全科团队模式中社区护士工作内容调查

目的调查全科团队模式中社区护士的工作内容。方法通过调查表进行专业任务论证分析,调查社区卫生服务中心和社区卫生服务点工作内容的区别。由社区卫生服务点内的社区护士记录工作日记,对社区卫生站点内护理工作内容及开展情况分析,比较全科团队模式与非全科团队模式的工作内容的区别。结果目前静安区社区卫生服务站点内开展的护理内容有50项。全科团队模式中护士主要工作内容仍以疾病护理为主。结论全科团队模式是社区医疗卫生服务的发展方向,团队中社区护士工作内容已向“六位一体”功能深化,但仍有不足之处,主要工作内容仍以疾病护理为主,如何设法进一步推进,需要引起各方面的重视。     

全科团队模式中社区护士工作内容调查

目的调查全科团队模式中社区护士的工作内容。方法通过调查表进行专业任务论证分析,调查社区卫生服务中心和社区卫生服务点工作内容的区别。由社区卫生服务点内的社区护士记录工作日记,对社区卫生站点内护理工作内容及开展情况分析,比较全科团队模式与非全科团队模式的工作内容的区别。结果目前静安区社区卫生服务站点内开展的护理内容有50项。全科团队模式中护士主要工作内容仍以疾病护理为主。结论全科团队模式是社区医疗卫生服务的发展方向,团队中社区护士工作内容已向“六位一体”功能深化,但仍有不足之处,主要工作内容仍以疾病护理为主,如何设法进一步推进,需要引起各方面的重视。     

家庭医生服务模式下社区护士工作现状调查

目的了解深圳市家庭医生服务模式下社区护士的工作现状。方法采用自制调查问卷,对深圳市24个社区健康服务中心共186名社区护士进行调查。结果家庭医生服务模式下,深圳市社区护士目前最常做的工作主要有:基本医疗服务(81.3%)、健康管理(76.1%)、计划免疫(75.8%)、儿童保健(75.0%)、老年人保健(74.5%)、慢性病管理(72.3%)、健康教育(71.7%)以及计划生育指导(68.0%),而传染病管理(56.7%)、精神卫生保健(56.6%)、残疾人管理(56.3%)等工作开展相对较少。结论深圳市社区护士的工作内容既有基础医疗服务,又有公共卫生服务,已逐步向社区"六位一体"的功能扩展,但还需针对工作中开展不足的项目逐步完善。     

全科团队家庭化健康管理服务辖区内运行模式探讨

目的：在社区卫生规范服务中,以契约式服务为起点,为提高本辖区内人群的预防保健意识以及重点人群的干预与管理,探索全科团队家庭化健康管理服务辖区内运行模式的方法。方法对户口在大溪沟人和街社区和建设路社区常住居民家庭成员中健康人群、高危人群、疾病人群进行全科团队家庭化健康服务管理。服务内容包括：家庭健康需求调查与分析、健康档案的建立与管理、健康体检、健康评估、健康干预、疾病管理、动态跟踪管理等。动态掌握家庭不同人群的健康状况、危险因素和疾病信息。针对家庭实施契约式服务,通过向家庭成员宣传国家基本和重大公共卫生免费服务项目内容,改善居民遵医就医行为,适时地提供门诊、出诊及转诊等便民服务和需求指导。结果在社区人群中开展全科团队家庭化健康管理服务模式,切实使社区居民充分享受国家基本公共卫生服务,也为慢性病的高危人群和疾病的早发现、早诊断、早预防、早治疗起到关键作用,同时提高了居民基本医疗的利用率。结论该模式具有良好的实用性、可行性、可操作性和社会效益,具有较高的推广性,值得社区卫生服务中心借鉴。     

英国护士在初级保健护理中的作用带给我们的启示

2012年2月19日-2012年4月18日,作者随卫生系统健康管理专题培训团赴英国利物浦大学医学院及贝德福德大学卫生学院进行学习培训。期间参观了私人诊所、全科服务站点、全科医疗中心、社区康复中心等处,并进行了学术交流。经过此次培训,我对英国的医疗卫生保健系统、全科医疗状况、GP团队的运作、护士角色的扩展、护士的护理服务理念等情况有了深入的了解,受益匪浅,值得我们在今后的初级保健卫生服务工作中借鉴。     

