实施医院社区一体化延续护理障碍因素的调查分析

Barriers to implementing hospital-community collaborative transitional care:a survey study

目的了解和分析护士实施医院社区一体化延续护理的障碍因素,为构建符合我国国情的医院社区一体化出院患者延续护理模式提供参考。方法自行设计问卷对南京市某三甲医院及13所社区卫生服务中心的29名护理管理者和308名护士进行调查。结果医院社区一体化模式下护士实施延续护理面临的障碍主要有护理人力资源不足313人(92.9%)、患者出院准备不充分284人(84.3%)、延续护理服务经费短缺276人(81.9%);问卷18个条目中缺乏国家相关政策扶持,缺乏规范化延续护理方案等4条护士认同率显著低于护理管理者(P<0.05,P<0.01);缺乏明确的收费标准,护士实施护理能力不足等4条医院护士认同率显著低于社区护士(均P<0.01)。结论护士实施医院社区一体化延续护理面临多重障碍,相关管理者应重视一线护理人员的诉求,采取适当措施以确保其顺利实施,从而构建适合我国国情的出院患者医院社区一体化延续护理模式。

Objective To investigate and analyze barriers to implementing hospital-community collaborative transitional care. Methods A total of 29 nursing managers and 308 nurses were selected from a tertiary hospital and 13 community health service centers and were investigated using a self-designed questionnaire. Results The biggest barrier to implementing hospital-community collaborative transitional care was shortage of nurses （92.9 %）, followed by inadequate discharge planning （84.3 % ）, and lack of financial support （81.9%）. Percentage of nurses agreeing with four of 18 items （e. g. , lack of national policy and deficiency of standardized operating procedures, etc） was significantly lower than that of nursing managers （P〈0.05,P〈0.01）, and percentage of community nurses agreeing with 4 items （e. g. , lack of clear charge criteria and incompetence of nurses, etc） was significantly higher than that of hospital nurses （P〈0.01 for all）. Conclusion Nurses do have barriers to implementing hospital-community collaborative transitional care. The relevant managers should focus on clinical nurses＇ demands and take targeted actions to ensure the implementation of transitional care, thus to develop hospital-community collaborative transitional care model.