling,and physical threats)[38].However it can also take the form of an underprepared or distressed team member which in the critical care environment can rapidly lead to chaotic team function in times of crisis [39].Given that an inability to maintain team function in the presence of a disruption could have dire consequences on the outcome of the patient,training to manage these scenarios is as important as training to mastery of clinical skills.This can be done by establishing codes of conduct and “zero-tolerance ”hospital policies regarding abusive be-havior [37],identifying individuals of concern and

training them in team skills in small group role-play settings [40],or as previously discussed,utilizing simu-lated crisis scenarios to train specifically for team function and communication.It is also recommended that health care organizations have a well-designed plan for conduct compliance monitoring and a policy of non-retaliation for those who report violations or participate in the investiga-tion of violations [38].While disruptive behaviours are not limited to physicians,disruptive behaviour by physicians often has the greatest impact because of their positions of relative power in healthcare systems.This is likely to be true in the PICU as well.

Fundamental to the aviation industry is the acceptance that people,processes,equipment and systems can fail.As the aviation industry moves forward,experts now speak about the importance of establishing a ‘just culture,’where workers are encouraged to report errors without fear of reprisal [41].At the same time,there are clear expectations around acceptable and non-acceptable behaviour.In contrast,disruptive behaviour in health care has been frequently tolerated as a way of doing business.Yet,it is clearly evident that disruptive behaviour impairs communication within the health care team.One of the common outcomes of such behaviour is the reluctance to clarify orders or ask questions because of the fear of provoking an antagonistic response.This has great potential to adversely affect patient safety or outcomes of care [42].Given the complexities of today ’s ICU,disruptive behavior can no longer be ignored.Leadership (both managers and medical directors)ought to make clear expectations around acceptable and non-acceptable behav-iours,increase awareness of the impact of disruptive behaviour on safety and hold all clinicians,including physicians,accountable when this occurs.

Briefings:Although standard practice in aviation,briefings are uncommon in critical medicine.Yet,using a briefing before a procedure or at the beginning of a shift,gets everyone at the same start point,diminishes surprises and positively impacts how a team works together.

Appropriate Assertion:Teaching people how to speak up and creating an environment where they will state their concerns is a critical factor in safety.Effective leaders flatten the hierarchy,create familiarity and make it feel safe to speak up and participate.

Critical language techniques:The adoption of critical language (e.g.a consistent phrase)can be used by all team members to relay the message:“I ’m concerned,I ’m uncomfortable,this is unsafe.”When such a phrase is used,the message is communicated to the team leader that everyone needs to stop and listen to the member ’s concern.Critical language helps lessen the natural tendency to speak indirectly and deferentially.

Use of standardized checklists:Standardized communications,such as checklists,can help offset lapses in communication such as those that occur at shift change.

Situational awareness:refers to the care team maintaining the “big picture ”and thinking ahead to plan and discuss contingencies.This ongoing dialogue keeps members of the team up to date with what is happening and how they will respond if the situation changes.It is a key factor in safety.

Debriefing:is the process of spending a couple of minutes after a procedure,or at the end of a day,to discuss what the team did well,what were the challenges,and what should be done differently the next time.

Table 1Tools and behaviours for effective communication

Table Adapted from:Leonard,Graham and Bonacum (2004)and Powell and Homenhaus (2006)

Indian J Pediatr

The Impact of Communication Training on Quality Care

While studies using CRM training techniques in medicine are in their infancy,initial results in surgery,emergency medicine and anesthesiology are promising[19,43–46].In 2002,Morey et al.[47]demonstrated reductions in clinical error rates and improvements in staff attitudes toward teamwork after a focused teamwork training intervention in an academic emergency room.The educational intervention was based on five principles:(1)maintain team structuring and climate,(2)apply problem solving strategies,(3)communicate with the team,(4)execute plans and manage work loads,and(5)improve team skills.Likewise,researchers from a large hospital in the UK initiated an educational intervention aimed at improving patient safety in operating theatres through changing teamwork practices[48].Following a two-day seminar for identified‘champions’of teamwork practice and a one-day seminar for all in an operating room theatre, a system of regular team self reviews(briefing before an operating list and debriefing after the event)and close-call (near-miss)reporting was introduced.Also,addressed in the educational sessions were nontechnical aspects of patient care and safety in theatres including communica-tion,teamwork,leadership,situational awareness and barriers.Initial data demonstrated a significant improve-ment to patient safety,as well as inter-professional gains including greater empathy for another professional’s role.

