三级医院主导"互联网+护理服务"工作体验及服务质量的田野研究

Field research on work experience and service quality of"Internet plus nursing service"led by tertiary hospitals

目的了解三级医院主导"互联网+护理服务"工作体验及服务质量,为构建适合我国国情的"互联网+护理服务"质量控制指标体系奠定基础。方法2021年9月至2022年2月,采用田野研究方法,通过目的抽样法结合开放性抽样法对青岛市市北区、市南区、崂山区、城阳区、即墨区的10个居民区的11名"互联网+护理服务"出诊护士,进行为期5个月的参与式观察。结果"互联网+护理服务"出诊护士的工作体验:满足社会和患者的刚性需求,护士职业价值感及满意度倍增;监管机制尚存缺陷,信息化建设需不断加强;患者安全与护士执业安全问题尚有隐患。解析出影响"互联网+护理服务"质量的6项关键因素:出诊前物品准备不规范、上门服务着装不规范、操作前评估准备工作不到位、操作过程中缺乏同理心、院外感染预防意识不强、操作后未根据患者情况进行健康教育。结论青岛市三级医院主导"互联网+护理服务"模式,实现社区与上级医院之间的双向转诊,切实提升了延伸性护理质量,患者及家属接受度及满意度高,护士工作积极性、职业价值大幅提升,仍需建立健全"互联网+护理服务"工作规范,实现护理服务同质化及专科多样化,带动社区医护人员综合素质的提升。

Objective To understand the work experience and service quality of"Internet plus Nursing Service"led by tertiary hospitals to lay the foundation for building an"Internet plus Nursing Service"quality control index system suitable for China's national conditions.Methods Using field research method,combining purposive sampling with open sampling,from September 2021 to February 2022,the 11"Internet plus Nursing Service"visiting nurses from 10 residential areas in Shibei District,Shinan District,Laoshan District,Chengyang District and Jimo District of Qingdao were observed for 5 months.Results The work experience of"Internet plus Nursing Service"visiting nurses:meeting the rigid needs of society and patients,and nurses′professional value and satisfaction were multiplied;there were still shortcomings in the regulatory mechanism,and information technology construction needed to be continuously strengthened;there were still hidden dangers in patient safety and nurse professional safety issues.Six key factors influencing the quality of Internet plus nursing service were analyzed:non-standard preparation of articles before visiting,non-standard dress for door-to-door service,inadequate preparation for pre operation evaluation,lack of empathy during operation,weak awareness of infection prevention outside the hospital,and failure to carry out health education based on patients′conditions after operation.Conclusions The Internet plus nursing service model is dominated by the tertiary hospitals in Qingdao,which has realized two-way referral between the community and the superior hospitals,and has effectively improved the quality of extended care.The acceptance and satisfaction of patients and their families are high,and nurses′work enthusiasm and professional value have increased significantly.It is still necessary to establish and improve theInternet plus nursing service work standards to achieve the homogenization and diversification of nursing services,promote the comprehensive quality of community medical staff.