国内外中期照护发展现况及启示

文章综述了国外居家医院、护士主导的病房、社区医院、老年日间病房、医护疗养所5大模式的中期照护实施方式、内容及效果,结合我国中期照护的现况及特点,提出建立多元化中期照护服务模式、加强中期照护团队人员培养、提高各类照护机构在中期照护中的利用度等建议,旨在为中期照护在我国的发展提供新的思路。     

Carolina照护模式在眼科病房中的应用

目的:探讨Carolina照护模式在眼科病房中的应用效果。方法:将2018年1月1日～6月1日收治的200例眼科住院患者作为对照组,实施一般优质护理服务;将2018年7月1日～12月1日收治的200例眼科住院患者作为观察组,实施以Carolina照护模式为导向的优质护理服务。比较两组满意度、收到感谢信及锦旗情况。结果:观察组满意度、收到感谢信及锦旗情况优于对照组(P0.01)。结论:在眼科病房护理服务中实施Carolina照护模式,能够提高住院患者满意度,对我国优质护理服务有重要的指导意义。     

我国台湾地区医院全能照护见闻及启示

文章介绍了我国台湾地区医院全能照护的护理特点,包括台北市立联合医院人性化的服务环境、振兴医院人性化的设备及高雄医学大学附设中和纪念医院全能照护的护理理念,并根据我国大陆地区职业教育现状提出改进护理人文教育的建议,即增设人文关怀课程,提升教师人文素养,实行人性化管理,提高护理人才培养质量。     

台湾辅英科技大学失智症照护课程介绍及启示

从课程简介、课程目标、教学内容、教学方法、考核方式几方面介绍台湾辅英科技大学失智症照护课程概况,并结合大陆地区老年照护教育现状,提出应进一步完善老年照护专业课程内容,优化教学方法,突出学生的主体作用,实行多元考核方式,提高学生老年照护专业能力。     

加拿大Baycrest老年医学中心见闻与启示

该文将从老年医疗服务、文化艺术与精神照护、老年日间照护项目和机构养老服务4个方面简要介绍加拿大Baycrest老年医学中心的医疗照护模式,以及提供这些医疗服务的多学科协作团队。提出了在老年医疗和护理中要重视个体化关怀、建立"日间照料"照护模式、坚持创新和专业化原则的建议。     

家庭式病房晚期癌症患者配偶照护感受的质性研究

目的了解家庭式病房晚期癌症患者配偶在照护患者过程中的真实感受。方法 2015年9月至2016年3月,采取立意抽样法选取在上海交通大学附属仁济医院老年科家庭式病房住院的10例晚期癌症患者的配偶为研究对象,采用现象学研究方法对其进行半结构式访谈,根据Colaizzi内容分析法分析资料,整理并提炼主题。结果家庭式病房的晚期癌症患者配偶的照护感受包括4个主题:抱怨和无助感;不确定感和丧失感;满足感和自我价值感;调整心态,接受事实。结论在护理家庭式病房的晚期癌症患者的同时,还需关注其主要照护者,尤其是配偶的身心健康,可以运用以家庭为中心的护理模式、临终关怀服务等为患者及其配偶提供医疗照护和心理支持;同时,呼吁政府构建完整的社会支持系统,减轻晚期肿瘤患者家属照护压力。     

老年患者急性期快速恢复病房的研究进展

老年患者急性期快速恢复病房是一种特殊的照护病房，以促进老年患者住院期间功能维持为核心，达到快速恢复、尽早回归家庭的目的。该文综述了老年患者急性期快速恢复病房的起源、发展、关键要素、工作程序及使用效果等，并结合中国国情提出老年患者急性期快速恢复病房的发展方向，为护理实践提供参考。     

老年住院病人4种照护模式的临床应用现状

分析我国现有的老年住院病人家属照护、专职人员照护、团队照护、无照护4种照护模式的临床应用现状,旨在为临床工作中更好地利用家属、专职照护人员等资源为老年病人提供优质护理服务提供参考。     

老年病房护士预立医疗照护计划的知信行现状调查

目的 :调查老年病房护士对预立医疗照护计划的认知、态度、行为状况并进行相关影响因素分析。方法:采用自设问卷,便利选取北京市三级甲等综合医院和老年专科医院的老年病房护士进行调查。结果 :老年病房护士知识得分正确率为84.0%,经历过丧亲以及接受过相关培训的护士知识掌握较好(P0.05);调查对象对预立医疗照护计划的态度得分为(4.16±0.56)分,较高职称及护理过临终患者的护士所持态度更加积极(P0.05);调查对象行为得分为(2.73±0.90)分,其中所在病房是老年专科护士培训基地和接受过相关培训的护士行为得分更高(P0.05)。结论 :老年病房护士对预立医疗照护计划知识掌握较好,但仍可进一步提高,所持态度较积极,但工作中开展预立医疗照护计划的行为较少。     