A similar study demonstrated in a reduction in both operative technical error and non-operative procedural errors following formal training in teamwork skills[49]. None of these studies have addressed the impact of providers’ethnicity or culture on communication patterns; however,experience from the aviation industry indicates that teamwork training is effective across cultures. Conclusions

More than50years of research in aviation has demon-strated that cognitive and technical skills alone are not enough to ensure adequate safety.Rather,what are needed are effective teamwork skills.Similarly,in medicine,concept of‘team’must move beyond our traditional models towards a more collaborative and respectful approach based on evidence.Strategies and techniques,such as the ones used in the aviation industry,may help address communication difficulties resulting from different training and cultural back-grounds.Both organizational and ICU leadership need to take an active approaching to addressing disruptive behaviors by increasing awareness of the harm that can result,both to patient outcomes and team morale.At the same time,research will be needed to explore the utility and effectiveness of aviation-type approaches to team-work in the ICU environment.Only by making commu-nication and collaboration educationally explicit and a structured part of everyday practice can we begin to respond to the safety challenges inherent to the ICU. Conflict of Interest None.

Role of Funding Source None.

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峄山碑及译文

《峄山碑》全文及译文 《峄山碑》是秦始皇二十八年（公元前219年）东巡时所刻，下面是小编为大家带来的峄山碑全文及译文，欢迎阅读。 碑文 皇帝立国，维初在昔，嗣世称王 讨伐乱逆，威动四极，武义直方 戎臣奉诏，经时不久，灭六暴强 廿有六年，上荐高号，孝道显明 既献泰成，乃降专惠，亲巡远方 登于绎山①，群臣从者，咸思攸长 追念乱世，分土建邦，以开争理 功战日作，流血于野，自泰古始 世无万数，陀及五帝，莫能禁止 廼今皇帝，壹家天下，兵不复起 灾害灭除，黔首康定，利泽长久 群臣诵略，刻此乐石，以箸经纪 注：①绎山：指峄山。 皇帝日：“金石刻尽，始皇帝所为也。今袭号而金石刻辞不称，始皇帝其于久远也。如后嗣为之者，不称成功盛德。”丞相臣斯、臣去疾，御史大夫臣德。昧死言，臣请具刻诏书，金石刻因明白矣。臣昧死请，制日可。 注释： 皇帝立国，维初在昔，嗣世称王 （维是发语词，不翻。嗣世，一代代，继承。这三句，是一句话。） 讨伐乱逆，威动四极，武义直方 （武义直方，就相当于说正义战争。） 戎臣奉诏，经时不久，灭六暴强 （戎臣，就是带兵的将领。灭六暴强即诛灭六国。） 廿有六年，上荐高号，孝道显明

