Responsibility Distribution Between the Government and Society in Guaranteeing Basic Senior Care Services

The 20th National Congress of the Communist Party of China put forward the task to ensure all elderly people enjoy basic senior care services.In an aging society,basic senior care services are key to protecting the basic human rights of the elderly.The government-society partnership is an ideal model to guarantee basic senior care services.In terms of responsibility distribution,the government and social organizations should follow the principle of subsidiarity.On the one hand,social organizations undertake the responsibility to provide basic senior care services under public constraints with regard to service prices,service content,and service targets;On the other hand,the government is the responsible guarantor for minimum senior care services and the prevention of risks.The government’s responsibility of guaranteeing minimum senior care services lies in the government taking over relevant projects after the occurrence of risks.Constrained by the principle of subsidiarity,the government’s responsibility for risk prevention shifts from ex-ante prevention to interim and ex-post prevention.Emphasis should be placed on the principle of the government and society assuming shared responsibilities for risk prevention and achieving risk prevention through government spending.

Water, Sanitation and Hygiene in Lower-Level Health Care Facilities of Dar es Salaam Region in Tanzania: Status towards Achieving the Sustainable Development Goals and Way Forward

Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.

Nurse Mentor Training Program to Improve Quality of Maternal and Newborn Care at Primary Health Centres: Process Evaluation

Quality of maternal and newborn care could be improved if health care providers’ knowledge and competencies as well as system level constraints are addressed. However, due to several barriers staff nurses who form the frontline of health care workforce have limited access to enhancing their clinical knowledge and competencies. To address this gap, a new cadre of nurse mentors (NMs) for the public health system were trained by specialists from a teaching hospital in a special 5-week training course. This included 54 hours of theory and 110 hours of practical in clinical obstetric and newborn care, apart from mentoring, quality improvement and health systems issues. The nurse mentors were assigned to support staff nurses in the primary health care centres (PHCs) in eight northern Karnataka districts. Each NM covered 6-8 PHCs monthly for 2 - 3 days and thus a total of 385 PHCs were reached. They received support in the field through supportive supervision visits done by the specialists who had trained them, as well as by refresher training and clinical postings to the district hospitals. This paper presents impact of the training program on change in immediate and long term knowledge and competency scores of nurse mentors. Their baseline knowledge scores changed from 44.3 ± 12.7 to 72.1 ± 13.8 immediately after the training in obstetric and from 18.2 ± 19.1 to 66.4 ± 14.9 in newborn (p p p > 0.05). Skills score soon after training increased from 62.2 ± 13.2 to 69.6 ± 12.5 in obstetric after a 1 year period and from 52.6 ± 9.3;63.5 ± 14.4 in newborn (p < 0.001) content areas respectively. These findings have implications for those interested in improving quality of maternal and child care through nurse-dependent health delivery systems.

Knowledge and Skills Gap of Midwives to Conduct Obstetric Ultrasonography Screening in Primary Health Care Facilities in Kajiado and Kisii Counties, Kenya

Background: Ultrasound remains a tool of much importance in maternity care with midwives regarded as key health professionals when it comes to care of pregnant mothers. There is however limited study on the knowledge and skills gaps of midwives in conducting obstetric ultrasonography screening. The purpose of this study was to assess the specific obstetric ultrasonography knowledge and skills gaps among midwives based in primary health care facilities. Methods: A cross-sectional study employing both qualitative and quantitative method was conducted between July and August 2019 with 274 midwives. A structured questionnaire was used to collect data while Focus group discussion and Key Informants Interview were used to collect qualitative data. Descriptive statistics were used to summarize the data test associations between variables while the qualitative data were used to compliment the questionnaire data in eliciting more information on the gaps. Findings: Almost all (94.5%) the midwives had never been trained on any basic obstetric ultrasound while six of those that had been trained in early stages by the project lacked equipment to practice the acquired skills. More than three quarters of the respondents opined that they wished to provide personalized care services to mothers/clients seeking Antenatal Care Services (ANC) in their community at a fee while only 13.9% had knowledge that obstetric screening should be done before 24 weeks gestation. Four out of ten of the respondents scored themselves a one (1) on the level of confidence they have using an ultrasound machines or technology. Conclusion: There still remains a huge gap as far as training of midwives on basic ultrasound screening is concerned. The lack of basic obstetric ultrasound screening skills is a barrier to rolling out Point of Care Ultrasound (POCUS) screening services. However, midwives are motivated and willing to learn basic ultrasonography skills to further the objectives of Universal Health Coverage (UHC). Concerted efforts should be made to train midwives on basic obstetric ultrasonography skills in addition to availing mobile/hand held ultrasound technology in Primary Health facilities for them to apply the transferred skills. A sustainable business model to enable mothers continuously afford the services is critical as well.

