中国台湾老年中期照护特色病房见闻及其对大陆地区的启示

文章介绍了笔者在中国台湾行政院卫生署旗山医院中期照护病房的参观体会,分别从中期照护概念、病房设立目的、服务内容、收录流程、环境特色方面阐述了病房的实际情况,并结合大陆地区老年护理实际情况提出建立中期照护服务模式和服务机构、培养老年中期照护服务人才等建议,以期为大陆地区老年护理发展提供借鉴。     

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。     

基于单元照护的整合式护理模式对护士动线的影响

[目的]探讨基于单元照护的整合式护理模式在冠心病病房中的应用及其对护士动线的影响。[方法]将武汉亚洲心脏病医院20楼冠心病病房13名护士作为研究对象,采用自制的护士动线记录表,对比2018年4月及2019年4月,即实施基于单元照护的整合式护理模式前后的护士动线数据进行统计学处理。[结果]实施后数据整体低于实施前,下降比例最大的是病房-护士站,其次是病房-治疗室和病房-医生办公室。同时,实施单元照护护理模式前,N2、N3层级护士的动线数据普遍比N0、N1级少;实施单元照护护理模式后,N_1～N_3层级护士的动线整体下降,N0级护士则上升。[结论]基于单元照护的整合式护理模式在冠心病病房的实施可以减少护士动线,保证护士在病人身边的有效时间,增强病人对护理服务的感知度和满意度。     

国内外灵性照护模式的相关研究进展

笔者就国内外灵性照护的概念、灵性照护理论模型、灵性照护模式及交流模式等方面进行综述,旨在提高医护人员对国内外灵性照护模式相关研究进展的认识,以期为我国灵性照护模式的构建及应用提供参考。     

重症加强监护病房开展舒缓疗护全人照护模式的研究进展

本文从生理、心理社会与精神方面总结了重症加强监护病房（Intensive Care Unit,ICU）患者的全人照护需求,就身体照护、心理社会支持及精神支持3个方面对ICU舒缓疗护的全人照护模式进行综述,旨在为我国ICU舒缓疗护的开展提供参考依据。     

骨折病人中期照护模式的研究进展

介绍了骨折病人的特点、中期照护的概念及目标、国内外中期照护模式;指出我国建立骨折中期照护模式的必要性及存在的问题,提出骨折中期照护模式的建立应优先考虑社区医院、建立专业的骨科照护团队并给予专业化的培训。     

ICU病人灵性照护的研究进展

对灵性照护相关概念、重症监护室(ICU)病人及家属对灵性照护的需求、ICU灵性照护的影响因素、ICU灵性照护模式和指南等方面进行综述,为我国ICU开展灵性照护提供建议与思考。     

试论适合城市社区发展的老年慢性疾病患者出院后照护模式的构建

目的 探讨适合我国城市社区老年慢性疾病患者出院后照护模式的构建.方法 介绍目前国内外老年人概况及我国人口老龄化带来的问题、老年人慢性疾病的流行病学慨况、目前城市社区老年慢性疾病患者出院后照护模式的现状及发展趋势,在借鉴国外经验及分析我国国情的基础上,提出构建适合我国城市社区老年慢性疾病患者出院后照护模式的思路和策略.结果 构建适合我国城市社区老年慢性疾病患者出院后照护模式的思路和策略包括:在医院建立老年护理专业架构及成立老年专科护理小组;在医院及社区建立及实施老年慢性疾病患者出院计划模式.结论 构建适合我国城市社区老年慢性疾病患者出院后照护模式是当前拓宽、发展老年护理事业的必然途径,将能够为医疗卫生保障体系的改革和健康发展起到促进作用.     

综合型医院安宁照护现状及对策的质性研究

[目的]通过护生在临床安宁照护情境中的现场体验,形成较有价值的理论,指导护理管理、护理教育与护理实践。[方法]采用质性研究的方法,通过分项目记录、直接观察及半结构访谈工具,收集护生在综合型医院安宁照护病房中的现场体验资料。[结果]综合型医院安宁照护硬环境拥挤和嘈杂,软环境紧张和郁闷;缺乏对安宁照护的规范化管理和培训。[结论]综合型医院安宁照护整体状况亟待改进,护理教育和管理者应高度重视安宁照护的研究及死亡教育,以促进我国安宁照护事业的长足发展。     

