我国社区护理方向硕士研究生培养现状分析

以社区护理方向硕士研究生为切入点,分别从国内外社区护理发展趋势、护理学科发展、国家政策及该方向硕士研究生教育现状等方面,阐述国内社区护理方向硕士研究生培养的必要性及可行性,并从培养目标、课程设置、教育管理、质量考评及导师遴选等方面,提出培养社区护理硕士研究生的具体思路与做法,以期更好地促进我国社区护理学与社区卫生服务的发展。     

关于我国社区护理工作的研究

社区护理是结合公共卫生学和护理学的理论与技能,提高社区群众生活质量,以及健康水平的护理服务活动。本文主要概述了社区护理的定义,分析了我国及国外社区护理的现状,指出了现存的问题,探讨我国社区护理的发展。     

加强社区护理是完善社区卫生服务功能的重要措施

在阐述我国社区卫生服务发展的基础上,提出社区护理是社区卫生服务的重要组成部分.通过分析我国社区护理的现状,发现影响其发展的主要因素,同时借鉴国外发达国家社区护理发展的经验,提出了健全社区护理机构、完善社区护理教育及加强社区护理服务等促进我国社区护理发展的对策和建议.     

浅议我国城市社区老年护理的发展与完善

针对我国人口老龄化的现状,分析了社区老年护理对满足老年人卫生服务需求方面的优势,同时分析了我国社区老年护理发展的现状,最后在总结国外社区老年护理发展经验基础上,为我国社区老年护理的发展提供可借鉴的思路。     

关于我国社区护理管理的现状及对策探讨

在我国社区起步较晚,而且受我国经济水平、社区护理管理水平等因素的干扰,我国社区护理发展速度较为缓慢。为提高我国社区护理水平,一个重要的步骤就是提高我国的社区护理管理水平。通过针对我国目前的护理管理现状,初步提出了一些相应的改进策略。     

城市社区卫生服务机构护理人力资源的研究现状

通过对近几年我国各省城市社区卫生服务机构护理人力资源的现状调查进行综合分析,了解我国城市社区护理人力资源配置的特点,以及学历、职称、数量、培训等现状及存在的问题,为管理部门制定相关管理政策提供参考依据,以促进城市社区护理人力资源的合理配置及社区护理的发展。     

社区常见家庭护理问题的临床路径探索

目的为改善社区管理现状,探索科学的社区护理管理模式,开展了社区常见家庭护理问题的临床护理路径探索。方法社区家庭护理专职护士对社区患者按照规范的临床护理路径实施系统开展护理操作,并与未进入临床护理路径的社区患者进行比较,开展专职护士间的比较,达到探索科学临床护理路径的目标。结果进入社区家庭临床护理路径的患者转归情况与社区接受一般护理治疗无差异,在许多护理学指标方面都显示出管理优势,在护理造作质量的优秀率上进入路径操作高于一般临床护理,进入路径的患者住院天数及费用低于一般护理治疗患者。结论社区临床护理路径这一全新的护理服务模式,正随着我国的改革开放被引入,其高品质、低费用的服务宗旨符合我国目前的卫生体制改革的政策。     

浅析社区护理干预方式及其构设

提高身心健康是预控疾病的有效措施,而预控疾病则是社区护理干预的最终目的。社区护理干预属于一项系统的、复杂的护理活动。但是就我国目前形势来看,我国社区护理干预水平和国际先进护理水平之间还存在着较大的差距。本文对我国社区护理干预方式的构设现状和常用的干预方式的内容进行研究,提出了适合我国社区护理的干预方式,旨在缩短我国社区护理干预水平和国际之间的差距,大力研究和推广适合本国国情的社区护理干预方式。     

当前我国社区护理发展存在的问题与对策

社区护理将公共卫生学与护理学结合在一起,以促进和维护人们的健康为中心,既强调疾病的预防,又强调健康的护理,并以预防服务为工作重点,面向整个社区人群。作为社区卫生服务的重要内容之一,积极发展社区护理事业是现代医学发展和社会发展的必然要求。本文立足于社区护理的主要特点及我国社区护理发展的现状,分析其所面临的主要问题,并提出相应对策。     