（皇帝二十六年，公元前221年。群臣上表，请求秦王称皇帝号。就叫上荐高号。这个孝道，是说秦国各代国君，均有统一之志，始皇帝的统一，乃是完成祖先之道。）既献泰成，乃降专惠，亲巡远方 （溥惠，尃惠。溥就是普。我用的书里面，百度百科里面，都错成了专字。既献泰成，乃降尃惠，亲巡远方。应该是这样子才对。既，就是完成了的意思。泰成，就是大成。完成了统一大业。普惠，把恩泽给了所有的人。寴车巛，就是亲巡。从车和从辵，都是表示动作的形符。坐车出巡，就是车巛。） 登于绎山①，群臣从者，咸思攸长 （登上峄山，大家都发起了怀古之悠情。） 追念乱世，分土建邦，以开争理 （过去是乱世，起因于分土建国，就是封建制。所以，大家才会去争斗。） 功战日作，流血于野，自泰古始 （功战就是攻战。自太古以来就是如此。） 世无万数，，阤yi3及五帝，莫能禁止 （无数代以来，到五帝时代，都不能禁止。阤，延续。） 廼今皇帝，壹家天下，兵不复起 （如今统一了，不再打仗了。） 灾害灭除，黔首康定，利泽长久 （黔首，就是百姓。） 群臣诵略，刻此乐石，以箸经纪 （诵略，因为皇帝的功德是说不完的，所以，大臣说的，只是大略。是为诵略。经纪，就是法度，秩序。） 以上内容，是始皇帝的刻辞。下面，是秦二世的内容。上面的是四言诗。下面的，是散文了。 皇帝曰：‘金石刻尽始皇帝所为也，令袭号而金石刻辞不称始皇帝。其于久远也，如后嗣为之者，不称成功盛德。丞相臣斯、臣去疾、御史大夫臣德昧死言：‘请具刻诏书，金石刻因明白矣。’臣昧死请。制曰：“可’。” 译文 皇帝立国，维初在昔，嗣世称王 讨伐乱逆，威动四极，武义直方戍臣奉诏，经时不久，灭六暴强

古代晋灵公不君、齐晋鞌之战原文及译文

晋灵公不君（宣公二年） 原文： 晋灵公不君。厚敛以雕墙。从台上弹人，而观其辟丸也。宰夫胹熊蹯不熟，杀之，寘诸畚，使妇人载以过朝。赵盾、士季见其手，问其故而患之。将谏，士季曰：“谏而不入，则莫之继也。会请先，不入，则子继之。”三进及溜，而后视之，曰：“吾知所过矣，将改之。”稽首而对曰：“人谁无过？过而能改，善莫大焉。诗曰：‘靡不有初，鲜克有终。’夫如是，则能补过者鲜矣。君能有终，则社稷之固也，岂惟群臣赖之。又曰：‘衮职有阙，惟仲山甫补之。’能补过也。君能补过，衮不废矣。” 犹不改。宣子骤谏，公患之，使鉏麑贼之。晨往，寝门辟矣，盛服将朝。尚早，坐而假寐。麑退，叹而言曰：“不忘恭敬，民之主也。贼民之主，不忠；弃君之命，不信。有一于此，不如死也！”触槐而死。 秋九月，晋侯饮赵盾酒，伏甲将攻之。其右提弥明知之，趋登曰：“臣侍君宴，过三爵，非礼也。”遂扶以下。公嗾夫獒焉。明搏而杀之。盾曰：“弃人用犬，虽猛何为！”斗且出。提弥明死之。 初，宣子田于首山，舍于翳桑。见灵辄饿，问其病。曰：“不食三日矣！”食之，舍其半。问之，曰：“宦三年矣，未知母之存否。今近焉，请以遗之。”使尽之，而为之箪食与肉，寘诸橐以与之。既而与为公介，倒戟以御公徒，而免之。问何故，对曰：“翳桑之饿人也。”问其名居，不告而退。——遂自亡也。 乙丑，赵穿①攻灵公于桃园。宣子未出山而复。大史书曰：“赵盾弑其君。”以示于朝。宣子曰：“不然。”对曰：“子为正卿，亡不越竟，反不讨贼，非子而谁？”宣子曰：“呜呼!‘我之怀矣，自诒伊戚。’其我之谓矣。” 孔子曰：“董狐，古之良史也，书法不隐。赵宣子，古之良大夫也，为法受恶。惜也，越竞乃免。” 译文： 晋灵公不行君王之道。他向人民收取沉重的税赋以雕饰宫墙。他从高台上用弹弓弹人，然后观赏他们躲避弹丸的样子。他的厨子做熊掌，没有炖熟，晋灵公就把他杀了，把他的尸体装在草筐中，让宫女用车载着经过朝廷。赵盾和士季看到露出来的手臂，询问原由后感到很忧虑。他们准备向晋灵公进谏，士季说：“如果您去进谏而君王不听，那就没有人能够再接着进谏了。还请让我先来吧，不行的话，您再接着来。”士季往前走了三回，行了三回礼，一直到屋檐下，晋灵公才抬头看他。晋灵公说：“我知道我的过错了，我会改过的。”士季叩头回答道：“谁能没有过错呢？有过错而能改掉，这就是最大的善事了。《诗经》说：‘没有人向善没有一个开始的，但却很少有坚持到底的。’如果是这样，那么能弥补过失的人是很少的。您如能坚持向善，那么江山就稳固了，不只是大臣们有所依靠啊。

