整体护理模式病房建设的实践

从功能制护理走向整体护理是护理模式的重大变革。文章介绍了湘雅医院进行整体护理模式病房建设的具体步骤与经验,认为模式病房从护理业务和护理管理的各个环节紧密围绕病人,主动满足病人的需要,体现了“以病人为中心”的身心整体护理,全面地提高了护理质量。     

从整体护理谈护理观念的转变

整体护理的概念是:“以现代护理观为指导,以护理程序为核心,将护理临床业务和护理管理的各个环节系统化的工作模式”。系统化整体护理的特点是按照护理程序的科学工作方法为病人解决问题。它包括护理哲理,护士职责与评价、标准护理计划、标准教育计划、各种护理表格书写及护理质量保证等,皆以护理程序为框架,环环相扣,整体协调一致,以确保护理服务水平的全面提高。     

精神科护士在整体护理模式病房中的角度转变

系统化整体护理是以现代护理观为指导,以护理程序为核心,将护理临床业务和护理管理的各个环节系统化的工作模式。实施系统化整体护理是我国护理改革的系统化方案,当前许多医院建立了整体护理模式病房,结果模式病房的病人满意度高于其他病房。在实施过程中,护士的角色转变,对现代护理观的认识、接受和运用程度,对于促进系统化整体护理的开展起了至关重要的作用。     

建立系统化整体护理模式病房的体会

为了与国际先进护理模式接轨，我院自１９９５年起，从责任制护理转为实施系统化一只本报讯 理的模式病房试点，通过在４个病房半年多的试点，使病人满意率达９５％，医护关系改善，护士自身工作情绪高涨，收到了满意效果，这是因为系统化整体护模式克服了以往护理中的不足，以现代护理观为指导，以病人为中心，以护理程序为框架，将护理临床业务和护理管理的各个环节系统化。     

“树根式”配置一优化整体护理的尝试

整体护理是以现代护理观为指导，以护理程序为核心，将护理临床业务和护理管理的各个环节系统化的工作模式。2003年8月起我科逐渐摸索出一套“树根式”配置，规范工作流程，使整体护理的实施主体一责任护士有更多的机会和自己的分管病人接触、交流，完成组内病人的所有治疗、护理工作，切实做好宣教工作．记录好护理记录，完成各种表格的签字。责任护士在班内完成迎送新老病人，护理住院病人，正确评估病情，时间正确，记录连续。准确评价护理效果，有力地促进了护理质量的提高和病人满意度的提高。现将具体做法与效果介绍如下。     

手术室整体护理工作的探索

整体护理是一种新兴的护理工作模式,是以现代护理观为指导,以人为中心,以护理程序为核心,将临床护理和护理管理的各个环节系统化的工作模式,目标是根据人的生理,心理、社会、文化、精神等多方面的需要,提供适合人的最佳护理。自从我院开展整体护理以来,各科室的工作明显突出了护理工作的科学性,系统性和整体性。我们手术室护理以其专业特殊性有别于临床护理。但随着整体护理的深入开展,手术室的护理也应在整体护理的基础上通过对手术患者的术前访视和术后随访手术室的整体化护理,缓解患者在手术期间的恐惧心理。     

浅析整体护理中的内涵质量

整体护理是以现代护理观为指导，以护理程序为基础，将护理临床业务和护理管理的各个环节系统化的工作模式。这种工作模式的核心是以病人为中心，要求护士不仅要注意对患者的疾病护理，更要注重患者的心理变化，用关心、热情、体贴来消除患者的精神负担，满足患者生理、心...     

推广整体护理提高儿科护理人员素质

系统整体护理是以现代护理观为指导 ,以护理程序为核心 ,以科学的思维方法为指导 ,将护理临床业务与护理管理的各个环节结合起来 ,按照护理程序的科学工作方法 ,为服务对象解决健康问题。湖北省妇幼保健院儿科自 1997年开始试行系统化整体护理 ,对护士进行了分段业务培训 ,并对管理模式进行了探索 ,促进了护理质量的提高 ,现报告如下。1　对象与方法1.1　研究对象　儿科护士 10人 ,学历 :大专 8人 ,中专 2人 ;职称 :主管护师 2人 ,护师 4人 ,护士 4人 ;从事护理工作年限 :5年有 4人 ,5～ 10年 4人 ,10年以上有 2人。1.2　业务训练方法1.2 .1…     

影响基层医院整体护理质量因素的调查与分析

系统化整体护理是以现代护理观为指导,以护理程序为核心,将临床护理和护理管理各个环节结合起来。按照护理程序的科学工作方法,为服务对象解决健康问题,实施有效的护理。从2005年开始引进国外护理学发展的先进经验,有组织地开展了整体护理试点。通过模式病房手段,贯穿整体护理理念,并以点带面不断铺展。到目前为止,整体护理病区数从最初的20％到50％,甚至于达到100％。整体护理作为一种理念,已经在各级各类医院中得到认可,开展整体护理使医院的社会效益和经济效益取得了一定成效。     