台湾地区护理中的人文关怀见闻与启示

通过对台湾地区护理中的人文理念、人文环境、个性化服务、人性化服务及照护文化的介绍,启示如何促进大陆护理服务的发展。     

我国老年护理教育发展现状及趋势

随着人口老龄化的发展,我国老年护理服务的需求增加,但老年护理教育发展严重滞后,老年护理人才缺乏成为突出问题。从专业设置、教材编写、课程设置、教学条件、从业规范等方面综述了我国老年护理教育的发展现状和趋势,并为其发展提供参考和依据。     

Indicators of quality in nursing care — an alternative approach

Indicators of quality of nursing care were developed from a conceptual framework for geriatric nursing based on the twin concepts of care and having a positive attitude to the health and welfare of old people. These primary concepts were further developed using structural aids, in particular the theoretical guidelines for practice disciplines propounded by Dickoff et al. From this, a measure, called the Therapeutic Nursing Function (TNF) Indicator, was devised which attempted to identify those ward sisters who provided more patient-centred or therapeutic nursing care from ward sisters who gave routine-centred or non-therapeutic nursing care. The TNF Indicator, based on the conceptual framework, comprised a list of statements to which ward sisters responded. The scaling system divided responses into more--or fewer--therapeutic nursing responses. A stratified random sample of 25 ward sisters was used in the study and from this the characteristics of ward sisters in the upper and lower range of the scale were compared. Distinct variations were noted between groups in relation to demographic information, perception of geriatric nursing, use of nursing information, management approach and the ward sisters' concept of rehabilitation. A further instrument, the Therapeutic Nursing Function Matrix, attempted to measure the quality of care patients were receiving on geriatric wards. Nurse-patient interaction on a ward where the ward sister had a high TNF Indicator score was compared to a ward where the ward sister had a low score. The results showed that quality of care seemed to be related more to the orientation and perception of the ward sister than to any number of extraneous variables such as medical and paramedical input, ward facilities and ancillary staff support.     

芬兰老年护理发展经验对我国的启示与建议

人口老龄化现已成为一个世界性问题。健康老龄化观点的提出,使老年人的医疗预防保健工作对老年护理的可持续发展问题提出了更高要求。芬兰老年护理的政策、制度、人员培养及服务颇具特色,文章介绍了笔者在芬兰交流学习期间对芬兰老年护理工作的见闻与体会,分别从芬兰的养老保障制度、老年护理服务、老年护理人员培养等方面介绍芬兰老年护理概况,并结合我国老年护理工作的现状提出建议,从医疗保障体系、卫生保健工作、老年护理教育等进行思考,对发展和完善我国老年护理体系具有一定的借鉴和启迪。     

The effect of geriatrics evaluation and management on nursing home use and health care costs: results from a randomized trial

BACKGROUND: The Geriatric Evaluation and Management study was developed to assess the impact of a comprehensive geriatric assessment service on the care of the elderly. OBJECTIVES: We sought to evaluate the cost and clinical impact of inpatient units and outpatient clinics for geriatric evaluation and management. RESEARCH DESIGN: We undertook a prospective, randomized, controlled trial using a 2x2 factorial design, with 1-year follow-up. SUBJECTS: A total of 1388 participants hospitalized on either a medical or surgical ward at 11 participating Veterans Affairs medical centers were randomized to receive either inpatient geriatric unit (GEMU) or usual inpatient care (UCIP), followed by either outpatient care from a geriatric clinic (GEMC) versus usual outpatient care (UCOP). MEASURES: We measured health care utilization and costs. RESULTS: Patients assigned to the GEMU had a significantly decreased rate of nursing home placement (odds ratio=0.65; P=0.001). Neither the GEMU nor GEMC had any statistically significant improvement effects on survival and only modest effects on health status. There were statistically insignificant mean cost savings of $1027 (P=0.29) per patient for the GEMU and $1665 (P=0.69) per patient for the GEMC. CONCLUSIONS: Inpatient or outpatient geriatric evaluation and management units didn't increase the costs of care. Although there was no effect on survival and only modest effects on SF-36 scores at 1-year follow-up, there was a statistically significant reduction in nursing home admissions for patients treated in the GEMU.     

