社区医务人员对居家脑卒中患者分级护理认知的质性研究
|
摘要
目的了解社区医务人员对居家脑卒中患者分级护理的体验。方法对郑州市中原区3个社区的15名医务人员进行半结构式访谈,并用Colaizzi 7步法分析资料。结果提炼出3个主题,主题1:家庭照护为主,专业照护为辅,专业化照护需求参差不齐,照护现状不容乐观;主题2:科学分级,有效照护;主题3:分级之路,任重道远。其中主题3包括4个次主题:分级护理符合我国深化医药卫生体制改革要求,但缺乏有效政策支持;缺乏相应的分级护理评估工具;社区医疗资源不足,医务人员核心能力需提高;缺乏连续信息平台,无法做到医院-社区-家庭的连续照护。结论整合医疗资源,合理界定分级,规范分级照护内容,提升医务人员的核心能力,保证居家照护效果,完善共享信息平台,实现管理监督是居家脑卒中患者分级护理继续发展的主要任务。
Objective To understand the experience with grading nursing of stroke patients at home in community medical staff.Methods A semi-structured interview was conducted in 15 medical staffs in 3 communities of Zhongyuan District in Zhengzhou,and the data were analyzed by using Colaizzi method.Results Three themes were extracted.1) Family care supplemented by specialized care played the leading role;the demand for specialized care was different but the current specialized care is not satisfactory.2) Scientific grading nursing,with effective care.3) Grading nursing was full of challenges and it consisted of four subthemes:in line with the requirement of medical and health reform in China,but lack of effective policy support;shortage of corresponding grading nursing evaluation tools;shortage of community medical resources and the improvement of core competence of medical staff;lack of continuous information platform for the continuous care of hospital-community-family.Conclusion It is important to integrate medical resources,define the classification rationally,standardize the content of grading care,improve the ability of medical staff,ensure the effect of home care,complete the information platform and perform management supervision.
Objective To understand the experience with grading nursing of stroke patients at home in community medical staff.Methods A semi-structured interview was conducted in 15 medical staffs in 3 communities of Zhongyuan District in Zhengzhou,and the data were analyzed by using Colaizzi method.Results Three themes were extracted.1) Family care supplemented by specialized care played the leading role;the demand for specialized care was different but the current specialized care is not satisfactory.2) Scientific grading nursing,with effective care.3) Grading nursing was full of challenges and it consisted of four subthemes:in line with the requirement of medical and health reform in China,but lack of effective policy support;shortage of corresponding grading nursing evaluation tools;shortage of community medical resources and the improvement of core competence of medical staff;lack of continuous information platform for the continuous care of hospital-community-family.Conclusion It is important to integrate medical resources,define the classification rationally,standardize the content of grading care,improve the ability of medical staff,ensure the effect of home care,complete the information platform and perform management supervision.
引文
[1]Wang W,Wang D,Liu H,et al.Trend of Declining Stroke Mortality in China:Reasons and Analysis[J].Stroke Vasc Neurol,2017,2(3):132-139.DOI:10.1136/svn-2017-000098.2017.9.
[2]Park J H,Ovbiagele B.Relationship of Functional Disability after a Recent Stroke with Recurrent Stroke Risk[J].Eur JNeurol,2016,23(2):361-367.DOI:10.1111/ene.12837.2015.10.23.
[3]中共中央国务院.“健康中国2030”规划纲要[EB/OL].(2016-10-25)[2018-07-25].http://www.gov.cn/xinwen/2016-10/25/content_5124174.htm.
[4]陈积瑞.常见慢性病住院费用支出与医疗保险报销的相关性研究[D].南京:东南大学,2014.
[5]中华人民共和国人力资源和社会保障部.15城市启动长期护理险制度试点[EB/OL].(2016-07-08)[2018-07-20].http://www.mohrss.gov.cn/SYrlzyhshbzb/dongtaixinwen/buneiyaowen/201607/t20160708_243153.html.