峄山碑 释文

峄山碑释文 皇帝立国，维初在昔， 维是发语词，不翻。 嗣世称王，一代代，继承。 这三句，是一句话。 讨伐乱逆，威动四极，武义直方。 武义直方，就相当于说正义战争。 我们的战争是正义的。 我们作战的对象，是乱逆 戎臣奉诏，经时不久，灭六暴强。 戎臣，就是带兵的将领。诛灭六国。 廿有六年，上荐高号，孝道显明。 皇帝二十六年，公元前221年。 群臣上表，请求秦王称皇帝号。就叫上荐高号。 这个孝道，是说秦国各代国君，均有统一之志， 始皇帝的统一，乃是完成祖先之道。 既献泰成，乃降专惠，亲巡远方。 溥惠， 尃惠。 溥就是普。 我用的书里面，百度百科里面，都错成了专字。 既献泰成，乃降尃惠，亲巡远方。 应该是这样子才对。 既，就是完成了的意思。泰成，就是大成。 完成了统一大业。 普惠，把恩泽给了所有的人。 寴车巛，就是亲巡。 从车和从辵，都是表示动作的形符。 坐车出巡，就是车巛。 登于峄山，群臣从者，咸思攸长。 登上峄山，大家都发起了怀古之悠情。 追念乱世，分土建邦，以开争理。 过去是乱世，起因于分土建国，就是封建制。所以，大家才会去争斗。功战日作，流血于野，自泰古始。 功战就是攻战。自太古以来就是如此。 世无万数，陀及五帝，莫能禁止 无数代以来，到五帝时代，都不能禁止。 阤，延续。 乃今皇帝，壹家天下，兵不复起 如今统壹了，不再打仗了。 灾害灭除，黔首康定，利泽长久 黔首，就是百姓。 群臣诵略，刻此乐石，以著经纪 经纪，就是法度，秩序。

诵略，因为皇帝的功德是说不完的，所以，大臣说的，只是大略。是为诵略。以上内容，是始皇帝的刻辞。 下面，是秦二世的内容。 上面的是四言诗。 下面的，是散文了。 皇帝曰，金石刻尽始皇帝所为也， 今袭号，而金石刻辞不称始皇帝，其于久远也。如后嗣为之者，不称成功盛德。丞相臣斯，这是李斯。 臣去疾，此人据说是姓杜。 御史大夫臣德，此人史传无载。 左丞相，右丞相，御史大夫， 是政府首脑。 当时的官制，这三位均是宰相。 当时的制度，是宰相负责制。 可以开府。 就是可以自己组成一个行政班子。 人员由宰相任命。不通过皇帝。 当时的宰相，权利是很大的。 皇帝基本就是个国家象征。 秦始皇很厉害，所以他能管事儿。 到了二世，就不管事了。事全交给宰相处理。 汉朝的皇帝，其实也是不太过问事情的。 政务交给宰相处理。 皇权，相权，在中国历史上， 是皇权越来越大， 相权越来越小。 昧死言，臣请具刻诏书金石刻，因明白矣。臣昧死请。 制曰，可。这是皇帝说的。 皇帝说，可以。 昧死言，就是冒着因冒犯皇帝而可能被处死的危险，来进言。 这是一种大臣上书的格式。 因为皇帝总是对的，皇帝即是圣人。 你对他说话，可能就是错的。 这个峄山刻石就讲完了。 简单的，跟现代汉语没什么区别的词就不用讲了。 其实在战国后期，所有的人， 不论是哪国的百姓， 都是希望统一的。 春秋战国之际的所有思想家，其思想都是要求统一的。 无论是儒，墨，老庄，都要求统一。 社会整体的愿望就是统一，结束战争。 所以，如果不是秦国政治比较急功近利， 他完全可以是一个好的帝国。

