医养结合老年长期照护模式的探索与实践

[目的]探讨医养结合老年长期照护模式的建设和运行。[方法]从组织框架、管理体系、运行体系三个方面建设和运行医养结合老年长期照护模式。[结果]医养结合老年长期照护模式运行良好,老人对中心的服务满意度达98%。[结论]医养结合老年长期照护模式能够成功运行,可以改善我国养老体系医疗服务支持系统薄弱的现状。     

台湾地区长期照护模式对我国的启示

总结了台湾地区长期照护模式的特点,主要包括健全的法律体系,坚持"居家护理"理念,服务项目丰富,重视人员教育和培训,民间与政府通力合作等;照护模式分为机构式、小区式及特殊性3种。认为我国长期照护还存在许多不足,应借鉴台湾地区的长期照护经验进一步改革和完善我国的长期照护体系建设。     

我国失能老人长期照护现状及对策

从供求现状、照护人才、照护内容、政策方面综述我国失能老人长期照护现状,提出相应的对策,认为应提升照护人才素质、基于物联网先进技术提高照护质量及效率、借鉴国外成功经验与启示,构建中国特色失能老人长期照护体系。     

国内外长期照护服务质量评价的研究进展及启示

人口老龄化的加剧导致老年人对长期照护服务的需求剧增, 如何保障长期照护服务的质量是社会广泛关注的热点话题。发达国家长期照护服务开展较早, 已形成完善的服务质量评价体系, 并对评价结果进行了有效的利用。我国长期照护服务起步较晚, 尚无统一的长期照护服务质量评价标准, 评价指标呈现多元化, 还需在借鉴国外经验的基础上探索具有中国特色的长期照护服务质量评价体系, 覆盖长期照护服务全流程;遴选核心指标, 切实反映长期照护服务质量优劣, 强化评价结果的应用, 提高长期照护服务质量评价效能, 推动我国长期照护的可持续发展。     

美国《老年长期照护》课程理念及对我国的启示

介绍了长期照护概念及照护专员角色分析,对美国《老年长期照护》课程理念进行了综述,提示我国《老年长期照护》课程设置须面向照护场所,建立长期照护人才多层次培养输送体系。     

德国与日本长期照护服务分级制度及启示

通过分析德国和日本建立长期照护服务分级制度的经验,结合我国试点地区的实践,为建立我国长期护理分级制度提供参考。从照护对象、分级依据和分级照护标准及服务方式3方面分析德日两国照护服务受益人群范围的差异,日本依据照护时间而德国依据个体自理障碍的程度为照护分级标准,并均据此提供多层次的照护服务。相较于二者,我国长期照护服务发展还不尽完善,纳入的照护人群范围较为局限,大部分试点地区尚未建立相应的护理服务等级,并且长期照护分级服务形式仍存在碎片化的问题。针对我国长期照护服务分级制度的建设困境,建议未来从覆盖范围、构建护理需求等级标准、建立多层次和有序的照护分级服务方式方面加以完善。     

失能老人长期照护存在的问题及对策

我国失能老人长期照护中存在制度缺失、资源短缺、服务质量低等问题。需要政府的统一规划,根据各个地区的资源差异状况、构成并推动不同特色社会支持体系的建设,为老年人的长期照护提供相应的有力措施。     

基于Kano模型的失能老年人长期照护需求研究进展

该文综述Kano模型的发展以及基于此模型的失能老年人需求的研究进展,指出Kano模型在失能老年人长期照护需求方面存在的不足和发展方向,为未来建立科学化、多样化的失能老年人长期照护体系提供参考。     

早产儿出院后对家庭护理需求的调查研究

目的 调查早产儿家庭照护者对出院后的需求现状,探讨其影响因素.方法 选取我院211例早产儿为研究对象.采用自行设计调查问卷进行家庭护理需求调查分析.结果 照护者对出院后家庭护理有较高需求,随访方式希望采用电话随访,占比62.5％.生活中对喂养知识需求较高,占比67.3％.出院后照护者希望能对其心理进行照护,特别是照护压力方面.结论 早产儿照护者对家庭照护需求迫切,需求内容包括:喂养知识、小儿抚触、疾病护理,对知识和后续长期的护理需求,亟待建立健全完善早产儿家长中心式照护体系,完善院前、院后的护理.     

