高职院校与卫生服务中心（站）社区护理对接的软硬件建设

进入21世纪,党和国家高度重视卫生服务体系的建设,2006年国务院办公厅印发《国务院关于发展城市社区卫生服务的指导意见》,2009年4月6号《中共中央国务院关于深化医药卫生体制改革的意见》提出：加快建设以社区卫生服务中心为主体的城市社区卫生服务网络建设。     

临床护理文化与护理高职院校校园文化对接的重要性研究

深入护理院校与临床护理之间的合作,必须重视临床护理文化与护理高职院校校园文化的对接。此对接一方面是对护理校园文化的激励和渗透,另一方面是对临床护理文化的辐射和促进,同时对于整体提升医疗护理行业的职业行为习惯、职业规范、职业氛围、职业精神有重要的引领和导向作用,而且进一步提高广大人民群众对护理人员的信任、对医疗卫生服务的认可和依赖。     

建立社区护理服务中心的构想

本文就建立社区护理服务中心的领导体制、服务队伍、服务模式等主要问题进行了初探，提出了相应的可行性构想。     

城市社区健康服务中心的护理风险管理

总结了城市社区健康服务中心的护理风险管理的经验。分析了护理风险的因素:社区护士角色的特殊性,就诊人群的特殊性及社区健康服务机构、配备的特殊性。制定了相应的对策:健全社区健康服务中心的各项规章制度,完善各项操作的详细指引;强化护理人员教育,提高综合素质;加强健康教育。     

高职院校护理专业群的建设与实践

专业群建设是职业院校加强内涵建设的重要抓手,可以强化办学特色、深化产教融合、提高人才培养质量、提升社会科技服务能力。该文在分析江苏医药职业学院推动“医疗卫生”与“医养结合”人才培养改革的基础上,提出面向康养产业链构建护理专业群的逻辑,然后从人才培养方案、课程体系与教学资源、教学方法、教学团队、实训基地和社会服务等方面,研究护理专业群组群逻辑,为服务人民群众的“全生命周期、健康全过程”建设工作提供有益支撑,助力“健康中国”战略。     

高职院校护理专业群的建设与思考

专业群建设是卫生职业教育双高建设工作的关键,是卫生职业院校提高人才培养质量,提升社会服务水平和贡献度的着力点,是进一步密切校院合作、医教协同的机制建设载体。天津医学高等专科学校以高职护理专业集群式发展内涵和组群逻辑为基础,在产教融合平台搭建、人才培养模式创新、课程体系改革、双师队伍能力提升、教材改革建设、1+X技能等级证书制度推进、国际化水平提升等方面进行探索实践,以提升高职护理专业群建设水平。     

建立精神病社区医疗护理服务中心的探讨

随着社会的发展 ,生活节奏加快 ,精神疾病的患病率有逐年上升趋势 ,同时 ,由于经济的快速增长 ,人民生活水平及文化水平不断提高 ,人们的健康观也发生了根本的改变 ,更多的人们开始认识与关注精神疾患。精神病人为一特殊的群体 ,同时对医护人员的需求也较特殊[1] 。为满足人民的健康需求 ,我院 2 0 0 0年 7月建立了一个精神病社区医疗护理服务中心。现介绍如下。1　建立精神病社区医疗护理服务中心的背景我院原是一所市级精神病专科医院 ,1998年 10月由城郊迁入市区后 ,在以“专科为主、综合发展”的思路指导下 ,除继续开展精神病治疗专科外…     

高职院校护理专业群建设策略与成效

随着高等职业院校"双高"计划的实施,大健康产业快速发展,人们对健康护理服务需求的 日益增长,江苏医药职业学院积极探索护理专业群建设策略,通过优化专业组成,围绕人才培养体系、专业群课程体系、"产教研创训"一体化平台及教学团队等实施改革.该文总结专业群建设经验,为其他院校高职护理专业群建设提供借鉴和参考.     

北京市西城区两个社区站护理服务内容的调查

为了探讨社区护理服务的需要,本文对北京市西城区南、北两个社区卫生服务站的护理服务内容,居民健康教育、健康管理和经营体制进行了调查对比。结果表明南、北社区站社区护理共同点是:为居民提供了基本护理技术与服务;参加居民健康教育、咨询和指导;参与居民健康档案采集和慢病干预。不同点是:南站家庭输液少,居民健康教育项目多、面广、内容丰富、实际,社区护士已将居民健康教育纳入护理服务中,计区护理服务侧重于慢性病干预。但依托医院生存的经营体制,不利于竞争机制引进,社区护理的开展仅靠人为精神因素,不能持久。北站家庭输液、导尿、换药侵入性操作多,社区护理服务侧重于慢性病的治疗。自负盈亏的生存经营体制,有利于引进竞争机制,容易拓宽护理服务范围。     