如何翻译古文

如何翻译古文 学习古代汉语，需要经常把古文译成现代汉语。因为古文今译的过程是加深理解和全面运用古汉语知识解决实际问题的过程，也是综合考察古代汉语水平的过程。学习古代汉语，应该重视古文翻译的训练。 古文翻译的要求一般归纳为信、达、雅三项。“信”是指译文要准确地反映原作的含义，避免曲解原文内容。“达”是指译文应该通顺、晓畅，符合现代汉语语法规范。“信”和“达”是紧密相关的。脱离了“信”而求“达”，不能称为翻译；只求“信”而不顾“达”，也不是好的译文。因此“信”和“达”是文言文翻译的基本要求。“雅”是指译文不仅准确、通顺，而且生动、优美，能再现原作的风格神韵。这是很高的要求，在目前学习阶段，我们只要能做到“信”和“达”就可以了。 做好古文翻译，重要的问题是准确地理解古文，这是翻译的基础。但翻译方法也很重要。这里主要谈谈翻译方法方面的问题。 一、直译和意译 直译和意译是古文今译的两大类型，也是两种不同的今译方法。 1．关于直译。所谓直译，是指紧扣原文，按原文的字词和句子进行对等翻译的今译方法。它要求忠实于原文，一丝不苟，确切表达原意，保持原文的本来面貌。例如： 原文：樊迟请学稼，子曰：“吾不如老农。”请学为圃。子曰：“吾不如老圃。”（《论语?子路》） 译文：樊迟请求学种庄稼。孔子道：“我不如老农民。”又请求学种菜蔬。孔子道：“我不如老菜农。”（杨伯峻《论语译注》） 原文：齐宣王问曰：“汤放桀，武王伐纣，有诸？”（《孟子?梁惠王下》） 译文：齐宣王问道：“商汤流放夏桀，武王讨伐殷纣，真有这回事吗？（杨伯峻《孟子译注》） 上面两段译文紧扣原文，字词落实，句法结构基本上与原文对等，属于直译。 但对直译又不能作简单化理解。由于古今汉语在文字、词汇、语法等方面的差异，今译时对原文作一些适当的调整，是必要的，并不破坏直译。例如： 原文：逐之，三周华不注。（《齐晋鞌之战》） 译文：〔晋军〕追赶齐军，围着华不注山绕了三圈。

峄山碑全文及译文

峄山碑全文及译文文件排版存档编号：[UYTR-OUPT28-KBNTL98-UYNN208]

《峄山碑》全文及译文《峄山碑》是秦始皇二十八年（公元前219年）东巡时所刻，下面是小编为大家带来的峄山碑全文及译文，欢迎阅读。 碑文 皇帝立国，维初在昔，嗣世称王 讨伐乱逆，威动四极，武义直方 戎臣奉诏，经时不久，灭六暴强 廿有六年，上荐高号，孝道显明 既献泰成，乃降专惠，亲巡远方 登于绎山①，群臣从者，咸思攸长 追念乱世，分土建邦，以开争理 功战日作，流血于野，自泰古始 世无万数，陀及五帝，莫能禁止 廼今皇帝，壹家天下，兵不复起 灾害灭除，黔首康定，利泽长久 群臣诵略，刻此乐石，以箸经纪 注：①绎山：指峄山。 皇帝日：“金石刻尽，始皇帝所为也。今袭号而金石刻辞不称，始皇帝其于久远也。如后嗣为之者，不称成功盛德。”丞相臣斯、臣去疾，御史大夫臣德。昧死言，臣请具刻诏书，金石刻因明白矣。臣昧死请，制日可。 注释： 皇帝立国，维初在昔，嗣世称王