西南地区基本养老服务均等化测度与区域差异

基本养老服务均等化是老年人共享改革成果和社会公平正义的重要体现。文章从“物质帮助-照护服务-关爱服务”三个维度对西南地区基本养老服务均等化水平进行测度、分析与预测。研究发现:时间演变上,2012—2022年西南地区水平整体稳步上升,各子维度波折上升;区域差异上,西南总体呈现两阶段变化趋势,以区域内差异为主,子维度区域差异为照护服务>关爱服务>物质帮助;未来趋势上,2023—2025年基本养老服务均等化水平持续上升且区域差异不断缩小。据此,提出了保障物质、持续照护、重视关爱的养老服务举措。

中国基本养老服务制度的伦理向度

基本养老服务制度关乎伦理,蕴含遵循以人民为中心的核心价值、彰显共建共享的顶层设计、聚焦正义和效率的协调统一、秉持公共善和个体善相辅相成的伦理属性;在制度的执行和贯彻中存在保基本与需求多样性的差距、传统代际养老责任意识与普惠性相背离、资源配置的均衡性不足等方面的实然伦理困境;只有聚焦基本养老服务责任的顺序性和协同性相结合、传统孝老爱亲文化的创造性转化和创新性发展、基本养老服务分配形式公平和实质公平相统一等应然伦理路径,基本养老服务制度建设才能在“善”的应然方向彰显更大效能。

角色安排与功能优化:我国老年人探访关爱制度研究

建立特殊困难老年人探访关爱制度是推动实现全体老年人享有基本养老服务及健全新时代我国老年人关爱服务体系的重要内容和关键支撑。在国家基本养老服务的宏观范畴和居家养老服务制度网络的交互中精准把握探访关爱制度的要素构成、功能价值及运行逻辑。现时态中尽管从政策层面和制度层面对探访关爱服务进行了整体安排,实际运行中依然存在类型划定、资源整合、方法应用及功能联通等方面的缺失和障碍。从标准体系构建、运行机制协同及服务质量保障等制度层面加以建构,并从规范流程、内优外联和赋能业务等实践层面予以优化,确保其制度红利的充分释放。

中国式现代化进程中的基本养老服务制度:生发逻辑、概念厘清与体系建构

建立基本养老服务制度是实现中国式现代化的题中应有之义。必须准确界定“基本养老服务制度”的概念内核,明确其对象普遍性、内容基础性、水平基准性之“基本”特性、“养老”之目标指向、“制度”之架构定位,厘清基本养老服务与养老服务、公共养老服务、基本公共服务等相近概念之学理边界,概括其全面覆盖、内涵丰富,政府主导、多元协同,需求导向、分层分类,统筹协调、融合发展,动态调整、逐步完善之典型特征,并注意法律法规针对性、管理机构整合性、设施建设全域性、服务内容层次性、供给主体多元性、需求评估精准性、人才培养系统性、资金保障多维性、运行机制流畅性、标准体系科学性,方能实现基本养老服务人人可及。

