人口老龄化与护理管理面临的挑战和对策

老年人口增加给护理管理带来了新的挑战,产生了相应的影响,如护理服务需求显著增加,合理的老年护理人力资源配置的构建,健全的社区老年护理服务机构的建立,老年护理保险制度的进步。对策有高起点、前瞻性地制定规划,有计划地发展护理事业,社区长期护理及社区组织的发展,多渠道培养老年护理专业人才,建立各层次老年护理保健制度。     

人口老龄化与护理管理面临的挑战和对策

老年人口增加给护理管理带来了新的挑战,产生了相应的影响,如护理服务需求显著增加,合理的老年护理人力资源配置的构建,健全的社区老年护理服务机构的建立,老年护理保险制度的进步.对策有高起点、前瞻性地制定规划,有计划地发展护理事业,社区长期护理及社区组织的发展,多渠道培养老年护理专业人才,建立各层次老年护理保健制度.     

发达国家老年护理经验及对我国老年护理的展望

分析日本、瑞典、美国、德国老年护理的发展,提出我国的老年护理应借鉴发达国家的经验,制订完善的法律与制度,建立完善的管理网络与服务机构,发展多样化、差异化的养老模式,重视以职业教育培训为主的多元化老年护理教育,探讨适合我国目前老年护理发展的模式。     

连续护理模式在老年慢性病护理中应用的质性研究

随着世界人口老龄化进程不断加剧,中国作为世界第一人口大国,亦已迈入老龄化社会[1],且其老龄化速度及高龄老年入口的增长速度均快于其他国家.老年人不仅是慢性非传染性疾病的主要患病对象[2],且生理衰老往往还会导致其出现焦虑、离退休和空巢综合征等心理及精神问题,最终使医疗开支与日俱增、医院床位周转困难和医疗资源匮乏等.在国内对于老年护理服务的发展,仍侧重对社区护理服务体系的建立和完善,却忽略了连续护理的价值.医院、社区、老年公寓等老年慢性病护理服务机构的工作脱节,不仅浪费了医疗护理资源,亦增加了老年人的不便和负担.本研究通过半结构式访谈,了解老年慢性病护理工作者对连续护理模式的理解以及现阶段在老年慢性病护理中应用连续护理模式所面临的问题,现报告如下.     

发达国家老年护理经验及对我国老年护理的展望

分析日本、瑞典、美国、德国老年护理的发展,提出我国的老年护理应借鉴发达国家的经验,制订完善的法律与制度,建立完善的管理网络与服务机构,发展多样化、差异化的养老模式,重视以职业教育培训为主的多元化老年护理教育,探讨适合我国目前老年护理发展的模式。     

北京市五区县老年人口长期护理机构护理供给现况分析

伴随着我国人口的老龄化,失能老年人口数量将会增加,而家庭结构的演化又使居家的长期护理不能满足失能老人的需求,我国失能老年人口的长期护理问题亟待解决。文章通过对北京市老年人口长期护理机构的调查,对目前长期护理机构的产权性质、护理人员的资质和报酬、床位利用情况、护理内容和服务质量进行了总结,并发现目前机构内长期护理处于较低的发展水平,老年痴呆患者的长期护理无法解决,自理老人占据较多的长期护理供给市场,农村失能老人面临更多的困难。提出了有关长期护理机构设置和发展的政策建议。     

我国养老服务需求现状及其长期护理服务策略

人口快速老龄化已成为我国重大的社会问题。分析了我国人口老龄化规模大、发展速度快、程度高、超前于经济发展的特点,以及由此带来的长期护理服务需求及问题,包括缺乏长期护理的保障机制、长期护理服务能力不足、社区功能尚不健全。为应对日益严重的老龄化发展趋势,提出了老年长期护理服务的对策,如建立长期护理保障机制、探索适合国情的长期护理服务模式、提高长期护理专业机构的服务能力。     

医养结合理念下延续护理在养老机构中的研究现状

随着人口老龄化发展,老年人养老服务已成为我国面临的一项严峻问题。医养结合作为新型养老模式,整合医疗与养老资源,可同时满足疾病管理和养老服务的共同需求;而延续护理满足了养老机构老年病人出院后仍旧存在的较高的护理需求,具有积极意义。主要对医养结合理念下养老机构延续护理研究现状进行阐述,为建立和完善养老机构延续性护理模式提供参考,实现健康老龄化。     

