国外家庭护理流程化管理模式的概况及启示

随着人口老龄化卫生压力日益增加,家庭护理由于具有良好的成本效益,已成为许多发达国家缓解老年卫生资源供需矛盾的基本卫生政策。家庭护理的发展平台是社区卫生服务。从经营方式上划分,目前国际上存在3种社区卫生服务发展模式,代表国家分别是美国、英国和日本。这3个代表国家,以流程化管理理念为基础,在不同的社区卫生服务模式下发展了相应的家庭护理服务模式。现介绍美国、英国和日本家庭护理流程化管理模式,为促进我国家庭护理科学化管理,提高家庭护理服务效率提供借鉴和参考。     

家庭护理

971677新生儿家庭护理服务探讨/王喜华一//中华护理杂志一1996,31(7)一416一417 总结了对678例新生儿进行家庭护理的体会,其中有138例为患病新生儿。其方法:建立双联联系单,包括新生儿室医护人员基本情况及服务类型,以便双向选择,通过对患病新生儿增加服务次数以获得满意效果。家庭护理服务可提高新生儿健康水平,方便家属,密切护患关系,使新生儿室的护理工作得到延续发展。而全而的护理知识、精湛的护理技术是做好业余护理服务的保证,保持良好的服务态度是做好家庭护理服务的关键。家庭护理服务能体现护十的自身价值,使护理质最不断得到提高…     

家庭卫生保健与康复护理

就康复护理(rehabiliation nursing)来说,这是卫生保健史上一个挑战和令人激动的时刻。与过去任何时候相比,现在向门诊病员和家庭保健系统提供了更多的服务。人们对康复服务的兴趣与日俱增。随着老年人口增长、医学技术的进步和急性期住院时间缩短,家庭保健和康复护理正在迅速发展。家庭卫生保健的历史最早的家庭卫生保健是于1796年在美国创办。当时的目的是向病人和贫民提供服务。在以后的一个世纪里,成立了各种出访护士协会(visiting nurse associations)。1898年,美国洛杉矶县卫生局成为第一家向病人和贫民提供家庭护理保健服务的官方卫生机构。到40年代,医院也开办了家庭保健服务。服务范围从单一护理逐渐扩大到物理治     

家庭护理

002369介绍日本社区卫生保健机构/罗艳华刀中华护理杂志一1999,34(11)一701一702 1.设立(老人)家庭护理站,服务对象是65岁以上的老人和所有在家疗养者。服务内容是护士到家庭,为病人提供服务,如洗发、擦澡、褥疮处置、康复训练等护理。2.老人保健机构,即集医疗机构与福利机构之     

家庭护理

930675家庭护理理论/肖淑贞//护理杂志(中国台湾)一1992,39(3)一11~17 家庭是护理重要服务对象,近年来护理理论蓬勃发展,文章乃就六个主要护理理论—斑移招、凡吃、凡理、N山,~、C时em、Rd把r’ts的护理理论,介绍其应用家庭护理的情形。家庭护理理论系从护理的角度提供护理人员有关家庭、家庭环境、家庭健康及家庭护理的基本概念,家庭护理理论发展之限制及未来发展之方向亦在文中讨论。图]参2,(原文摘要)930676照顾亲人之评价的概念/刘雪娥//护理杂志(中国台湾)一1992,39(3),一19~23 家中某一成员.尤其是老年人催患慢性病时,对其他家属的…     

家庭护理

950815日本老年人的家庭医疗护理和康复/李冀湘//中华医院管理杂志一1994·10(6)一38。~382 方针:以医疗护理和服侍服务为重点.特别鼓励护理工作的优质服务;促进开展家庭医疗护理制度,而家庭疗养是提高老人生活质量的根本;尽可能提供离老人家庭近的完整成套服务。措施:实行1989年12月制定的《促进老年人保健福利十年规划》、199。年6月修汀的老人福利法等福利方面的8项法规、1991年9月份修订的老人保健法。尤其在实行里992年公布并修改的老人福利法之后,各级政府官员直接领导家庭护理工作.使工作大为改观,转变为行政官员参与的家庭医疗护理…     

美国家庭临终护理现状

应美国墨尔黑德州立大学的邀请 ,受医院派遣 ,笔者有幸于 2 0 0 0年 6月至 8月赴美国墨尔黑德州立大学进行为期 2个月的研修学习。学习期间 ,该校在介绍美国临终护理现状时 ,安排有家庭临终护理见习 ,在见习的同一天笔者还参观了家庭临终护理服务中心。现将有关情况介绍如下。1　家庭临终护理服务中心概况该服务中心为肯塔基州的圣·可丽尔医疗中心下属机构 ,有专门主管医生 ,但医生不在服务中心 ,在自己的诊所。中心以护士为主 ,由 7名护士组成 ,都为注册护士 ,其中一个是开业护士。中心管理工作由护士长承担 ,每个护士大约管 5个病人 ,病…     