混合式教学在不同生源基础护理教学中的应用与效果评价——以武汉铁路职业技术学院护理专业为例

医疗与护理专业生源类型有别、人才培养规格需求多样,为根据不同层次生源进行分类分层教学、因材施教,将2021级高职护理专业287名学生按照不同生源分成了英才班、普高班和中职对口升高职专班。通过分析不同生源学生理论课及实验课成绩探索线上线下混合式教学模式,建设高效课堂,提高教学质量,培养高素质高水平技术技能型人才。教学实践证明,采用混合式教学模式有利于激发学生的学习兴趣,有效实施因材施教,取得较好的教学效果。

A Survey of Learning Needs about Oral Care for Intubated Patients among New Nursing Staff

Our aim was to understand the actual conditions of oral care for intubated patients by new nurses. This study was carried out from December 2017 to March 2018. We applied the theme of the dissipation of the dissociation between nursing skills learned in basic nursing education and nursing skills required in practice. A questionnaire survey was conducted at four facilities among new nursing staff who had acquired their nursing license in the past year. The questionnaire was composed of questions about their experiences of oral care for intubated patients, when they learned these skills, and what they wanted to learn. Answers were obtained from 118 new nurses. Learning about oral care was important for approximately 20% of the nurses, although it was not considered mandatory by all of the nurses. As infection control measures have revealed the acute needs of care for intubated patients, it is important for nursing students to learn about oral care and attitudes towards intubated patients, along with methods to make intubated patients more comfortable.

呵护童年:基础教育的课程担当

童年正在消逝,对此,基础教育应该主动担当责任并有所作为。首先,基础教育要保护好儿童的好奇心和探究欲,这是基础教育打好基础的起点和重点;其次,基础教育要激发并引导儿童“会玩”与“慧玩”,保障儿童过好、过足童年生活;最后,学校教育要为儿童设计“慧玩课程”,改变并拓展现有的知识本位的课程结构,让儿童在“慧玩课程”中快乐而和谐地发展。

分析临床基础护理强化与睡眠护理在消化道出血住院患者中的应用价值

目的:分析临床基础护理强化联合睡眠护理对消化道出血住院患者治疗效果及睡眠质量的影响。方法:选取2022年1月至2022年12月厦门大学附属第一医院消化内科收治的消化道出血住院患者60例作为研究对象,按照随机数字表法分为观察组和对照组,每组30例。采用匹兹堡睡眠质量指数(PSQI)比较2组患者睡眠质量的差异,并比较2组患者的临床疗效及止血情况。结果:干预后,观察组PSQI评分显著低于对照组,观察组的总有效率显著高于对照组,观察组的止血时间、住院时间均显著短于对照组,观察组输血量显著少于对照组,观察组的再出血率显著低于对照组,差异均有统计学意义(均P<0.05)。结论:在为消化道出血住院患者提供临床基础护理干预的前提下,强化联合睡眠护理干预能让治疗效果显著提高,并能快速止血,减少患者的出血量及再出血,提升睡眠质量,加快康复进程,值得推广应用。

基于SHA 2011的天津基层医疗卫生机构基本公共卫生服务开展情况分析

[目的]强化经常性卫生费用核算数据政策分析,为基本公共卫生服务项目后续开展提供依据。[方法]以天津市2016-2019年基层医疗卫生机构预防服务费用核算结果为基础,分析基层医疗卫生机构基本公共卫生服务项目开展情况和存在问题。[结果]2016-2019年,天津市基层医疗卫生机构预防服务费用呈逐年增长趋势,由2016年的14.25亿元增加至2019年的18.04亿元。预防服务费用主要流向预防接种项目、慢性病管理和老年人健康管理项目;预防服务费用筹资来源仍以政府筹资方案为主,但家庭卫生支出占比呈快速增长趋势,主要是由于二类疫苗接种费用的快速增长所致。[结论]天津市基层医疗卫生机构预防服务费用流向与其基本公共卫生工作重点一致,但基层医疗卫生机构传染病防控投入程度与其职能不匹配。基层医疗卫生机构二类疫苗接种服务家庭卫生支出负担过重。