深圳市全科团队服务模式中社区护士的功能角色现状及对策探讨

[目的]探讨全科团队服务模式中社区护士的功能角色现状及对策。[方法]采用自制调查问卷,随机抽样调查我市120名社区团队护士、成员与管理人员。[结果]66.7%的调查对象认为护士参加全科团队社区服务后,其功能角色有较多改变,社区护士的专业知识、技能及能力的满意度分别为55.7%,66.4%和57.8%。对社区护士的工作任务与职责满意度最高,为65.9%；对工作量评价满意度最低,为13.3%；对团队成员间相互信任与尊重的满意度为70.9%。[结论]社区护士与团队成员对护士在团队服务中知识、技能与能力评价比较满意；对社区护士卫生服务参与评价满意和基本满意。护士理论知识、操作技能和综合能力对满足居民健康需求存在差距。     

基于工作分析的社区全科团队人力资源配置研究

<正>随着社区服务工作逐渐展开和深入,我国各个地方积极探索其实践模式,其中社区全科团队服务是最重要、常用的一种模式。全科团队服务模式指的是由全部医生、社区护士还有进行预防保健的工作人员,最少3人,最多7人组成的一个小团队,团队组成之后主要的服务对象为社区居民,一般来说人数最少3 000人,最多能够达到10 000人[1]。这种管理模式是居住地管理,通过建立家庭健康档案让社区居民能够享受到综合性的卫生服务,让多发疾病或常见疾病的社区患者     

社区护士服务于预防保健项目的成本分析

目的分析社区健康服务中心护士服务于预防保健项目的成本。方法调查深圳市南山区人民医院下属5所具有代表性的社区健康服务中心护士提供预防保健服务过程中物资、劳务等成本的消耗情况和各类服务项目的数量,对从事预防保健的社区护士的工作内容及工作时间进行为期10个月的追踪调查,应用医疗服务项目成本核算方法对社区护士服务于预防保健项目进行成本分析。结果社区健康服务中心每位护士平均每分钟工作成本为1．28元。结论进一步满足居民的社区预防保健服务需求,提高社区护士服务效率,同时政府应加大和完善预防保健项目的补偿机制。     

某地级市社区护士工作现状与居民护理需求的调查

目的调查某地级市社区护士工作现状与居民护理需求。方法采用自行设计的调查问卷对135名社区护士和338户社区居民进行调查。结果社区护士的工作重点在治疗护理方面,而预防、康复、保健、健康宣教和计划生育5项的工作力度明显不够;社区护理工作现状与居民需求存在差异,居民对社区护理服务的需求从疾病治疗向疾病预防和健康促进转变。结论社区护士应转变观念,加强疾病预防和健康促进的理念;社区护理应以居民需求为导向,尽快建立以社区人群健康为中心,融医疗、预防、保健、康复、健康教育、计划生育于一体的综合性社区护理服务模式。     

全科团队工作模式下社区护士角色及其工作满意度的调查分析

[目的]了解全科团队工作模式下社区护士角色及其工作满意度。[方法]选取2013年6月—2015年6月深圳市90名社区护士为研究对象,分别采用定量资料收集和定性资料收集2种方式调查深圳市社区护士角色功能现状和工作满意度情况。[结果]健康评估和照顾者、教育者和宣传者、咨询者、管理者和组织组、合作者和协调者是社区护士的主要角色。社区护士对工作量、工作时间、报酬及待遇、工作环境、岗前培训及学习培训、团队关系、团队管理满意度较低,对团队工作效率、团队合作、工作任务及职业满意度、社区支持满意度较高。[结论]社区护士角色主要集中于健康评估和照顾者、教育者和宣传者、咨询者、管理者和组织组、合作者和协调者,且工作满意度不高。     

北京市社区护士工作现状与问题的案例分析

目的:了解目前社区护士的工作现状,探讨社区护士在履行“六位一体”社区卫生服务功能中存在的主要问题,为今后更好地开展社区护理工作提供依据.方法:采用案例分析法,将北京市某社区卫生服务中心作为案例,通过结构式观察法和深入访谈法了解该中心社区护士的工作现状与问题.结果:社区护士工作内容排在第一位的是机构内的基本医疗方而的直接护理工作(平均时间为76.4分钟/人·天),其次是机构内的公共卫生方面的间接护理工作(65.4分钟/人·天);根据方谈结果,共归纳一级主题5个,二级主题10个.结论:月前社区护士参与公共卫生服务工作以间接护理为主,为了促进社区护理的健康、持续发展,需要进一步调整社区护士编制,使之与工作负荷相匹配,加强慢性病管理,重视慢性病管理的效果.     