护士就业现状分析

为了解现阶段我国护理人力资源现状和护生就业形势,采用文献研究法,对我国护理人力需求、护生就业现状等问题进行了研究。结果显示,我国护理人力需求在临床、社区护理等领域缺口较大,而护士的就业形势却依然很严峻。在社区护理、临床护理、涉外护理等领域的就业仍存在许多不合理的问题。因此,积极探索提高护生就业率的策略,进一步改善护士就业现状,是时代发展的需要。     

Decline in Veterans’ Admissions to Nursing Homes during COVID-19: Fewer Beds,More Fear,and Finding Alternative Care Settings

ObjectiveExamine the decline in admission to community nursing homes among Veterans that occurred following the onset of the COVID-19 pandemic.DesignMultimethods study using Department of Veterans Affairs (VA) purchasing records to examine trends in total admissions and semistructured interviews with staff connected to the VA community nursing home program to contextualize observed trends.Setting and participantsAll VA-paid admissions to community nursing homes (N = 56,720 admissions) and national data on nursing home admissions from LTCFocUS. Semistructured interviews were conducted with 9 VA staff from 4 VA medical centers working in the VA community nursing home program, including social workers, nurses, and program coordinators.ResultsBetween April and December 2020, community nursing home admissions among Veterans were 35% lower compared with the same period in 2019. Nationally, total nursing home admissions decreased by 19.6%. VA community nursing home program staff described 3 themes that contributed to this decline: (1) fewer nursing home beds available, (2) lower admissions due to fear of Veterans being exposed to COVID-19 in nursing homes, and (3) leaving nursing homes in favor of living at home with home-based care.Conclusions and ImplicationsThe decline in nursing home admissions among Veterans raises questions about how replacing nursing home care in favor of home- and community-based care affects the health outcomes and well-being of Veterans and their caregivers.     

郊区居民保健意识及社区护理需求调查

目的 调查江西省九江市市郊农村居民健康保健意识、社区护理需求等.方法 采用问卷调查法,于2008年3-5月抽取九江市市郊2个村的农村家庭进行问卷调查.结果 农村居民健康知识缺乏,居民迫切需要的社区护理项目有5项,分别为一般常见病的简单处理241人,占87.2%;社区紧急救护251人,占86.6%;社区的健康教育250人,占86.2%;老年慢性病护理253人,占83.1%;上门基础护理232人,占80.0%.结论 农村居民保健意识有待提高,社区护理需求大,应结合地区特点,尽快加强农村社区护理服务.     

Predicting the risk of "permanent" nursing home residence: the role of community help as indicated by family helpers and prior living arrangements.

OBJECTIVE. This study examines the difference between permanent and transitory residence in a nursing home with special emphasis on the extent to which the risk of a long nursing home stay is reduced by the availability of informal help in the community. DATA SOURCE. Secondary data were used, taken from the National Long-Term Care Surveys of 1982 and 1984. The 1982 NLTCS samples disabled elderly living in the community. For these community dwellers, the 1984 NLTCS provides information on continued residence in the community and on their nursing home episodes between 1982 and 1984. METHOD OF ANALYSIS. The analysis is based on estimates from a multinomial logit regression with three explicit categories: persons with at least one long nursing home stay (n = 292), persons with only short stays (n = 227), and persons who died without ever having had a nursing home stay (n = 945). The implicit category: persons living in the community in 1984 without having had any nursing home stay (n = 3,368). PRINCIPAL FINDINGS. This study demonstrates the systematic differences in the personal characteristics that predict the risk of long stays from those that predict short stays in a nursing home. Controlling for limitations in physical and cognitive functioning, the regression analysis shows that indicators of informal help in the community have a statistically significant and relatively large effect on the risk of long stays; but the effects of these indicators on the risk of short stays is numerically smaller and not statistically significant. Specifically, when the burden of caregiving is shared by a spouse and children, the risk of a long stay in a nursing home is reduced by 9.3 percentage points; in contrast, the risk is increased by 18 percentage points for childless elders who are living alone and by 45.8 percentage points for elders living with adults other than a spouse or children. CONCLUSION. The relatively strong effects of family helpers and living arrangements on the risk of long nursing home stays confirm the hypothesis that, after controlling for the effects of physical and cognitive functioning, adequate help in the community reduces the risk of permanent nursing home residence. But help in the community has no effect on the risk of short nursing home episodes because these episodes are likely to be extensions of acute hospital care. The findings provide essential information for designing a long-term care program because they suggest the magnitudes of the effects that such a program can have on reducing the risk of permanent nursing home residence.     