家庭护理

960946护理服务新趋势一家庭护理/胡靖…//山西护理杂志一1995,9(3)一109~110 为适应时代的要求,将具有丰富临床经验,技术精湛、责任心强的护理人员组成护理队伍。制定家庭护理对象、内容以及一系列管理制度。如形成的家庭病房、病区.社区联合体有固定办公室,每日有人值班.接待     

美国家庭护理现状

本文着重介绍美国关于家庭护理的法规和对家庭护理病人评估及管理方面的情况，期望有益于我国家庭护理工作的发展。     

家庭护理

971165老干部家庭病床的护理探讨/高俊兰刀中华护理杂志一1996,31(6)一369一370 家庭护理服务内容:为各种慢性病患者制订家庭治疗护理方案;协助脑血管意外恢复期、手术后或骨折恢复期等患者进行功能锻炼、换药、针灸、膀耽冲洗、导尿等;为肿瘤、高血压、冠心病患者测血压、做心电图、用药指导及自我保健指导;为老慢支、肺心病患者进行氧疗、肌肉注射、输液等。文内还介绍了家庭护理的组织结构,包括医护人员的组成,出诊时间安排及所采取的服务措施。开展老年家庭病房服务,使医、护、患关系由原来的主动被动型变为共同参与型与指导合作型,降低…     

国际居家护理模式现况与研究进展

随着全球老龄化的加剧,居家护理成为健康养老的新理念。如何为老年人提供连续实用、经济便利的居家照护服务,已成为各个国家长期照护体系改革的目标。目前国际上具有代表性的居家护理体系包括私人及社会保险支付费用、私有机构提供服务的模式(美国模式);政府支付费用、私有机构提供服务为主的模式(加拿大模式);政府与个人共同支付费用、多元化服务提供主体的模式(澳大利亚模式);保险支付费用、多元化服务提供主体的模式(日本模式)。本文总结以美国、加拿大、澳大利亚、日本为代表的居家护理模式,阐述居家护理的核心要素,分析其特征及优缺点,提出我国应借鉴其他国家居家护理的长处,结合我国社会制度和经济水平的特点,创建符合国情的居家护理模式。     

Research in home care

Past and present research in the home care setting predicts future trends. Home care research studies will continue to reflect social and economic issues of the future since research and researchers do not exist in a vacuum but are influenced by their era. Because of the generalized concern about economic stability and health care costs and the heightened interest in home care, investigations related to nursing interventions, client outcomes, and reimbursement will increase. As researchers search to identify long-term, positive client outcomes, the role of physical and psychosocial environmental factors will receive greater attention. Clients, too, do not exist in a vacuum but reflect the family and support systems which do, or do not, surround them. For home care research to serve as the scientific base for practice, continuing and increasing collaboration must occur between nursing service and education. More joint appointments or shared positions are likely as blending occurs in researchers' roles and nursing service staff assume more responsibility for research projects. The struggles involved with financial support of home care research will not cease. Home care researchers will continue to compete for funding with other nursing, health care, and research investigators. Specific strategies will enhance funding opportunities for home care nursing. These include: (1) increasing methodologic soundness, (2) increasing sophistication of studies and investigators, (3) publicizing findings and benefits of projects, and (4) developing a successful history of obtaining funding and conducting studies. Research in the home care setting will thrive if it attracts more and more nurses with scientific skills similar to those identified by Sir Medawar: "Among scientists are collectors, classifiers, and compulsive tidiers-up; many are detectives by temperament and many are explorers; some are artists and others artisans. There are poet-scientists and philosopher-scientists and even a few mystics."     

Changes in home health care delivery

The Taylor hypothesis suggests that the effect of DRGs is an episodic increase in referrals to home health care agencies of both chronically ill and acutely ill patients. These patients will need to recuperate from the acute illness that caused their hospitalization in the first place. The New Jersey experience indicates that the tightening reimbursement system will permit a shorter episode of home care services than in the past few years. Agencies will have to provide seven-day, twenty-four-hour service. At the same time, they will have more difficulty justifying seven-day intervention to the Medicare program. Understanding the full effects of the change in health care delivery reimbursement on patient care and nursing care will require research and investigation.     

老年患者居家护理服务的发展现状与思考

从应对人口老龄化方面总结了国内外老年患者居家护理的发展过程与现状,提出完善我国老年患者居家护理的几点建议,包括发展医院延伸服务,建立医院-社区-家庭一体化结构,健全长期护理保险制度,培养专业居家护士,发挥中医药特色优势,发展具有中国特色的老年患者居家护理服务模式。     

An evaluation of a paediatric home care scheme

The policy background of paediatric home care schemes is reviewed and an evaluation of such a scheme is described. The home care scheme is shown to be a worthwhile service provision. However, it is suggested that this service development can only represent an improved use of resources when there is a complementary reduction in hospital provision.     