老年护理机构出院临终患者疾病构成帕累托图分析

目的 了解北京、天津、上海三城市老年护理机构出院临终患者的主要病种、多发病种,探讨我国城市老年护理机构临终关怀服务的重点.方法 运用帕累托图分析2005至2007年北京、天津、上海22所老年护理机构出院临终患者疾病构成情况.结果 心血管疾病、脑血管疾病、呼吸系统疾病、晚期恶性肿瘤、老年衰竭的累计构成占老年护理机构出院临终病例疾病构成的95%以上.结论 我国城市老年护理机构出院临终病例疾病病种相对比较集中,特别是心血管疾病、脑血管疾病、呼吸系统疾病、晚期恶性肿瘤、老年衰竭等应作为老年护理机构临终关怀服务的重点.     

The evaluation of an intermediate care--geriatric evaluation unit in a Veterans Administration Hospital

In response to the increasing care needs of geriatric patients and attendant hospital costs, the Nashville Veterans Administration Medical Center, which has 393 beds and admits 8400 patients annually, initiated an Intermediate Care Service in 1988. A geriatric team was formed, sharing staff and resources from existing units. To determine the efficacy of intermediate care, automated data sources at the Nashville Veterans Administration Medical Center provided data on discharge status, length of stay, and diagnoses of patients in both the acute and intermediate care units. The first year's experience indicated that careful communication and education of nursing staff was required to initiate the Intermediate Care Service with no staff resigning. An interdisciplinary team facilitated better patient care and discharge planning. Among 190 patients discharged from this service, 57% were discharged home and 22% into nursing homes; this can be compared to those discharged from acute care units of the hospital: 84% home and 4% to a nursing home; 20% of the patients in the Intermediate Care Service were discharged to a lower level of care than the initial hospital discharge plan had indicated. A 1.4-day decrease in average length of stay in the hospital has occurred since initiation of the Intermediate Care Service.     

Family members' experiences of the quality of geriatric care

The quality of institutional geriatric care is a topical issue in Finland. The study to be described here is part of a Finnish project on the quality assessment and development of long-term geriatric care provided by the City of Helsinki. The health care division of the City of Helsinki authorized an outside survey of long-term geriatric care in the hospitals providing such care in 1998. Based on the results, recommendations concerning the development of geriatric care were issued. In the years 1999-2000, a further education programme was arranged for ward nurses, chief nurses and heads of profit centres concerning leadership in long-term geriatric nursing. A re-survey was conducted in 2001, using the same criteria of quality assessment. The purpose of this paper is to report on the quality of institutional geriatric nursing as evaluated by family members in 2001 and to compare the responses to those obtained in 1998. The results are presented as frequency and percentage distributions, means and medians and cross-tabulations. The responding family members were generally content with the care of their elderly relatives: 92% said they were very satisfied or satisfied with the care, and the average of the marks given for geriatric care was 8.3 (range 4-10). Family members were more content now than in 1998, when the corresponding figures were 86% and 7.3 (range 4-10). Nevertheless, the results still highlight certain aspects that should be improved and developed.     

Passive therapeutic gardens. A study on an inpatient geriatric ward

A brief history of the link between horticultural activities and care of patients, particularly psychiatric patients, is reviewed in this article. Past research on both passive and active garden activities is examined in terms of physical and psychological benefits to patients. A passive garden intervention on an inpatient geriatric ward is described. Participants in this study were patients on a geriatric inpatient ward in a mid-sized regional hospital in New Zealand. Behavioral observations of patient movement on the ward were used to demonstrate the effects on patient behavior in response to the presence of the conservatory garden. Results showed a positive reaction to the conservatory, which was maintained 6 months after the initial plants were installed. The benefits of such garden installations are discussed, and areas for further research are outlined. Procedures, ethical concerns, and practical considerations of setting up such a conservatory on an inpatient ward are discussed.     

老年护理机构出院临终患者疾病构成帕累托图分析

目的了解北京、天津、上海三城市老年护理机构出院临终患者的主要病种、多发病种,探讨我国城市老年护理机构临终关怀服务的重点。方法运用帕累托图分析2005至2007年北京、天津、上海22所老年护理机构出院临终患者疾病构成情况。结果心血管疾病、脑血管疾病、呼吸系统疾病、晚期恶性肿瘤、老年衰竭的累计构成占老年护理机构出院临终病例疾病构成的95％以上。结论我国城市老年护理机构出院临终病例疾病病种相对比较集中,特别是心血管疾病、脑血管疾病、呼吸系统疾病、晚期恶性肿瘤、老年衰竭等应作为老年护理机构临终关怀服务的重点。