整体护理思想指导下的护理思路

随着医学模式的转变及社会人群对护理服务要求的提高,护理工作从面向疾病拓展到而向健康,提出了整体护理模式的概念,强调以病人为中心,以护理程序为基础和核心,注重护理工作的连续性,以及健康宣教和心理护理。整体护理是近些年我国深入开展护理改革的重要举措,也是适应医学发展的新型护理模式。本文针对某医院普外科科室在整体护理思想指导下的护理工作方法与管理方法的改进进行了分析。     

多元文化与现代护理

从人们日益增长的医疗卫生保健需求出发,提出应将多元文化应用于护理之中,并阐述了护士在多元文 化中应充当的角色。     

北京市农村地区老年人长期护理的需求现状及相关因素研究

目的 了解北京农村地区老年人长期护理现状和未来选择意愿及相关因素,为政府完善有关老年人长期关爱和照顾政策提供参考.方法 2012年12月至2013年1月,采用现况调查的方法,以北京农村地区1022名60岁以上老年人为调查对象,问卷调查其人口学信息、健康状况、长期护理现状和未来长期护理模式的选择意愿;采用Х^2检验和多元非条件Logistic回归,分析调查对象未来选择不同长期护理模式的相关因素.结果 调查显示有6.00％（59/1016）的老人目前需要长期护理,有82.86％（841/1013）的老人今后会选择家庭长期护理模式,有7.68％（78/1013）的老年人选择社区长期护理模式.单因素分析发现,影响老年人选择家庭长期护理的因素有文化程度、职业、月人均收入、居住情况、同住子女数量、医疗保险、养老保险、慢性病患病情况、听力、味觉和触觉自我评价（Х^2=33.03、136.17、99.32、88.83、58.07、147.71、108.11、9.85、33.78、30.45、22.22,P＜0.05）.多因素分析发现影响老年人选择家庭长期护理的相关因素是职业、月人均收入、与配偶居住情况、参加新农合以及对视力状况的自我评价,OR值（95％CI）分别为：2.48 （1.21～5.10）,0.82（0.71～0.95）,1.64（1.08～2.49）,4.78（2.93～7.82）,0.72（0.59～0.89）.结论 以家庭为基础的综合性长期护理和健康管理体系建设,是北京市农村老年人未来重要的选择和需求方向.     

Unmet health care and health care utilization

The objective of this study is to examine the causal effect of health care utilization on unmet health care needs. An IV approach deals with the endogeneity between the use of health care services and unmet health care, using the presence of drug insurance and the number of physicians by health region as instruments. We employ three cycles of the Canadian Community Health Survey confidential master files (2003, 2005, and 2014). We find a robustly negative relationship between health care use and unmet health care needs. One more visit to a medical doctor on average decreases the probability of reporting unmet health care needs by 0.014 points. The effect is negative for the women‐only group whereas it is statistically insignificant for men; similarly, the effect is negative for urban dwellers but insignificant for rural ones. Health care use reduces the likelihood of reporting unmet health care. Policies that encourage the use of health care services, like increasing the coverage of public drug insurance and increasing after hours accessibility of physicians, can help reduce the likelihood of unmet health care.     

An instrumental variables approach to post-acute care nursing home quality: Is there a dime's worth of evidence that continuing care retirement communities provide higher quality?

For the affluent elderly, continuing care retirement communities (CCRCs) have become a popular option for long term care and other health care needs related to aging. While CCRCs have experienced significant growth over the last few decades, very little is known about the quality of care CCRCs provide. This paper is the first to rigorously study CCRCs on a national scale and the only study that focuses on nursing home quality. Using a national sample from 2005, we determine if the quality of post-acute care provided by CCRC nursing homes is superior to traditional nursing homes. To mimic randomization of patients, instrumental variables analysis is used with relative distance as an exclusion restriction to handle the endogeneity of the type of facility where care is provided. After adjusting for endogeniety, we find that CCRC nursing homes provide post-acute care quality that is similar or lower to traditional nursing homes, depending on the quality measure.     

State-level income inequality and family burden of U.S. families raising children with special health care needs

Growing evidence supports the hypothesis that income inequality within a nation influences health outcomes net of the effect of any given household's absolute income. We tested the hypothesis that state-level income inequality in the United States is associated with increased family burden for care and health-related expenditures for low-income families of children with special health care needs. We analyzed the 2005-06 wave of the National Survey of Children with Special Health Care Needs, a probability sample of approximately 750 children with special health care needs in each state and the District of Columbia in the US Our measure of state-level income inequality was the Gini coefficient. Dependent measures of family caregiving burden included whether the parent received help arranging or coordinating the child's care and whether the parent stopped working due to the child's health. Dependent measures of family financial burden included absolute burden (spending in past 12 months for child's health care needs) and relative burden (spending as a proportion of total family income). After controlling for a host of child, family, and state factors, including family income and measures of the severity of a child's impairments, state-level income inequality has a significant and independent association with family burden related to the health care of their children with special health care needs. Families of children with special health care needs living in states with greater levels of income inequality report higher rates of absolute and relative financial burden.     