深圳市社区老年人家庭护理供需调查及其影响因素分析

目的调查分析深圳市社区老年人家庭护理服务供需现状及影响因素。方法采用自行设计的调查问卷随机对深圳市6个社区216名老年人和78家社区健康服务中心进行调查,了解老年人家庭护理服务的供需现状及相关影响因素。结果84％老年人对家庭护理有需求,接受过家庭护理服务者占38．1％。32项家庭护理需求项目中,居前6位的需求项目依次是血压监测、血糖监测、健康咨询、照顾者指导、心理护理、服药指导。78家社区健康服务中心有48家提供家庭上门服务,开展家庭护理服务的中心有44．0％提供10个以上项目,67．0％的中心提供5个以上项目,17．0％提供2个以下项目,30家不提供家庭上门服务。影响社区家庭护理服务开展的主要原因是护理人员配置不足、风险系数大、医疗环境及设施受限。结论老年人对家庭护理服务有较大需求,社区健康中心提供的家庭护理服务相对滞后,家庭护理服务供不应求,当务之急是增加社区护理人员数量,建立和完善社区家庭护理行业规范,促进家庭护理的稳定发展。     

深圳市社区老年人家庭护理供需调查及其影响因素分析

目的 调查分析深圳市社区老年人家庭护理服务供需现状及影响因素.方法 采用自行设计的调查问卷随机对深圳市6个社区216名老年人和78家社区健康服务中心进行调查,了解老年人家庭护理服务的供需现状及相关影响因素.结果 84%老年人对家庭护理有需求,接受过家庭护理服务者占38.1%.32项家庭护理需求项目中,居前6位的需求项目依次是血压监测、血糖监测、健康咨询、照顾者指导、心理护理、服药指导.78家社区健康服务中心有48家提供家庭上门服务,开展家庭护理服务的中心有44.0%提供10个以上项目,67.0%的中心提供5个以上项目,17.0%提供2个以下项目,30家不提供家庭上门服务.影响社区家庭护理服务开展的主要原因是护理人员配置不足、风险系数大、医疗环境及设施受限.结论 老年人对家庭护理服务有较大需求,社区健康中心提供的家庭护理服务相对滞后,家庭护理服务供不应求,当务之急是增加社区护理人员数量,建立和完善社区家庭护理行业规范,促进家庭护理的稳定发展.     

Needs assessment for hospital-based home care services

Careful needs assessment is a prerequisite to addressing issues of health care program effectiveness and program planning from a population-based perspective. Home care program evaluation literature is lacking in examples of strategies for such assessment. A nurse-screening of admissions was conducted at an acute care general hospital to estimate need for hospital-based home care (HBHC) services among the 2,613 patients discharged from medical and surgical services over a 5--month period. After careful delineation of inclusion and exclusion criteria for identifying HBHC patients and participant-observer training, the nurse's judgments on patient appropriateness for HBHC care were shown to agree reliably with those of the HBHC staff (k = +.45). In the study hospital under current conditions, an estimated 64% of discharged patients appropriate for home care do not receive these services. A comparison of the incidence according to service of HBHC-appropriate patients and patient-referral rates to HBHC suggests that one service over-refers (neurology), but most under-refer. Screening nurse salary expenditures constitute the major costs of this approach to home care needs assessment, which is recommended only for addressing major, infrequent programmatic policy issues.     

居家护理服务模式的构建

通过构建和应用居家护理服务模式,保证了患者在出院后能够得到专业支持和帮助,为临床提供了一种先进、有效的延伸护理服务模式,体现了护理的专业性、持续性和延伸性。     

Unplanned hospital readmissions: a home care perspective

BACKGROUND: The extensive literature concerning hospital readmissions is grounded in a medical or hospital perspective, and fails to address hospital readmissions during home care. OBJECTIVES: To describe clients who have unplanned returns to an inpatient setting during the first 100 days of home care service delivery. METHOD: Using the Hospital Readmission Inventory (HRI), an audit tool with previously established validity and reliability, 916 medical records for clients from 11 midwestern home care agencies were reviewed retrospectively. RESULTS: Typically, clients were referred for their first home care admission after a 9-day hospital length of stay for a cardiovascular, respiratory, or neoplastic disorder. After an average 18-day length home care stay, clients were readmitted to the hospital, usually due to the development of a new problem, or due to deterioration in health status related to the primary or to a secondary medical diagnosis. Significant respiratory, cardiovascular or GI symptoms were generally present at hospital readmission. Typically, readmitted clients were 75 year old married females, who had been able to care for themselves at home. At hospital readmission, home care nurses judged these clients to be moderately ill, and likely in need of acute care. CONCLUSIONS: Chronic illness appears to be the best indicator for hospital readmission. The crucial time period for hospital readmission during home care is the first 2-3 weeks following hospital discharge. Intensive study of home care service arrangements utilized by readmitted patients, as well as agency variations, are needed. Study findings concerning patients readmitted from home care point to similarities with rehospitalized patients generally. Findings may assist home care clinicians in targeting high risk patients who could benefit from interventions aimed at minimizing unplanned returns to the hospital.