（维是发语词，不翻。嗣世，一代代，继承。这三句，是一句话。） 讨伐乱逆，威动四极，武义直方 （武义直方，就相当于说正义战争。） 戎臣奉诏，经时不久，灭六暴强 （戎臣，就是带兵的将领。灭六暴强即诛灭六国。） 廿有六年，上荐高号，孝道显明 （皇帝二十六年，公元前221年。群臣上表，请求秦王称皇帝号。就叫上荐高号。这个孝道，是说秦国各代国君，均有统一之志，始皇帝的统一，乃是完成祖先之道。） 既献泰成，乃降专惠，亲巡远方 （溥惠，尃惠。溥就是普。我用的书里面，百度百科里面，都错成了专字。既献泰成，乃降尃惠，亲巡远方。应该是这样子才对。既，就是完成了的意思。泰成，就是大成。完成了统一大业。普惠，把恩泽给了所有的人。寴车巛，就是亲巡。从车和从辵，都是表示动作的形符。坐车出巡，就是车巛。） 登于绎山①，群臣从者，咸思攸长 （登上峄山，大家都发起了怀古之悠情。） 追念乱世，分土建邦，以开争理 （过去是乱世，起因于分土建国，就是封建制。所以，大家才会去争斗。）功战日作，流血于野，自泰古始 （功战就是攻战。自太古以来就是如此。） 世无万数，，阤yi3及五帝，莫能禁止 （无数代以来，到五帝时代，都不能禁止。阤，延续。） 廼今皇帝，壹家天下，兵不复起

齐晋鞌之战原文和译文

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列阵，摆开阵势。 [3]邴夏：齐国大夫。御，动词，驾车。御齐侯，给齐侯驾车。齐侯，齐国国君，指齐顷公。 [4]逢丑父：齐国大夫。右：车右。 [5]解张、郑丘缓：都是晋臣，郑丘是复姓。郤（x ）克，晋国大夫，是这次战争中晋军的主帅。又称郤献子、郤子等。 [6]姑：副词，姑且。翦灭：消灭，灭掉。朝食：早饭。这里是吃早饭的意思。这句话是成语灭此朝食的出处。 [7]不介马：不给马披甲。介：甲。这里用作动词，披甲。驰之：驱马追击敌人。之：代词，指晋军。 [8] 未绝鼓音：鼓声不断。古代车战，主帅居中，亲掌旗鼓，指挥军队。兵以鼓进，击鼓是进军的号令。 [9] 病：负伤。 [10]张侯，即解张。张是字，侯是名，人名、字连用，先字后名。 [11]合：交战。贯：穿。肘：胳膊。 [12]朱：大红色。殷：深红色、黑红色。 [13]吾子：您，尊敬。比说子更亲切。 [14]苟：连词，表示假设。险：险阻，指难走的路。 [15]识：知道。之，代词，代苟有险，余必下推车这件事，可不译。 [16]师之耳目：军队的耳、目（指注意力）。在吾旗鼓：在我们

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所以克受伤后仍然击鼓不停。(7)病：负伤。(8)合：交战。(9)贯：射。穿。肘：胳膊。(10)朱：大红色。殷：深红色。(11)识：知道。 (12) 殿：镇守。(13)集事：成事。(14)擐（huan）：穿上。兵：武器。 (15) 即：就。即死：就死，赴死。(16)勉：努力。(17)并：合在一起。辔（Pei）：马组绳。(18)援：拉过来。枴〉襲）：鼓槌。(19)逸：奔跑，狂奔。(20)周：环绕华不注：山名，在今山东济南东北。 【译文】 六月十七日，国和晋国的军队在鞌摆开了阵势。邴夏为顷公驾车，逢丑父担任车右。晋国解张为卻克驾车，郑丘缓担任车右。顷公说：“我暂且先消灭了这些敌人再吃早饭。”军没有给马披甲就驱车进击晋军。卻克被箭射伤，血流到鞋子上，但他一直没有停止击鼓，并说：“我受伤了！”解张说：“从开始交战，我的手和胳膊就被箭射穿了，我折断了箭，继续驾车，左边的车轮因被血染成了深红色，哪里敢说受了伤？您还是忍住吧？”郑丘缓说：“从开始交战，只要遇到险阻，我一定要下去推车，您哪里知道这些？可是您却受伤了！”解张说：“我们的旗帜和战鼓是军队的耳目，军队进攻和后撤都听从旗鼓指挥。这辆战车只要一个人镇守，就可以成功，怎么能因为负了伤而败坏国君的大事呢？穿上铠甲，拿起武器，本来就是去赴死；受伤不到死的地步，您要奋力而为啊！”解张左手把马绳全部握在一起，右手拿过鼓槌来击鼓。战马狂奔不已，晋军跟著主帅的车前进，军大败，晋军追击军，围著华不注山追了三圈。 2、版本二