援疆汉族失能老年人选择居家长期照护的原因及其影响因素

目的：了解失能老年人选择居家长期照护原因及其影响因素,为分类别、分人群开展长期照护服务提供参考。方法：采用自设问卷调查728名援疆汉族失能老年人的一般情况及其选择居家长期照护的原因,并运用Multinomial Logistic回归分析法分析失能老年人选择居家长期照护的影响因素。结果：56.0%的失能老年人受＂恋家情结＂的影响而选择在家中接受照护;个体特征、来疆历史背景、失能程度等是失能老年人选择居家长期照护的影响因素。结论：相关部门在发展本地区的长期照护时,应重点提高居家照护服务质量,关注失能程度较重、经济状况较差以及老年失能女性群体。     

Assessing pain as a fifth vital sign in long-term care facilities: Recommendations from the field

In long-term care facilities, pain management is complex because dementia, delirium, and other reasons for residents' altered communication ability are a significant barrier to pain assessment. The purpose of this study was to explore the status of implementation of pain as a fifth vital sign in a sample of long-term care facilities. A three-round Delphi survey was used to obtain consensus from personnel in 60 long-term care facilities in NY State. Findings are presented in terms of recommendations related to pain criteria, assessment methods, frequency of pain assessment, responsibility for pain assessment, monitoring strategies, education, documentation, and pain management education. The results of this study highlight many important considerations in the treatment of pain as a fifth vital sign in long-term care facilities. Evidence-based practice will be facilitated by further research related to underexplored aspects of pain assessment and management, and further attention to care delivery systems that support continued knowledge acquisition and the implementation of best practices.     

Current prevention and control of health care-associated infections in long-term care facilities for the elderly in Japan

Residents of long-term care facilities for the elderly are vulnerable to health care-associated infections. However, compared to medical institutions, long-term care facilities for the elderly lag behind in health care-associated infection control and prevention. We conducted a epidemiologic study to clarify the current status of infection control in long-term care facilities for the elderly in Japan. A questionnaire survey on the aspects of infection prevention and control was developed according to SHEA/APIC guidelines and was distributed to 617 long-term care facilities for the elderly in the province of Osaka during November 2016 and January 2017. The response rate was 16.9%. The incidence rates of health care-associated infection outbreaks and residents with health care-associated infections were 23.4 per 100 facility-years and 0.18 per 1,000 resident-days, respectively. Influenza and acute gastroenteritis were reported most frequently. Active surveillance to identify the carrier of multiple drug-resistant organisms was not common. The overall compliance with 21 items selected from the SHEA/APIC guidelines was approximately 79.2%. All facilities had infection control manuals and an assigned infection control professional. The economic burdens of infection control were approximately US$ 182.6 per resident-year during fiscal year 2015. Importantly, these data implied that physicians and nurses were actively contributed to higher SHEA/APIC guideline compliance rates and the advancement of infection control measures in long-term care facilities for the elderly.Key factors are discussed to further improve the infection control in long-term care facilities for the elderly, particularly from economic and social structural standpoints.     

Factors affecting job satisfaction of nurses who work in long-term care

A questionnaire developed by the authors was sent to 1000 nurses in various speciality areas. It was used to assess degree of job satisfaction, reasons for dissatisfaction, and the relationships of the work setting and sociodemographic data. Because the authors wanted to compare nurses who work primarily with older adults within and outside long-term care, the percentage of time spent caring for patients aged over 60 was also studied. The degree of job satisfaction between nurses working in long-term care was compared. A comparison of job satisfaction was also made between nurses working at least 75% of the time with older adults and nurses not working primarily with older adults. Factors causing job dissatisfaction in the long-term care group and the non-long-term care group were identified. Strategies to increase job satisfaction in long-term care were presented.     

湖北省老年人安宁疗护认知现状与需求调查分析

目的 了解湖北省老年人安宁疗护认知现状及服务需求,为构建本区域安宁疗护实施方案提供参考依据。方法 2019年11月-12月,采用方便抽样法选取湖北省十堰市、孝感市、荆州市、随州市的23个社区的464例老年常驻居民为研究对象,运用安宁疗护国家课题组制定的问卷调查其对安宁疗护认知的现状和服务需求。结果 知晓安宁疗护者占28.45%,不同来源地区、文化程度和宗教信仰的调查对象对安宁疗护的认知比较,差异有统计学意义(P<0.05)。48.06%的被调查者首选在家中度过生命的终末期,被调查者对症状控制和心理关怀的需求较高。结论 安宁疗护认知受地区、文化程度和宗教信仰影响,老年人居家安宁疗护意愿较高,应积极探索居家式安宁疗护服务模式,注重症状管理与心理关怀的需求。     