Delayed Care and Unmet Needs among Health Care System Users: When Does Fiduciary Trust in a Physician Matter?

Objectives. To examine whether fiduciary trust in a physician is related to unmet health care needs and delayed care among patients who have a regular physician, and to investigate whether the relationships between trust and unmet health care needs and delays in care are attenuated for disadvantaged patients who face structural obstacles to obtaining health care.
Data Sources/Study Setting. The 1998–1999 Community Tracking Study (CTS) Household Survey, a cross-sectional sample representative of the U.S. noninstitutionalized population. This study analyzes adults who usually see the same physician for their health care ( n =29,994).
Study Design. We estimated logistic regression models of the association of trust with unmet health care needs and delayed care. We tested interactions between trust and barriers to obtaining care, including minority race/ethnicity, poverty, and the absence of health insurance. Control variables included patients' sociodemographic characteristics, health status, satisfaction with the available choice of primary physicians, and the number of physician visits during the last year.
Principal Findings. Patients' fiduciary trust in a physician is negatively associated with the likelihood of reporting delayed care and unmet health care needs among most patients. Among African Americans, Hispanics, the poor, and the uninsured, however, fiduciary trust is not significantly associated with the likelihood of delayed care. For unmet needs, only the uninsured have no significant association with trust.
Conclusions. Results show that trust is associated with improved chances of getting needed care across most subgroups of the population, although this relationship varies by subpopulation.     

A Research and Policy Agenda for Transitions from Nursing Homes to Home

SUMMARY

More than 1 million adults make the transition from nursing homes to the community every year, often using formal health services including Medicare Part A skilled home health care. Although the need for discharge planning is well described, and the risks associated with care transitions are increasingly recognized, there is very limited information about the process and outcomes as patients move from nursing home to home. This paper reviews pertinent published data and health services research as background information and outlines a research agenda for studying these important transitions.     

北京市老年人卫生服务需求研究

目的　了解北京地区老年人的健康现状及卫生服务需求 ,为政府及相关部门制定老年人保健政策和有针对性地开展老年人卫生服务提供依据。方法　抽样调查北京不同地区 (城区、城乡结合部、郊区农村 ) 6 0岁及以上老年人群 2 4 87人。调查内容涉及老年人的健康状况 ,医疗、护理、康复及保健需求 ,以及社区卫生服务。分析不同地区及人群的老年人健康现状与卫生服务需求的差异。结果　慢性病是老年人的主要卫生问题 ,罹患的前 4种慢性病是高血压、冠心病、骨关节病、脑血管病 ,糖尿病患病率增加较快。约 10 %的老人躯体功能有障碍 ,日常生活能力下降 ,生活需要他人帮助。老年人增多对医疗及护理照料服务的需求量增大。社区卫生服务的优势日益显出 ,得到老年人的认可。经济困难是影响老年人就医行为的主要原因。结论　老年人群是健康的弱势群体 ,随着人口老龄化 ,老年人卫生服务的需求增加。健康是影响老年人生活质量的重要因素 ,大力加强慢性病的防治应列为老年保健的中心任务 ,也是提高老年人生活质量的关键。     

Designing residential aged care for people at risk of,or experiencing,homelessness: An exploratory Australian study

The number of older people experiencing or at risk of homelessness, both long‐term and first‐time homelessness, is increasing. The proportion of women facing homelessness within that cohort is also increasing. When combined with complex health needs, appropriate long‐term care options remain limited. This qualitative study conducted in Sydney, Australia, aimed to explore the care needs of older people with comorbid health issues who are facing homelessness and, from this assessment, derive a preferred model of residential aged care. Interviews and focus groups were conducted with 29 participants from providers in the aged care and homelessness sectors. Data were analysed using a grounded theory approach. Causal and contextual factors, and consequences surrounding the experience of homelessness, informed the wide range of care needs of this group (model of care), and the organisational resources required to deliver them (management issues and staff). A trauma‐informed approach to care consistently applied by all staff to all processes throughout the care home was recommended. Such an approach would further strengthen existing models of care and take into account both health needs (such as mental health, substance dependence and acquired brain injury) and significant losses through the life course of this vulnerable population.     

Can family caregiving substitute for nursing home care?

Informal care should be a substitute for nursing homes but empirical evidence often suggests the opposite. This may be because informal care receipt is positively correlated with unobserved negative health characteristics. We exploit variation in children's characteristics as instruments for informal care to provide Two-Stage Least Squares (TSLS) estimates of nursing home use among a sample of 6855 individuals from the 1993-2000 waves of the AHEAD survey. While OLS results suggest informal care is associated with greater future nursing home risk, TSLS estimates show that receipt of informal care statistically and substantially reduces the risk of nursing home entry. This finding has implications for Medicaid and private long-term care insurance markets.