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。     

Extended-spectrum beta-lactamase-producing Enterobacteriaceae in community and private health care centers

In 1999, 39 of 2,599 isolates of the family Enterobacteriaceae (1.5%) collected by eight private laboratories in the Aquitaine region in France produced an extended-spectrum beta-lactamase (ESBL). Among these were 19 Enterobacter aerogenes isolates; 8 Klebsiella pneumoniae isolates; 6 Escherichia coli isolates; 3 Proteus mirabilis isolates; and 1 isolate each of Serratia marcescens, Morganella morganii, and Providencia stuartii. ESBL producers were isolated from 38 patients, including 33 residents of 11 clinics or nursing homes and 5 ambulatory patients. Seven different ESBLs were characterized. These mainly consisted of TEM-24 (25 isolates) and TEM-21 (9 isolates), but TEM-15 (2 isolates) and TEM-3, TEM-19, SHV-4, and CTX-M-1 (1 isolate each) were also characterized. Seven strains showed the coexistence of different TEM- and/or SHV-encoding genes, including a new SHV-1 variant, SHV-44, defined by the substitution R205L previously reported for SHV-3 in association with S238G. The epidemiology of the ESBL producers was investigated by random amplification of polymorphic DNA, typing by enterobacterial repetitive intergenic consensus PCR, analysis of resistance cotransferred with the ESBL, and analysis of the restriction profiles of the ESBL-encoding plasmids. Of the TEM-24-expressing strains, 18 were E. aerogenes isolates, including 9 from the same clinic, that were representatives of the epidemic clone disseminating in France. Of the TEM-21-producing strains that belonged to different species of the family Enterobacteriaceae (E. coli, K. pneumoniae, and P. mirabilis), 8 were isolated in the same nursing home. Outbreaks due to strain and/or plasmid dissemination in these clinic and nursing home were demonstrated. The presence of ESBL producers in five ambulatory patients probably resulted from nosocomial acquisition. Our data highlight the serious need to monitor patients for ESBL-producing Enterobacteriaceae in general practice.     

Barriers to providing diabetes care in community health centers

OBJECTIVE: We aimed to identify barriers to improving care for individuals with diabetes in community health centers. These findings are important because many such patients, as in most other practice settings, receive care that does not meet evidence-based standards. RESEARCH DESIGN AND METHODS: In 42 Midwestern health centers, we surveyed 389 health providers and administrators about the barriers they faced delivering diabetes care. We report on home blood glucose monitoring, HbA1c tests, dilated eye examinations, foot examinations, diet, and exercise, all of which are a subset of the larger clinical practice recommendations of the American Diabetes Association (ADA). RESULTS: Among the 279 (72%) respondents, providers perceived that patients were significantly less likely than providers to believe that key processes of care were important (overall mean on 30-point scale: providers 26.8, patients 18.2, P = 0.0001). Providers were more confident in their ability to instruct patients on diet and exercise than on their ability to help them make changes in these areas. Ratings of the importance of access to care and finances as barriers varied widely; however, >25% of the providers and administrators agreed that significant barriers included affordability of home blood glucose monitoring, HbA1c testing, dilated eye examination, and special diets; nonproximity of ophthalmologist; forgetting to order eye examinations and to examine patients' feet; time required to teach home blood glucose monitoring; and language or cultural barriers. CONCLUSIONS: Providers in health centers indicate a need to enhance behavioral change in diabetic patients. In addition, better health care delivery systems and reforms that improve the affordability, accessibility, and efficiency of care are also likely to help health centers meet ADA standards of care.     

职业学校学生卫生保健服务的需求分析

目的:通过对湖南省4个城市33所职业学校(职校)学生卫生与保健需求及资源和利用的调查分析,为职校卫生保健服务方向提供参考依据。方法:采用描述性分析和比率分析法对卫生保健服务资源、利用和卫生保健服务需要量进行比较分析。结果:职校学生卫生需求量不大但种类多样化;学生不喜欢到校内就诊,住院医疗流向主要是市内医院(47.7%);医药费用构成药店购药比例最大(37.8%);职校卫生资源不足,利用率也较低。结论:职校应切实转变卫生保健服务职能,推进医疗社会化;建立合理的医疗保障制度,有针对性提供卫生保健服务;提高学生的医疗保健意识,促进学生整体健康水平提高。     