影响老年慢性病患者接受居家护理服务因素的调查分析

目的了解老年慢性病患者居家护理服务的需求,探讨影响老年慢性病患者接受居家护理服务的因素。方法采用自行设计的调查问卷了解老年慢性病患者居家护理服务需求及影响老年慢性病患者接受居家护理服务的因素。结果老年慢性病患者居家护理服务需求为92．3％。医保因素、经济因素和照顾者素质是影响老年慢性病患者接受居家护理的重要因素,分别占了95．5％、84．8％和80．3％。结论老年慢性病患者居家护理需求较大。应以患者需求为导向,通过政府和机构的多方面合作,完善医保支付制度,在疾病护理及完善服务模式方面促进健康拓展服务,以满足老年慢性病患者对居家护理的需求。     

美国老年护理发展状况及对我国的启示

随着我国老年人口的增长,老年人健康服务需求增加,对老年专科护理人才的需要也日益提升。本文通过对美国老年护理发展状况进行简述,从中获得启示,为我国老年护理的快速发展提供更多的思路。     

失能老年护理专业养老模式的研究进展

目的：综述国内外失能老年专业养老模式的研究进展,为我国失能老年专业化养老模式发展提供参考。方法文献回溯搜集失能老年养老护理模式相关资料,归纳总结当前最新研究结果。结果国内失能老年长期护理的模式有家庭式、机构式、居家-社区式三种,2014年我国学者提出“类家庭”长期照护模式的构想及医养结合专业养老模式。国外的失能老年长期护理模式主要有日本的介护服务模式、加拿大的人文关怀融入的康复护理环境中失能进展过程模式及备用房屋模式、美国的高级实践护士主导的成人发展性失能家庭干预模式。结论我国失能老年护理专业养老模式的建立需要体现本国文化的特殊性,建立失能进程的预防体系及完善的监督评价体系,建立辅以符合国情的护理保险或补贴制度,建立有效运营的管理机制和标准化的社会养老服务。     

Nursing care of elderly people at home and ethical implications: an experience from Istanbul

Elderly people are a particularly vulnerable group in society and have special health problems. The world population of older people is increasing. People who are 65 years or older constitute 6% of the Turkish population, 90% of whom have chronic health problems. In Turkey, there is a high possibility that elderly people's requirements are not met by today's health care system in the way they would wish. They prefer not to be hospitalized when they have health problems. From a wider perspective, various countries are still seeking how to provide the best care for elderly people. Our goal was to characterize home-based care for elderly people using an ethical approach as an area of interest for nurses and other health care professionals now and in the future, both for Turkey specifically and from a global perspective. We studied four case histories and then prepared a composite scenario and a short questionnaire for elderly people living in a specific district of Istanbul to evaluate their expectations from the health care system. We compared our findings with situations in other countries and have proposed some practical solutions. The results showed that these older people preferred to receive nursing care at home instead of in hospital in Turkey, and also in many other countries. In this article we discuss our findings, comparing them with those in the literature, and suggest that there should be nursing care at home with insurance coverage while using a proper ethical approach.     

The effect of living in a nursing home on socialization in elderly people

The effects of institutionalization on elderly people are of significance both socially and physically Currently, about 5% of elderly people in the United States live in long-term care institutions, although approximately 33% of all elders will be institutionalized for at least a short period of time The effects on socialization of living in a nursing home have been studied and commented on from several perspectives Several studies directed attention to the elderly person living in an institution Others investigated the institution's response to residents' needs Some studies have focused on attitudes of health care workers towards elderly people, and still others have examined the interaction between workers and residents This review of the literature will first present studies focused on nursing home residents, then the institutions themselves, followed by studies of nursing home staff, and finally those focusing on the interaction between staff and residents Discussion of possible directions for both practice and research will follow The studies reported here were conducted in the United States, England, Northern Ireland and Finland     

Long-term nursing care of elderly people: identifying ethically problematic experiences among patients, relatives and nurses in Finland

The aim of this study was to explore ethically problematic situations in the long-term nursing care of elderly people. It was assumed that greater awareness of ethical problems in caring for elderly people helps to ensure ethically high standards of nursing care. To obtain a broad perspective on the current situation, the data for this study were collected among elderly patients, their relatives and nurses in one long-term care institution in Finland. The patients (n = 10) were interviewed, while the relatives, (n = 17) and nurses (n = 9) wrote an essay. Interpretation of the data was based on qualitative content analysis. Problematic experiences were divided into three categories concerning patients' psychological, physical and social integrity. In the case of psychological integrity, the problems were seen as being related to treatment, self-determination and obtaining information; for physical integrity, they were related to physical abuse and lack of individualized care; and for social integrity, to loneliness and social isolation. This study provided no information on the prevalence of ethical problems. However, it is clear from the results that patient integrity warrants more attention in the nursing care of elderly patients.     

