区域同质化居家护理模式的构建及应用研究

Research on Construction and Application of Regional Homogeneous Home Care Model

目的构建区域同质化联动居家护理模式,促进区域内居家护理服务水平同质化,打造0.5公里居家护理服务圈,让患者在家就能享受到二级及以上医院的优质护理服务。方法建立基于分级诊疗的网格化三级联动居家护理服务模式,对申请加入居家护理的基层医疗卫生机构进行网格化管理,实现区域内二级及以上大型医院优质护理资源下沉;建立同质化居家康复护理技能培训体系,对基层卫生医疗机构护理队伍开展居家康复护理技能培训,于2018年1月―2月选择16所社区卫生服务中心28名社区护士作为试验组,给予同质化培训,借助市居家护理互联网信息平台实施同质化护理;从9所二级及以上医院居家护理团队中抽取24名护士作为对照组,接受常规培训;比较两组护士在居家护理理论、操作及临床实践能力方面的差异。结果基线调查结果显示,二级及以上医院居家护理小组成员的考核成绩高于社区护士,差异有统计学意义(p<0.01)。接受同质化居家康复护理技能培训后社区护士在居家护理理论知识、操作技能和临床实践能力等方面与二级及以上医院护士比较,差异均无统计学意义(p>0.05),两组护理能力和水平趋于同质化。结论区域同质化居家护理模式能促进不同医疗机构护理水平提高,有效整合基层医院护理资源,有利于推进分级诊疗,切实落实"双下沉,两提升"。

Objective To construct a regional homogeneous home care model to promote the homogeneity of home care services in the region,and create a home care service circle within 0.5 km,so that patients can enjoy high-quality nursing services of secondary and above hospitals at home.Methods We established a grid-based three-level home care service model based on hierarchical diagnosis and treatment.Grid-based management was conducted on primary medical and health institutions applying for home care,so as to achieve the sinking of high-quality nursing resources in large hospitals at the second and above levels in the region.Qualified home rehabilitation nursing skills training system was established.Home rehabilitation nursing skills training was conducted for the nursing team of primary health care institutions.From January to February 2018,28 community nurses from 16 community health service centers were selected as the experimental group to accept homogeneous nursing training through the municipal home care Internet information platform.24 nurses from the home care team of 9 second-level and above hospitals were selected as a control group and receive routine training.The home care theory,operation and differences in clinical practice capabilities of the two groups were compared.Results The baseline survey results showed that the assessment scores of home care team members in second-level and above hospitals were higher than those of community nurses,and the difference was statistically significant(p<0.01).After receiving homogeneous home rehabilitation nursing skills training,community nurses had no significant difference in home nursing theoretical knowledge,operational skills,and clinical practice ability compared with nurses in second-level and above hospitals(p>0.05).The nursing ability of the two groups tend to be hemogeneous.Conclusion The regional homogeneous home care model can promote the improvement of the nursing level of different medical institutions,effectively integrate the nursing resources of the grassroots hospitals,facilitate the promotion of hierarchical diagnosis and treatment,and effectively implement the"double sinking and two upgrading".