社区卫生服务中心非在编护理人员流失的相关因素分析与对策

目的分析社区卫生服务中心非在编护理人员流失的相关因素与对策。方法采用问卷调查的方法对我中心2006年6月～2008年5月非在编护理人员进行调查,找出护理人员流失的原因。针对原因,通过对非在编护理人员进行规范化管理。结果2008年6月～2010年5月非在编护理人员的流失数比2006年6月～2008年5月减少了31％。结论非在编护理人员的规范化管理,使非在编护理人员流失明显减少,稳定了护理人员队伍,提高了护理质量。     

成都市社区卫生服务中心人力资源配置及服务保障状况的调查研究

目的通过调查成都市社区卫生服务中心人力资源配置及服务保障状况,分析存在的问题,为进一步提高社区卫生服务的利用效率提供参考。方法采用方便抽样的方法,以问卷调查的形式,对成都市9所社区卫生服务中心进行调研。结果 9所社区卫生服务中心共有工作人员586人,其中卫生技术人员数为531人,占90.61%;每千人口执业医师(助理医师)数为0.24人,每千人口注册护士数为0.27人。大专学历的卫生技术人员占主体,为50.09%。职称主要以初级水平为主,占68.17%。卫生技术人员缺乏科研培训,参加省级及以上培训的人员较少。服务项目主要为医疗保健服务,内容较为单一。部分社区卫生服务中心的设备设施陈旧,个别设备配置不足。结论各级政府和卫生行政部门应加强对社区卫生服务中心的统筹兼顾,优化社区卫生人力资源配置和服务保障资源供给,真正实现"人人享有初级卫生保健"的目标。     

Linkages between community mental health centers and public mental hospitals

Directors of community mental health centers and superintendents of public mental health hospitals in one state were surveyed to gather data on interagency linkages. Implementation of affiliation agreements, exchange of staff training, and exchange of patient information were investigated. Affiliation agreements tended to be implemented with little difficulty and there was more interagency cooperation than that reported in earlier research. However, exchange of training and staff were still areas of minimal interaction. Geographic proximity was found to have a positive influence and competition a negative influence on cooperation. Further attempts at interagency linkages in the interest of continuity of patient care are recommended.     

Improving diabetes care in midwest community health centers with the health disparities collaborative

OBJECTIVE: To evaluate the Diabetes Health Disparities Collaborative, an initiative by the Bureau of Primary Health Care to reduce health disparities and improve the quality of diabetes care in community health centers. RESEARCH DESIGN AND METHODS: One year before- after trial. Beginning in 1998, 19 Midwestern health centers undertook a diabetes quality improvement initiative based on a model including rapid Plan-Do-Study-Act cycles from the continuous quality improvement field; a Chronic Care Model emphasizing patient self-management, delivery system redesign, decision support, clinical information systems, leadership, health system organization, and community outreach; and collaborative learning sessions. We reviewed charts of 969 random adults for American Diabetes Association standards, surveyed 79 diabetes quality improvement team members, and performed qualitative interviews. RESULTS: The performance of several key processes of care assessed by chart review increased, including rates of HbA(1c) measurement (80-90%; adjusted odds ratio 2.1, 95% CI 1.6-2.8), eye examination referral (36-47%; 1.6, 1.1-2.3), foot examination (40-64%; 2.7, 1.8-4.1), and lipid assessment (55-66%; 1.6, 1.1-2.3). Mean value of HbA(1c) tended to improve (8.5-8.3%; difference -0.2, 95% CI -0.4 to 0.03). Over 90% of survey respondents stated that the Diabetes Collaborative was worth the effort and was successful. Major challenges included needing more time and resources, initial difficulty developing computerized patient registries, team and staff turnover, and occasional need for more support by senior management. CONCLUSIONS: The Health Disparities Collaborative improved diabetes care in health centers in 1 year.     

上海市松江区14家社区卫生服务中心就诊伤害病例分析

目的了解上海市松江区社区卫生服务中心门/急诊伤害发生状况。方法以上海市松江区14家社区卫生服务中心作为伤害监测哨点医院,对2007年7月1日至2008年6月30 日首次就诊于哨点医院的伤害病例进行调查。结果共调查伤害病例11 162例。其中男、女性别比为2.44∶1,伤害高发年龄组为25～44岁(40.92%);夏季发生的伤害人数最多(30.11%),6月伤害病例占全年的10.82%;非故意伤害占伤害总人数的96.72%,以轻度伤害最多(96.28%)。前4位伤害发生原因为物体/器具的机械性作用、跌倒/坠落、非机动车交通事故和机动车交通事故。 结论中青年是伤害威胁的重点人群,物体/器具的机械性作用、跌倒/坠落、交通事故为优先防治的伤害种类。