社区团队式服务模式中社区护士角色功能的质性研究

目的 探讨社区护士在团队式服务模式中的角色功能和影响因素.方法 对14名医护人员采用半结构式面对面深度访谈进行资料收集与整理分析.结果 社区团队式服务模式中护理工作模式包括基本医疗服务为主、承担较多非社区团队护士工作和较少承担公共卫生服务角色;影响因素包括政府的投入与政策支持、公共卫生服务的效率与可行性、社区护士自身的...     

Mental health service users' and practitioners' experiences of engagement in assertive outreach: a qualitative study

Assertive outreach services have been central to community mental health policy within the UK. These multidisciplinary teams were established to engage with service users who have severe and enduring mental health problems and have found traditional community services unable to meet their needs. Mental health nurses have a pivotal role in these multidisciplinary teams, yet the nature of these relationships from the perspective of those who work in and receive care is poorly understood. This study set out to explore the nature and meaning of engagement for practitioners and service users within assertive outreach services. A qualitative approach, informed by philosophical hermeneutics, underpinned the study. Participants were recruited from a single assertive outreach team in the UK. To be eligible for the study, mental health practitioners needed to be employed within the assertive outreach team. All service users residing in the community and receiving care from the team were also eligible for inclusion. In total 14 interviews were conducted with mental health practitioners and 13 with service users. Data analysis was informed by Turner's method. Four themes emerged from the data; contact, dialogue, transformation and shared understanding. Meaningful engagement was found to manifest itself through experiences such as providing and receiving practical assistance, having a genuine two-way conversation and valuing the experiences and personal attributes of the other person. The findings indicate that engagement is an active, dynamic and skilled process, which leads practitioners and service users to transform together to create a new relationship.     

Models of mental health nurse-general practitioner liaison: promoting continuity of care

AIM AND RATIONALE: Community mental health nurses and general practitioners share a pivotal role in the provision of mental health care in the community. The focus of this study was to identify models of general practitioner collaboration used by these nurses, and analyse the implications of these models for promoting continuity of care. The study was derived from a larger study of how community mental health nurses promote wellness with clients who are experiencing an early episode of psychotic illness. METHODS: This qualitative study used interviews and observation to collect data. The study took place in 1999 in regional and rural New South Wales, Australia and involved community mental health nurses. FINDINGS: The findings show that two models of nurse and general practitioner (GP) collaboration emerged from the data: Shared Care and Specialist Liaison. In the Shared Care model, nurses maintain close contact with GPs throughout the episode of acute care. In the Specialist Liaison model, the community mental health team assumes overall responsibility for care and treatment throughout the acute episode of illness. Contact with GPs throughout the episode of care by the community mental health team is, at best, intermittent. CONCLUSION: The findings suggest that the Shared Care model is more consistent with supporting personal and organizational continuity of care, whereas the Specialist Liaison model is limited to encouraging personal continuity of care but further study is needed.     

社区卫生服务中心儿童保健团队的服务模式与效果

目的探讨社区卫生服务模式,提高社区儿童保健工作质量。方法在某社区卫生服务中心建立儿童保健模式,改造服务流程,合理分工,确定服务内容,实施团队式服务管理模式。结果 0~3岁儿童的系统管理率提高;社区居民满意度提高,差异均具有统计学意义(P0.01)。结论社区儿童保健服务管理模式可以提高儿童保健的服务质量。     

Partners in care: investigating community nurses’ understanding of an interdisciplinary team‐based approach to primary care