[6]梁建群.华阴市脑卒中患者长期照护现状与需求研究[D]西安:第四军医大学,2015.
[7]李莹爽,张振香.社区脑卒中患者照护需求的研究进展[J]中国实用神经疾病杂志,2017,20(14):114-116.DOI:103969/j.issn.1673-5110.2017.14.038.
[8]张振香,刘腊梅.社区脑卒中患者的护理需求及其影响因素[J].中国老年学杂志,2012,32(19):4250-4252.DOI:10.3969/j.issn.1005-9202.2012.19.067.
[9]Sousa D.Validation in Qualitative Research:General Aspects And Specificities of the Descriptive Phenomenological Method[J].Qual Res Psychol,2014,11(2):211-227.DOI:10.1080/14780887.2013.853855.
[10]中华人民共和国国家卫生和计划生育委员会.综合医院分级护理指导原则[EB/OL].(2009-05-21)[2018-02-18].http://www.moh.gov.cn/mohbgt/s9509/200905/40929.shtml.
[11]段洪连,刘美云,张拥波,等.缺血性脑卒中常用评估量表及其最新研究进展[J].中国全科医学,2011,14(35):4018-4021.DOI:10.3969/j.issn.1007-9572.2011.35.005.
[12]Morris J N,Belleville-Taylor P,Fries BE,et al.InterRAILong-Term Care Facilities(LTCF)Assessment for Manduser's Manual,9.1[M].Washington,DC:Australian Edition,2011:25-30.
[13]Prodinger B,Scheel-Sailer A,Escorpizo R,et al.European Initiative for the Application of the International Classification of Functioning,Disability and Health:Development of Clinical Assessment Schedules for Specified Rehabilitation Services[J].Eur J Phys Rehabil Med,2017,53(2):319-332.DOI:10.23736/S1973-9087.16.04438-5.2016.11.24.
[14]范晓华,南登昆,刘燧.功能独立性评测的信度与效度的初步研究[J].中华物理医学杂志,1998,20(3):171-174.DOI:10.3760/j:issn:0254-1424.1998.03.014.
[15]中华人民共和国民政部,老年人能力评估标准[EB/OL].(2013-08-29)[2018-07-10].http://www.mca.gov.cn/article/gk/wj/201805/20180500009037.shtml.
[16]许静,仲利娟,谢世平,等.河南省公立与民营社区卫生服务站三年发展比较分析[J].中国社会医学杂志,2018,35(4):389-392.DOI:10.3969/j.issn.1673-5625.2018.04.019.
[17]周灵利,汪和平,解龙,等.我国全科医生资源配置现状及公平性分析[J].中国全科医学,2017,20(19):2311-2315.DOI:10.3969/j.issn.1007-9572.2017.19.004.
[18]蒋慧琴,东梅.慢性病多学科协作模式下的护理现状和展望[J].护理学报,2017,24(22):28-31.DOI:10.16460/j issn1008-9969.2017.22.028.
[19]朱亚珍,朱凌燕,许燕玲.社区卫生站护士对医院-社区-家庭慢性病一体化管理体验的质性研究[J].中华护理杂志,2018,53(5):528-532.DOI:10.3761/j.issn.0254-1769.201805.003.
[20]容根南,承建国,许海民,等.上海市宝山区老年护理管理区域联动模式的构建与运行研究[J].护理学报,2018,25(24)13-16.DOI:10.16460/j.issn1008-9969.2018.24.013.
[2]Park J H,Ovbiagele B.Relationship of Functional Disability after a Recent Stroke with Recurrent Stroke Risk[J].Eur JNeurol,2016,23(2):361-367.DOI:10.1111/ene.12837.2015.10.23.
[3]中共中央国务院.“健康中国2030”规划纲要[EB/OL].(2016-10-25)[2018-07-25].http://www.gov.cn/xinwen/2016-10/25/content_5124174.htm.