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创作编号：BG7531400019813488897SX 创作者：别如克* 鞌之战选自《左传》又名《鞍之战》原文：楚癸酉，师陈于鞌(1)。邴夏御侯，逢丑父为右②。晋解张御克，郑丘缓为右(3)。侯日：“余姑翦灭此而朝食(4)”。不介马而驰之⑤。克伤于矢，流血及屦2 未尽∧?6)，曰：“余病矣(7)！”张侯曰：“自始合(8)，而矢贯余手及肘(9)，余折以御，左轮朱殷(10)，岂敢言病？吾子忍之！”缓曰：“自始合，苟有险，余必下推车，子岂＿识之(11)？然子病矣！”张侯曰：“师之耳目，在吾旗鼓，进退从之。此车一人殿之(12)，可以集事(13)，若之何其以病败君之大事也？擐甲执兵(14)，固即死也(15)；病未及死，吾子勉之(16)！”左并辔(17) ，右援拐?鼓(18)。马逸不能止(19)，师从之，师败绩。逐之，三周华不注(20) 韩厥梦子舆谓己曰：“旦辟左右！”故中御而从齐侯。邴夏曰：“射其御者，君子也。”公曰：“谓之君子而射之，非礼也。”射其左，越于车下；射其右，毙于车中。綦毋张丧车，从韩厥，曰：“请寓乘。”从左右，皆肘之，使立于后。韩厥俛，定其右。逢丑父与公易位。将及华泉，骖絓于木而止。丑父寝于轏中，蛇出于其下，以肱击之，伤而匿之，故不能推车而及。韩厥执絷马前，再拜稽首，奉觞加璧以进，曰：“寡君使群臣为鲁、卫请，曰：‘无令舆师陷入君地。’下臣不幸，属当戎行，无所逃隐。且惧奔辟而忝两君，臣辱戎士，敢告不敏，摄官承乏。” 丑父使公下，如华泉取饮。郑周父御佐车，宛茷为右，载齐侯以免。韩厥献丑父，郤献子将戮之。呼曰：“自今无有代其君任患者，有一于此，将为戮乎？”郤子曰：“人不难以死免其君，我戮之不祥。赦之，以劝事君者。”乃免之。译文1：在癸酉这天，双方的军队在鞌这个地方摆开了阵势。齐国一方是邴夏为齐侯赶车，逢丑父当车右。晋军一方是解张为主帅郤克赶车，郑丘缓当车右。齐侯说:“我姑且消灭了这些人再吃早饭。”不给马披甲就冲向了晋军。郤克被箭射伤，血流到了鞋上，但是仍不停止擂鼓继续指挥战斗。他说:“我受重伤了。”解张说:“从一开始接战，一只箭就射穿了我的手和肘，左边的车轮都被我的血染成了黑红色，我哪敢说受伤？您忍着点吧！”郑丘缓说:“从一开始接战，如果遇到道路不平的地方，我必定（冒着生命危险）下去推车，您难道了解这些吗？不过，您真是受重伤了。”daier 解张说:“军队的耳朵和眼睛，都集中在我们的战旗和鼓声，前进后退都要听从它。这辆车上还有一个人镇守住它，战事就可以成功。为什么为了伤痛而败坏国君的大事呢？身披盔甲，手执武器，本来就是去走向死亡，伤痛还没到死的地步，您还是尽力而为吧。”一边说，一边用左手把右手的缰绳攥在一起，用空出的右手抓过郤克手中的鼓棰就擂起鼓来。（由于一手控马，）马飞快奔跑而不能停止，晋军队伍跟着指挥车冲上去，把齐军打得打败。晋军随即追赶齐军，三次围绕着华不注山奔跑。韩厥梦见他去世的父亲对他说:“明天早晨作战时要避开