Describing Transfers Originating Out-of-Facility for Nursing Home Residents

ObjectivesPotentially avoidable hospitalizations are harmful to nursing home residents. Despite extensive care transitions research, no studies have described transfers originating outside the nursing home (eg, visiting family members or at a dialysis center). This article describes 82 out-of-facility (community) transfers and compares them to transfers originating within the nursing home (direct transfers).DesignSecondary data analysis with multivariable model for community transfer risk factors.Setting and ParticipantsEighty-two community transfers and 1362 transfers originating in the nursing home, involving 870 residents enrolled in the OPTIMISTIC demonstration project between January 1, 2015, and June 30, 2016.MethodsTransfers were compared using data from the Minimum Data Set and root cause analyses performed at time of transfer. Multivariable associations were assessed at the transfer level to define risk factors for community transfers. Project nurses collected data on community transfers to inform a root cause analysis.ResultsResidents with community transfers were younger (74.4 years vs 78.2 years), with lower prevalence of cognitive impairment (44.8% vs 70.3%) and higher rates of heart failure (38.7% vs 23.3%) than residents with direct transfers. Community transfers were more likely due to cardiovascular illness (31.2% vs 8.7%), whereas less likely to be for cognitive, behavioral, and psychiatric concerns (11.7% vs 22.7%). Nearly half (46%) of community transfers originated at dialysis centers. Residents transferred outside the nursing home were less likely to have documented limitations to care such as a do not resuscitate code status. Communication during community transfers was identified on root cause analyses as a potential area for improvement.Conclusions and ImplicationsCommunity transfers were more likely to occur in younger residents with higher rates of cardiovascular disease and lower rates of cognitive impairment. Improved communication between nursing home staff and outside providers as well as more extensive advance care planning for residents with cardiovascular disease may reduce community transfers.     

Osteopenia in the men of a Veterans Administration nursing home

We measured by photon absorptiometry the bone density at six sites in 65 nursing home men aged 57-85 y and in 25 independent community men aged 57-80 y. Average bone density in the community men ranged from 97% to 105% of age-matched normal men. In the nursing home men these values ranged from 71% to 92% of age-matched normal men (p less than 0.05 for comparison with the community men). About 50% of the nursing home men but none of the community men had a value less than 70% of age-matched normal men at one or more sites. Among the institutionalized men bone densities at all six sites (in g/cm2) were significantly (p less than 0.05) and directly correlated with body weight but were not significantly correlated with height, age, principal or secondary diagnoses, continuing medications, or functional level.     

Home-care nurses’ community involvement activities and preference regarding the place for end-of-life period among single older adults: A cross-sectional study in Japan

Older adults’ preference regarding where they want to spend their end-of-life (EOL) has been reported to be a significant predictor of the actual EOL location. Home-care nurses have often been reported to try involving single older adults’ neighbours in the support network of the older adults (community involvement activities) to allow them to stay at home. Hence, nurses’ community involvement activities may be among the significant factors of older adults’ preference to stay at home during EOL. Therefore, this study explored home-care nurses’ community involvement activities and its association with single older adults’ EOL preference. A cross-sectional questionnaire survey was conducted with older adults (aged 65 years or older) who lived alone and used home-care nursing services for more than 6 months, their home-care nurses, and managers of their home-care nursing agencies. Questions included participants’ characteristics, nurses’ community involvement activities and older adults’ preference to remain at home during EOL. We conducted multiple logistic regression analyses to explore the relationship between nurses’ community involvement activities and older adults’ preference to remain at home during EOL while controlling for their demographic variables. In total, 103 pairs of home-care nurses and single older adults from 27 home-care nursing agencies participated. Approximately 70% of older adults preferred to remain at home during EOL, and 50% of nurses implemented community involvement activities. Older adults’ preference to remain at home during EOL was associated with implementation of community involvement activities (Odds Ratio [OR]: 3.4; 95% Confidence Interval [95%CI]:1.1–9.8), home-care nurses’ higher practical clinical ability (OR: 1.4, 95%CI:1.0–1.8), and older adult's longer use of home-care nursing service (OR: 2.2, 95%CI:1.2–4.1). Community involvement activities may be essential in helping single older adults to stay at home as per their preference for EOL.     

