结构性嵌入:医养结合在社区居家养老中的实践逻辑

Structural Embeddedness:A Research of Combination of Medical and Elderly Care in Community Home-based Care Services

以结构性嵌入作为理论视角,从嵌入过程、嵌入特点、嵌入效应方面分析了Q社区开展的医养结合实践。医养结合的社区实践是医疗卫生服务结构性嵌入于居家养老服务体系的过程。在结构性嵌入过程中,基层医疗卫生服务具有可及性与不可替代性。通过长期的交往互动,医护工作人员与社区居民形成了信任的社会关系,然而也出现了嵌入过程中的缝隙化,体现为护理的不足。在此基础上,应从浅层次嵌入向深层次嵌入发展。作为服务对象的老年人,应由被动的接受服务向主动的自身保健、表达诉求转变。通过整合资源实现无缝隙嵌入的空间拓展。

Based on structural embeddedness theory,the paper analyzes the practice of combination of medical and elderly care in Q community from the view of embeddedness procedure,embeddedness characteristics and embeddedness effect. According to the paper,the practice of combination of medical and elderly care in Q community is the process that medical and health services are structurally embedded in the system of community home-based care services. In the process of structural embeddedness,primary medical and health services demonstrate accessibility and irreplaceability in Q community. Medical staffs and community residents build trust for long-term contact. However,there appears a gap,nursing deficiency,in the process of structural embeddedness. Therefore,the paper proposes that it is necessary to improve the degree of structural embeddedness from superficial embeddedness to deep embeddedness and the elderly,as service objects,should transform into subjects of self-care and rights claim. In the meanwhile,we should make up the gap in the process of structural embeddedness through resources integration.