试论适合城市社区发展的老年慢性疾病患者出院后照护模式的构建

目的探讨适合我国城市社区老年慢性疾病患者出院后照护模式的构建。方法介绍目前国内外老年人概况及我国人口老龄化带来的问题、老年人慢性疾病的流行病学概况、目前城市社区老年慢性疾病患者出院后照护模式的现状及发展趋势,在借鉴国外经验及分析我国国情的基础上,提出构建适合我国城市社区老年慢性疾病患者出院后照护模式的思路和策略。结果构建适合我国城市社区老年慢性疾病患者出院后照护模式的思路和策略包括：在医院建立老年护理专业架构及成立老年专科护理小组;在医院及社区建立及实施老年慢性疾病患者出院计划模式。结论构建适合我国城市社区老年慢性疾病患者出院后照护模式是当前拓宽、发展老年护理事业的必然途径,将能够为医疗卫生保障体系的改革和健康发展起到促进作用。     

Older people and the relationship between hospital services and intermediate care: Results from a national evaluation

In the UK, new intermediate care services have been established to prevent unnecessary hospital admissions, facilitate effective discharge and prevent premature care home admissions. This paper reports findings from a national evaluation of intermediate care, focusing on the relationship between hospital services and intermediate care. Participants included key managers and practitioners involved in the planning, management and delivery of intermediate care in five case study sites. During the study, they identified a range of tensions between hospital services and intermediate care, including concerns about the role and involvement of acute clinicians; the safety, quality and appropriateness of intermediate care; access to and eligibility for intermediate care; a lack of understanding and awareness of intermediate care; and the risk of intermediate care being dominated by acute pressures. Although participants were able to identify several practical ways forward, resolving such fundamental tensions seems to require significant and long-term cultural change in the relationship between acute and intermediate care. Overall, this study raises questions about the extent to which intermediate care will be able to rebalance the current health and social care system and make a substantial contribution to tackling ongoing concerns about emergency hospital admissions and delayed transfers of care.     

Involving older people in intermediate care

BACKGROUND: Intermediate care has become a crucial part of the United Kingdom government's programme for improving services for older people. Older people comprise a substantial part of the user base for these services, and it is increasingly recognized that there is a need for greater user involvement in service development for intermediate care. National initiatives undertaken in intermediate care have sought to widen and deepen the remit of such services, and in this way promote greater independence and improved quality of care for older people. In particular, the government has set out clear plans for reshaping services for older people in the National Health Service Plan and the rationale for greater involvement of older people in service development. This article considers ways in which these national and local objectives may be achieved and considers some of the implications for nursing. AIM: This paper aims to explore the concept of intermediate care and to identify trends and existing evidence of user involvement in care. In this way it charts a possible way forward for the development of a more 'user sensitive' approach. METHOD: The following databases were searched: Medline, Cochrane Library, the Social Science Citation Index and CINAHL. Key words were 'intermediate care', 'older people', 'formal care', 'primary care', 'social services' and 'geriatrics', used in combination. FINDINGS: The findings from this study indicate that there is considerable scope for increased user involvement in service development for intermediate care. Such challenges may be more effectively met through greater clarity of the concept of intermediate care, and a bridging of user involvement at the practice and policy levels. Nurses are key providers of intermediate care in the community. CONCLUSIONS: The involvement of older people in intermediate care service development must be premised on a shared comprehension of the purpose and function of intermediate care. Nurses must be involved in shifting intermediate care from being service-focused to patient-centred. Effective participation eschews the application of global constructs for older people, while supporting greater participation at all levels and robust implementation processes.     

国内外临终关怀研究进展及启示

综述国内外临终关怀研究进展,指出与国外临终关怀的模式及发展情况比较,我国临终关怀机构形式多以临终关怀病房/安宁病房及宁养病房为主,临终关怀事业主要存在受中国传统观念束缚对临终关怀缺乏重视、数量不足、从业人员缺乏专业培训、政府政策支持力度不够等问题。因此我国临终关怀模式的建立和发展需立足中国实情,将外来经验本土化,加大政府扶持力度,将临终关怀理念普及化。     

Development and evaluation of intermediate care

Intermediate care is being developed as part of the national strategy for older people in England and Wales to prevent their admission to hospital and facilitate early discharge. Evaluation of intermediate care is implicit within current policy directives. This project evaluated the client information across a number of intermediate care schemes within one National Health Service community trust for 3 months and disseminated the results to staff as part of a reflective workshop which also provided an opportunity for additional data collection. Rates of referral and acceptance on intermediate care were high for all the schemes except one, indicating reliable referral and inclusion criteria. Older people were the recipients of intermediate care with nearly half of them having experienced falls. A number of developments were identified by staff covering both current services and long-term strategy for intermediate care and indicating the importance of involving providers in the evaluation and development of services. Fall prevention initiatives and involvement of users and carers in the evaluation and development of intermediate care were also identified.     