[4]陈积瑞.常见慢性病住院费用支出与医疗保险报销的相关性研究[D].南京:东南大学,2014.
[5]中华人民共和国人力资源和社会保障部.15城市启动长期护理险制度试点[EB/OL].(2016-07-08)[2018-07-20].http://www.mohrss.gov.cn/SYrlzyhshbzb/dongtaixinwen/buneiyaowen/201607/t20160708_243153.html.
[6]梁建群.华阴市脑卒中患者长期照护现状与需求研究[D]西安:第四军医大学,2015.
[7]李莹爽,张振香.社区脑卒中患者照护需求的研究进展[J]中国实用神经疾病杂志,2017,20(14):114-116.DOI:103969/j.issn.1673-5110.2017.14.038.
[8]张振香,刘腊梅.社区脑卒中患者的护理需求及其影响因素[J].中国老年学杂志,2012,32(19):4250-4252.DOI:10.3969/j.issn.1005-9202.2012.19.067.
[9]Sousa D.Validation in Qualitative Research:General Aspects And Specificities of the Descriptive Phenomenological Method[J].Qual Res Psychol,2014,11(2):211-227.DOI:10.1080/14780887.2013.853855.
[10]中华人民共和国国家卫生和计划生育委员会.综合医院分级护理指导原则[EB/OL].(2009-05-21)[2018-02-18].http://www.moh.gov.cn/mohbgt/s9509/200905/40929.shtml.
[11]段洪连,刘美云,张拥波,等.缺血性脑卒中常用评估量表及其最新研究进展[J].中国全科医学,2011,14(35):4018-4021.DOI:10.3969/j.issn.1007-9572.2011.35.005.
[12]Morris J N,Belleville-Taylor P,Fries BE,et al.InterRAILong-Term Care Facilities(LTCF)Assessment for Manduser's Manual,9.1[M].Washington,DC:Australian Edition,2011:25-30.
[13]Prodinger B,Scheel-Sailer A,Escorpizo R,et al.European Initiative for the Application of the International Classification of Functioning,Disability and Health:Development of Clinical Assessment Schedules for Specified Rehabilitation Services[J].Eur J Phys Rehabil Med,2017,53(2):319-332.DOI:10.23736/S1973-9087.16.04438-5.2016.11.24.
[14]范晓华,南登昆,刘燧.功能独立性评测的信度与效度的初步研究[J].中华物理医学杂志,1998,20(3):171-174.DOI:10.3760/j:issn:0254-1424.1998.03.014.
[15]中华人民共和国民政部,老年人能力评估标准[EB/OL].(2013-08-29)[2018-07-10].http://www.mca.gov.cn/article/gk/wj/201805/20180500009037.shtml.
[16]许静,仲利娟,谢世平,等.河南省公立与民营社区卫生服务站三年发展比较分析[J].中国社会医学杂志,2018,35(4):389-392.DOI:10.3969/j.issn.1673-5625.2018.04.019.
[17]周灵利,汪和平,解龙,等.我国全科医生资源配置现状及公平性分析[J].中国全科医学,2017,20(19):2311-2315.DOI:10.3969/j.issn.1007-9572.2017.19.004.
[18]蒋慧琴,东梅.慢性病多学科协作模式下的护理现状和展望[J].护理学报,2017,24(22):28-31.DOI:10.16460/j issn1008-9969.2017.22.028.
[19]朱亚珍,朱凌燕,许燕玲.社区卫生站护士对医院-社区-家庭慢性病一体化管理体验的质性研究[J].中华护理杂志,2018,53(5):528-532.DOI:10.3761/j.issn.0254-1769.201805.003.
[20]容根南,承建国,许海民,等.上海市宝山区老年护理管理区域联动模式的构建与运行研究[J].护理学报,2018,25(24)13-16.DOI:10.16460/j.issn1008-9969.2018.24.013.