湖南省妇幼保健院妇产科急诊率升高相关因素分析

目的：探讨湖南省妇幼保健院近4年妇产科急诊升高的相关因素。方法：采用回顾性分析方法,对2009-01—2012—12在我院急诊科就诊的妇产科急诊患者相关资料进行分析。结果：近4年来我院妇产科急诊人次急剧升高,明显高于同期妇产科门诊就诊人次的增长率,尤其是产科急症迅速增加。结论：加强孕产期保健工作,加强三级急诊网络建设,尤其需加强基层医院妇产科急诊医学的发展。     

Assertive community treatment of the long-term mentally ill

For several reasons including the failures of deinstitutionalization, the inadequacy of community resources, and poor coordination among service agencies, the needs of people with long-term mental illness living in the community have not been adequately met. Yet recent changes in the mental health care treatment system have sustained the shift in the locus of mental health care from inpatient settings to the community. This article discusses the characteristics and needs of people with long-term mental illness living in the community. Gaps in service are identified, and an innovative assertive community treatment approach to close some of those gaps is described. Suggestions are proposed for differentiating the role of the psychiatric nurse from other clinicians in assertive community treatment teams.     

Identifying educational needs in end-of-life care for staff and families of residents in care facilities

AIM: the purpose of this article is to describe educational needs in end-of-life (EoL) care for staff and families of residents in long-term care (LTC) facilities in the province of Ontario, Canada. Barriers to providing end-of-life care education in LTC facilities are also identified. DESIGN, SETTING AND PARTICIPANTS: cross-sectional survey of directors of care in all licensed LTC facilities in the province of Ontario, Canada. RESULTS: directors of care from 426 (76.9% response rate) licensed LTC facilities completed a postal-survey questionnaire. Topics identified as very important for staff education included pain and symptom management and communication with family members about EoL care. Priorities for family education included respecting the residents' expressed wishes for care and communication about EoL care. Having sufficient institutional resources was identified as a major barrier to providing continuing education to both staff and families. CONCLUSION: through examining educational needs in EoL care this study identified an environment of inadequate staffing and over-burdened care providers. The importance of increased staffing concomitant with education is a priority for LTC facilities.     

试论老年照护体系的构建

介绍了一些国家老年照护体系的构成及建设,其主要的服务内容、服务方式及运作。在分析国外的经验及我国国情的基础上,提出居家养老是我国的主要养老模式,对居家老人尤其是体弱、高龄、独居者需提供充分的支持性服务应建设好各种类型的老年养护机构,以适应健康状况和经济状况不同的老人的需求;应加强对各类养护机构的设置、运作及管理的指导和监控,以保证服务的质量。提出护理专业工作者应学习老年护理的理论、知识和技能,在老年照护体系的构建中发挥专业特长。     

Clinical problems in the long-term care of patients with chronic depression

Title.  Clinical problems in the long-term care of patients with chronic depression.
Aim.  This paper is a report of a study to explore problems encountered by mental health professionals in the long-term care of patients with chronic depression.
Background.  Patients who do not profit from psychopharmacological or psychotherapeutic treatment often need long-term care. Although they experience severe symptoms and loss of functioning, little is known about these people and the care they receive.
Method.  Experts in chronic depression ( n  = 8) participated in a four-phase Delphi study in 2006–2007. Problems were elicited through a focus group interview (first round) which was analysed using thematic analysis. The resulting problem list was validated (second round) and scored twice on a 7-point Likert scale (third and fourth rounds) by the participants. Urgency and changeability scores of 35 problems were obtained and a hierarchy of problems was set. In addition, qualitative data from the focus group interview were used to frame the results in the context of long-term care for patients with chronic depression.
Results.  Problems were subdivided into five areas. Relapses by the patient, a pessimistic attitude by the professional and demoralization in both were major problems. Also noted were the negative societal connotations of chronic depression and the lack of a coherent view on treatment within mental health care.
Conclusion.  Chronicity of depression may be denied by both patients and professionals, resulting in an overly strong focus on cure and a limited quality of care. The results may be used as a starting point for construction of a best-practice programme to improve long-term care.