Conceptualization of a Toolkit to Evaluate Everyday Competence in Planning Transitions From Nursing Homes to the Community

Living independently in the community is a primary goal for older adults, particularly for the estimated 10% to 20% of long-stay nursing home residents who have low care requirements. According to the model of person-environment fit, individuals with high levels of everyday competence have the ability to solve problems associated with everyday life. Nursing home residents with high levels of everyday competence and low care needs have poor person-environment fit, placing them at risk for declines in function, maladaptive behavior, and affective disorders. The goal of this article is to present a framework for the integration of everyday competence with standardized goal-setting and care-planning processes to enable the transition of appropriate nursing home residents back to the community. Barriers to community transitions exist across several Key Domains: rehabilitation, personal assistance and services, caregiver support, finances, housing, and transportation. We propose a research agenda to develop and implement a toolkit based on this framework that nursing home staff can use to overcome barriers to transition by (1) assessing residents' everyday competence, (2) developing personally meaningful goals that facilitate transition, and (3) conducting structured care planning to support resident goals around returning to the community. If successful, this toolkit has the potential to reduce costs associated with nursing home care and to improve functional health, psychological well-being, and quality of life for older adults. The proposed framework and toolkit complement national efforts focused on transitioning nursing home residents back into the community.     

Effects of the Medicare Alzheimer's Disease Demonstration on nursing home entry.

STUDY QUESTION: Did the Medicare Alzheimer''s Disease Demonstration, with its goal of improving caregiver outcomes through case management and subsidized community services, affect the nursing home entry rate of treatments with dementia compared to controls? DATA SOURCES: Interviews conducted at baseline and six months thereafter. Measures include date of nursing home entry, client and caregiver health, and income. STUDY DESIGN: The demonstration randomly assigned voluntary applicants into treatment and control groups. Treatment group cases were eligible for case management and for an 80 percent discount on community care benefits, up to about $600 per month. DATA COLLECTION: All cases received baseline and semi-annual assessment interviews for up to three years after enrollment. Analyses are among cases that remained in the demonstration for more than 30 days after enrollment (n = 8,095). PRINCIPAL FINDINGS: The intervention of case management and subsidized community service had no effect on nursing home entry rates for treatments overall, compared to those of controls, and few effects on treatment subgroups, with the exception of one site where it may have increased nursing home entry rates. CONCLUSIONS: Providing case management and subsidized community services with the goal of improving caregiver outcomes may have little effect on nursing home entry rates for people with dementia.     

First nursing home admissions: time spent at home and in institutions after discharge.

We tracked 96 percent of a sample of 1,942 nursing home patients admitted to a nursing home for the first time in 1982-83. Patients discharged alive from the nursing home were followed for two years or until death. The relative time spent at home, in hospitals, and in skilled nursing facilities is reported. Of the 705 patients discharged from their initial nursing home admission to homes in the community, about 50 percent made only one transfer and only 15 percent made four or more transfers. Of the 509 discharged to a hospital, 26 percent died there and 37 percent of the 374 survivors made four or more moves in the next two years. In all, 1,332 patients were discharged alive and they spent almost two-thirds of the subsequent two years, or their remaining lifetimes, in the community. Of those who transferred only once, over two-thirds of their follow-up time was spent in their own homes. Policies concerned with long-term care should use some type of actuarial data base to successfully plan and implement long-term care insurance.     

宝安区西乡街道桃源居社区居家老人护理需求研究

目的调查分析桃源居社区居家老人对社区护理服务需求的现状,为开展居家护理服务和制定内容规划提供依据。方法编制居家老人护理需求评估表,通过专业人员对240名老年人的健康功能状况和居家护理服务需求进行入户评估。结果67.08%的居家老人有居家护理服务,年龄、文化程度、自理能力是影响老年人护理需求的影响因素。结论开展居家护理能够有效提高老年人的自我保健意识和能力,对保障老年人的健康生活具有重要意义。