养老机构老年人综合能力评估等级划分方式的研究

目的 对养老机构老年人综合能力评估结果进行分段划分,确立各分段综合能力评估得分界值,为养老机构开展老年人综合能力评估提供个性化照护及合理配置养老机构护理人员资源提供依据。方法 调查3家养老机构725名老年人的能力现状,形成老年人综合能力评估量表后,应用聚类分析法对第4家机构的246名老年人综合能力评估得分进行分段,用判别分析建立判别函数确立分段界值。结果 根据最佳分类数并结合判别分析结果将老年人的综合能力评估等级划分为4个等级,等级越高,能力越差;各分段的界值分别为0~35分、36~51分、52~80分、81~110分。结论 老年人综合能力评估需将心理状态与认知能力、感知觉和沟通、日常生活与社会参与能力等多方面综合考虑,需使用综合评价方法才能得出合理的划分方式,科学合理的划分结果对于养老机构为老年人提供更安全、高效、优质的个性化养老护理服务具有重要的指导意义。     

西安市部分养老机构老年人的慢性病患病状况及其危险因素

目的探讨西安市部分养老机构老年人慢性病的流行现状及其危险因素。方法采用整群抽样的方法,对西安市部分养老机构472名老年人慢性病患病状况进行横断面调查,并对危险因素进行多因素Logistic回归分析。结果调查人群慢性病患病率为80.6%,同时患两种及以上慢性病的老年人占总调查对象的55.3%,其中高血压、白内障、脑血管病和冠心病的现患率分别为37.1%、27.0%、23.5%、17.9%。慢性病的主要危险因素为女性、向心性肥胖和慢性病家族史。参加医疗保险为慢性病的保护因素。结论西安市养老机构老年人的慢性病患病率较高,加强慢性病防治知识的宣传教育、做好健康促进工作应作为养老机构慢性病管理的重点。     

长期护理保险制度下构建失能老人多平台综合延续护理模式

目的在长期护理保险制度下构建失能老人多平台综合延续护理模式,并探究该模式对失能老人自理能力和心理健康水平的影响。方法选取该院出院的失能老人168例,建立延续性护理技术服务档案数据库。根据信封法随机分为对照组(87例)和干预组(81例)。对照组仅接受常规出院健康知识宣教,干预组在此基础上增加基于多平台协作的综合延续护理。比较失能老人的自理能力和心理水平。结果干预组干预后各时间点的自理能力得分和心理评分均有明显提高,且得分均高于同期对照组,差异有统计学意义(均P<0.05)。结论长期护理保险制度下构建的失能老人多平台综合延续护理模式能够改善失能老人的自理能力和心理健康水平。     

Social security in the aged requiring nursing care--a review of status and perspectives

Our current approach in the case of elderly people requiring nursing and care--namely, provision of supplementary social assistance benefits when old-age pension amounts are insufficient and if the incomes of children and grandchildren are below certain levels--is turning over 70 percent of all persons in residential care into recipients of rather modest amounts of pocket-money. Their financial provision for old age, built over decades, becomes null and void. In the case of home care, small invalid care allowances are granted to cater for additional needs, amounts, however, which are adequate neither to cover for the expenses involved nor to properly honour the caretaking efforts incumbent on the relatives. This reveals two decisive shortcomings in our present system for helping persons in need of care: benefit and service provision give undue priority to residential service delivery, instead of enhancing the necessary extension of community-based or ambulatory services; the current societal distribution of financial burdens is not compatible with the requirements of a publicly organized scheme for protection against general life-hazards that could hit everyone and should therefore be borne jointly. The article sets out the above situation through examples illustrating the various life situations of people needing nursing and care, and discusses three alternative approaches to achieving social security and protection: to extend health insurance coverage to non-curable/non-rehabilitable conditions; to create a separate social insurance branch to cover the life risk of needing nursing and care; and to initiate federal legislation for introduction of tax-financed, flat-rate invalid care allowances proportional to the care intensity required, while establishing user charges in the case of residential care services.(ABSTRACT TRUNCATED AT 250 WORDS)     

嘉兴地区综合医院老年病房患者长期护理需求现状与对策

目的了解目前嘉兴地区综合医院老年病房患者的长期护理需求现状,为本地区相关政策的制订提供参考。方法自行设计老年病房长期护理需求调查表,对在嘉兴地区综合医院老年病房住院的147例患者现状及长期护理服务需求进行分析。结果 68.7%的老年住院患者需要全护理,28.5%需要治疗性护理项目注射或静脉输液。患者最需要的不是治疗,是长期的生活照顾及专业护理。现有护理人力不能完全满足老年患者长期护理的需求。结论综合性医院老年病房发挥的是老年长期护理机构的作用,造成医疗资源不合理使用,因此要发展本地区社区老年人家庭护理,依托社区资源建设长期护理机构。