Aim. This study investigated community nurses understanding of teamwork in primary care. Background. Internationally trends indicate a movement towards the development of primary care as a key element in health service delivery. This will have implications for the organisation of community nursing services by creating the need for more coherent integrated structures for service delivery. In this context, teamwork is associated with a range of positive outcomes including higher levels of quality care and job satisfaction. Design. A research study was undertaken to investigate community nurses’ understanding of an interdisciplinary team‐based approach to primary care using a qualitative research design. Focus groups were held with community nurses working in the areas of public health nursing, general nursing and practice nursing. Methods. Three focus groups were established. Twenty seven participants were recruited to form three groups comprising public health nurses (n = 10), general nurses (n = 10) and practice nurses (n = 7). A sequenced‐questioning framework guided the systematic process of data collection. Data analysis engaged a thematic content analysis framework. Results. The analysis of the data revealed the following themes: teamwork, promoting community services, promoting health, professional roles and skills and knowledge for primary care. Conclusion. Nurses can contribute significantly to the re‐orientation and development of primary care services. There must be greater efforts to encourage interdisciplinary approaches. The outcomes of this study can inform strategies for effective team working in primary care. Collective team efforts enhance patient care and effective teamwork requires a greater understanding of group processes and team development. Relevance to clinical practice. Nurses clearly articulated their contribution to primary care, but recognised that there are many challenges to overcome. An enhanced primary care team has the potential to allow the public access to both the individual and collective skills and knowledge of team members.     

A community-oriented primary care nursing model in an international setting that emphasizes partnerships

PURPOSE: To present an interdisciplinary, community-oriented primary care nursing model that effectively draws upon the strengths of advanced practice nurses (APNs), both nurse practitioners and community health nurses. DATA SOURCES: Articles in professional nursing journals, international data sources, and the clinical experiences of the authors, both domestic and international. CONCLUSIONS: The model, developed domestically, was utilized successfully by APNs internationally in a medical mission endeavor in rural Haiti. Many partners, domestic and Haitian, worked as an interdisciplinary team to deliver quality health care to an impoverished population. Graduate nursing students participated in the program, which offered opportunities and challenges for both novice and expert nurses. IMPLICATIONS FOR PRACTICE: Nurse practitioners, community health nurses, and nursing faculty members can use this model to enhance their professional practice. They can learn that clients can be optimally cared for whether the community served is domestic or international. Nursing faculty can teach graduate nursing students about the value of partnerships and collaboration.     

Relocating care: negotiating nursing skillmix in a mental health unit for older adults

Mental health care in Australia in the last 20 years has moved from stand-alone psychiatric hospitals to general hospitals and the community. This paper reports an action research project exploring the experiences of nurses on an acute mental health unit for older adults staffed with a skillmix of mental health and general nurses, which recently transitioned from a psychiatric to a general hospital. The new service provides comprehensive health care, including the management of physical co-morbidity and a recovery orientation. Recovery acknowledges the role and rights of consumers and carers in planning and management of care, choice and individual strengths (Shepherd). The new ward received additional resources to establish the model of care, including a broader skillmix. The paper explores the dynamics of development of a new model of care and of bringing together staff with different professional orientations, cultures and priorities. Focus groups and interviews were conducted with 18 staff. Analysis resulted in three themes relating to the impact of competing goals and foci of care upon professional boundaries; competing organisational cultures and the impact of service change upon work practices. The findings are explored in relation to ideas about health care delivery associated with neoliberalism.     

Characteristics of severely mentally ill patients in and out of contact with community mental health services

Community mental health nurses have been criticized for failing to prioritize work with people with a severe or enduring mental illness, many of whom have no contact with specialist mental health services and rely entirely on their general practitioner and primary care team. It is important to ensure that those in contact with specialist services actually need this level of input but, conversely, that those in contact with only primary care receive a service that is equipped to meet their needs. This study examines the differences between these two groups of patients. A sample of 253 community-based patients with a severe or enduring mental illness was divided into those with mental health service contact and those without. Differences in the demographic characteristics of the two groups were assessed and further, more detailed, comparisons were made with a sub-sample of 49 individuals randomly drawn from this larger sample. Instruments adopted for these purposes comprised the Camberwell Assessment of Need and the Life Fulfilment Scale. It was found that patients with a psychotic disorder were more likely than those with neurosis to be in contact with mental health services and patients with schizophrenia were significantly more likely to be on the active caseload of a community mental health nurse than those from all other diagnostic groups. However, patients' levels of need, unmet need and quality of life did not differ in relation to their service contact. Whilst the study provides limited evidence that community mental health nurses are targeting people with the most serious disorders, questions remain about the large proportion not receiving specialist care. Because primary care plays a significant role in the care of severely mentally ill people living in the community, the further mental health training of general practitioners and practice nurses is becoming increasingly important.