国际卫生系统绩效评价的递嬗历程与比较分析

绩效评价是监督卫生系统和提高卫生服务质量的有效方法,各国政府均对其给予重要关注。通过对世界卫生系统评价先进国的评价历史背景的递嬗过程、概念框架及维度设计、政策支撑环境三个方面进行分析和归纳,探究其对中国卫生系统绩效评价实践的指导意义。     

The new brain: concepts, challenges, and opportunities for mental health nursing

The new paradigm that the brain is able change itself (neuroplasticity) is acknowledged and teased out in terms of the ramifications for mental illnesses. Parallel studies in pain (central sensitization) and mirror neurones are examined to conceptually clarify these ramifications in relation to mental health, and to expand our understanding of empathy and social inclusion beyond good ideas to being a part of our nature. The paper then focuses on making clear what the concepts, challenges, and opportunities for mental health nursing might be; even advancing possibilities for recovery through better understanding the third space or intersubjective. What ramifications this has for mental health nursing is reviewed in terms of a paradigm change and the necessity for conceptual clarity, as it relates to the uniqueness of the person right before our very eyes. The author contends that to embrace this new paradigm is not only necessary but ethically obligatory, as it opens up new possibilities for understanding ourselves and this changeable person.     

The concept of spirituality in nursing theories: differing world-views and extent of focus

Although nursing has recognized spirituality as an important aspect of holistic patient care, exactly what spirituality means has remained rather amorphous. The purpose of this article is to present aspects of spirituality found in modern nurse theorists' ideas. These aspects are presented both in relation to reciprocal interaction or simultaneous action world-views and in relation to the extent of focus on the concept within the model or theory. This discussion will provide the researcher and practitioner with additional theoretical understanding on which to ground investigations and base practice.     

Deconstructing quality: A conceptual framework for the new paradigm in day care provision for the under eights

The issue of quality in day care provision for children has received considerable attention in recent years. Researchers, practitioners, parents and other stakeholders all have a need to define what is meant by good quality care. However, because quality as a relative, values based concept that is wholly constructed and subjective, there can be no single, universal definition of quality in day care. This paper argues that the best alternative to a universally accepted definition of quality is a conceptual framework within which different definitions of quality can be deconstructed. Such a framework is described. Developed from work undertaken in the health care field, it builds on existing day care work to provide a practical tool that can be used by stakeholders to understand the values implicit in different definitions of quality and the processes that went into the production of those definitions.     

Beyond Cause and Effect: Some Thoughts on Researc and Practice in Child Psychiatric Nursing

TOPIC: A comprehensive conceptual framework that informs about the complexity of childhood psychopathology. PURPOSE: To discuss the importance of a unifying conceptual framework and multiple partnerships in research and practice that can inform critical events and effects of interventions at various system levels in the treatment of children. SOURCES: Literature review. CONCLUSIONS: The most informative research and intervention will occur by using multiple measures and sources of information. As understanding of children and their problems in development and in context grows, intervention research that will be both useful, timely, and cost-effective must include cross-discipline teams of researchers and practitioners who will speak to these complexities.     

Normal Inability Versus Pathological Disability: Why Ossorio's Definition of Mental Disorder Is Not Sufficient

Ossorio's proposed definition of mental disorder as "inability to engage in deliberate action" is evaluated and compared to Wakefield's analysis of mental disorder as "harmful dysfunction." Ossorio's definition is found to be neither necessary nor sufficient for disorder. The most severe problem is its extreme over inclusiveness; normal mental functioning includes many restrictions on deliberate action, and entire nonpathological domains, such as ignorance and lack of skill, are encompassed within Ossorio's definition. Bergner's attempt to defend Ossorio's definition through various construals of its clauses is found to be ad hoc and unsuccessful, tt is argued that the harmful dysfunction analysis adequately explains the shared classificatory judgments about disorder and non-disorder that Ossorio's definition fails to explain, and that Bergner's "epistemological" objection to the harmful dysfunction analysis is invalid.     

Nursing's metaparadigm concepts: disimpacting the debates

Theoretical advances in nursing have been complicated by polarization and extreme positions regarding nursing's approach to its main metaparadigm concepts: person, health, environment and nursing. In this paper, the authors deconstruct some of the central arguments that are used to further this polarization. Using a critical interpretive approach, they explain some of the logical implications imposed by various extreme positions for the larger project of nursing's health and social mandate, and consider the effects of such polarization. On the basis of an appreciation of the serious difficulties inherent in certain philosophical and theoretical positions currently evident within nursing's literature, the authors argue for a less extreme and more integrated reference point for nursing's theory and practice.     

国家卫生指标体系:概念框架与基本属性

目的:建立一套既适合我国国情,又能与国际接轨的卫生统计指标体系的概念框架。方法:通过现场调研和访问相关网站,进行国内外相关文献的收集与检索;分别在国家和省级两个层面,通过组建专家组、召开研讨会和函询的方式完成指标筛选;用UML作为建模语言,描述框架的基本属性。结果:概念框架由健康状况、卫生系统和环境与行为影响因素3个维度组成,其中健康状况维度包括人口特征、发病与患病、失能与残障、营养与发育、死亡5个类;卫生系统维度包括疾病预防与控制、医疗服务、妇幼保健、卫生监测、卫生资源5个类;环境与行为影响因素维度包括地理与环境因素、社会经济因素、医疗保障、危险因素5个类。在670个指标组成的基础卫生统计指标体系最终遴选了其中211个指标作为各个类的基本属性,构成卫生统计指标集。指标集的每一个指标均反映了健康状况及其影响因素的特定方面。用UML视图展示了国家卫生统计指标概念框架三个维度之间的关系,以及三个维度内部的指标分类及类间关系。结论:本研究所确定的211个统计指标对于开发基于网络直报的国家卫生信息系统具有重要的指导意义。经过进一步补充完善,可作为国家层面卫生统计信息的基本指标集,应用于反映人民健康状况、卫生系统工作绩效和卫生管理和卫生服务的辅助决策。     

Development and testing of a quality of life model for long-term female cancer survivors

This research resulted in the evolution of a model depicting the quality of life of long-term female cancer survivors. The foundation for this model's development was Ferrell's (1993) breast cancer model, which incorporates physical, social, psychological and spiritual domains of life. The Ferrell model was adapted following focus-group discussions with 11 long-term female cancer survivors. The adjusted model included new categories, within each of Ferrell's initial domains, that were specific to the focus group participants. Administration of a new instrument, the Long-Term Quality of Life (LTQL), to 187 long-term female cancer survivors produced a final model that included the interaction of all four domains in six major concepts of quality of life. This new model, which reflects the complexity of life in long-term female cancer survivors, may be useful to health professionals in designing interventions to meet the unique needs of these women.This research was supported by two grants: Quality of Life of Long-Term Female Cancer Survivors, funded by Bristol-Myers through the Oncology Nursing Society; and the College of Nursing Research Initiation Grant, funded by Michigan State University College of Nursing, Gwen Wyatt, Principal Investigator.