Nurse-led intermediate care: patients' perceptions

Intermediate care currently forms one of the UK Government's main initiatives for improving the quality of post-acute care. This paper examines patients' and carers' experiences of a nurse-led unit, which aims to provide intermediate care for people no longer acutely ill. Drawing on findings from qualitative interview data, we demonstrate that patients viewed this model of care as acceptable but that they had markedly inconsistent experiences of care and reported considerable variation in their perceptions of the Unit's purpose. Some possible reasons for this are explored. Implications for the development of good quality nurse-led intermediate care are outlined.     

国内部分三甲医院危重疾病患者口腔护理情况调查

目的了解国内三甲医院重症监护室危重疾病患者口腔护理情况,为提高危重疾病患者口腔护理水平提供依据和建议。方法采用信访、向危重病人口腔护理专家咨询和走访等调查方式,获得国内危重疾病患者口腔护理现状信息。结果本次调查共发放调查问卷184份,回收有效问卷79份,有效回收率42.93%。所有回复者均认为口腔护理对于危重疾病患者很重要,有98.7%的重症监护室采取了不同的方式进行护理前评估,包括检查口腔基本情况及口腔分泌物提取,评估实施者主要为床旁责任护士（63.3%）。目前使用最多的口腔护理方式为棉球擦洗法（62.5%）,护理频率每日2～3次,每次平均时间9.1±5.1min,主要使用的口腔护理液有生理盐水（76.0%）、碳酸氢钠（22.8%）、呋喃西林（13.9%）、双氧水（13.9%）等。结论目前国内口腔护理水平相差较大,应加强针对循证口腔护理的培训,有必要建立危重疾病患者口腔护理的全国统一规范。     

The impact of intermediate care services on job satisfaction, skills and career development opportunities

Aim. The purpose of this study was to examine, in depth, the impact of intermediate care services on staff job satisfaction, skills development and career development opportunities. Background. Recruitment and retention difficulties present a major barrier to the effective delivery of intermediate care services in the UK. The limited existing literature is contradictory, but points to the possibility of staff deskilling and suggests that intermediate care is poorly understood and may be seen by other practitioners as being of lower status than hospital work. These factors have the potential to reduce staff morale and limit the possibilities of recruiting staff. Design. The research is based on interviews with 26 staff from case studies of two intermediate care services in South Yorkshire. Results. Participants reported high levels of job satisfaction, which was because of the enabling philosophy of care, increased autonomy, the setting of care and the actual teams within which the workers were employed. For most disciplines, intermediate care facilitated the application of existing skills in a different way; enhancing some skills, while restricting the use of others. Barriers to career development opportunities were attributed to the relative recency of intermediate care services, small size of the services and lack of clear career structures. Conclusions. Career development opportunities in intermediate care could be improved through staff rotations through acute, community and intermediate care to increase their awareness of the roles of intermediate care staff. The non‐hierarchical management structures limits management career development opportunities, instead, there is a need to enhance professional growth opportunities through the use of consultant posts and specialization within intermediate care. Relevance to clinical practice. This study provides insight into the impact of an increasingly popular model of care on the roles and job satisfaction of workers and highlights the importance of this learning for recruitment and retention of staff.     

我国17省市儿科ICU调查

目的 分析近10年我国儿科重症监护病房(ICU)状况、存在问题并提出建议。方法 向全国近40所儿科床位100张以上的医院发出调查表。结果 分布于17省市的27所医院回复，内科ICU共44个：儿童重症监护(PICU)18个、新生儿重症监护(NICU)20个、P及NICU6个。ICU平均床位12(6-40)张，每张床位有0．43(0．43-1．25)台呼吸机，0．56(0．2—1．4)台多功能监护仪。床位和医师及护士比分别为1：0．75和1：1．37。51．9％的医院开展转运。2000年共收治病人15805人，病死率4．6％(0．9％—10．4％)，体重轻于1000g和1000-1500g的早产儿存活率分别为42.2％、75．1％，心肺复苏存活率71．4％。结论 我国三级医院儿科ICU正稳步发展，与92年比较，人员、设备有所改善。转运工作未广泛开展，一些ICU床位被非危重病人占据。建议ICU建立分级管理制度，积极开展转运，开展前瞻性危重评分预测死亡，以对ICU治疗效果作出更科学的评估。