加强乡村医疗卫生体系建设提升基层医疗卫生服务能力

2023年中共中央办公厅、国务院办公厅印发《关于进一步深化改革促进乡村卫生医疗体系健康发展的意见》提出了构建紧密型县域医共体,致公党辽宁省委会、大连市委会成立了专门课题组,对大连地区县以下医疗卫生体系建设情况进行调研,梳理出问题所在,并提出了具体建议与解决方案。

养老服务高质量发展:内涵、方向及路径

养老服务高质量发展已经成为一个重要政策目标。养老服务高质量发展是能够满足人民养老服务需求的发展,是体现新发展理念的发展。推动养老服务高质量发展必须坚持以满足老年人的美好生活需要为根本宗旨,以全体老年人享有基本养老服务为基本目标,以养老事业与养老产业协同发展为基本思路,并发挥市场机制配置资源的决定性作用。推动养老服务高质量发展,要从全局高度认识其重要性,营造人人参与养老服务发展的环境,鼓励新技术应用和模式创新,积极推进基本养老服务体系建设,提高养老服务资源利用效率,以更宽广的政策视野、更广泛的社会参与、更强劲的创新驱动、更坚实的基本保障、更有效的资源配置开创养老服务发展新局面。

普通病房护士安宁疗护基本能力评估量表的研制及信效度检验

目的研制普通病房护士安宁疗护基本能力量表,并检测其信效度。方法通过文献回顾、小组讨论、专家咨询、小样本预调查等方法募集、筛选条目初步形成测试量表;于2021年1-3月用该量表对1000名来自各内科、各外科、急诊科、妇产科及重症监护室等科室的护士进行调查;使用SPSS和AMOS软件对数据进行项目分析、探索性因子分析和验证性因子分析,以验证量表的信效度,最终形成正式量表。结果经因子分析提取5个公因子,37个条目,累计方差贡献率71.031%,量表整体Cronbach’sα系数为0.953,折半信度为0.772,重测信度为0.963,验证性因子分析模型拟合良好,χ^(2)/df=2.57,近似误差均方根(root mean square error of approximation,RMSEA)=0.059,比较拟合指数(comparative fit index,CFI)=0.909,增量拟合指数(incremental fit index,IFI)=0.910,非规范拟合指数(Tucker-Lewis index,TLI)=0.901。结论本研究构建的普通病房护士安宁疗护基本能力评估量表信效度良好,可以用于评价普通病房护士安宁疗护基本能力。

中央政策试验的差异化模式及其选择逻辑——基于两项社会政策的案例研究

政策试验是中国社会政策建立及发展的重要机制。政策试验具有多种类型,但中央政府准备开展政策试验时,如何对此前地方自主试验的政策进行评估并考量以何种方式在全国范围内进行试点推广,已有研究对此讨论不足。论文依据政策试验及政策学习理论建立分析框架,通过对城镇职工基本医疗保险和长期护理保险这两项社会政策试点过程的回顾,从“创制紧迫性”和“政策工具确定性”两个维度,分析中央政府在开展试点过程中如何进行政策试验的模式选择。在“创制紧迫性”和“政策工具确定性”都较高的情况下,政策试验项目会采用政策目标和政策工具均比较明确的“由点至面验证型”的“金字塔模式”,而在上述两者都较低的情况下,政策试验项目会采用政策工具比较模糊的“多点试验探索型”的“木桶模式”。论文阐释了中央政府进行试点方案的选择机制,细化了社会政策试验策略选择中的评议标准,展示了政府在社会政策学习中的多元学习源及学习渠道。论文通过论证梳理了中国政策试验中纵向政府间的复杂互动关系,进一步深化了对于中央政府在政策试验中行动逻辑的理解。

基于关怀教育理论的护理学基础课程思政教学实践

探讨在护理学基础教学中融入以关怀教育理论为框架的课程思政,并评价教学效果。结果表明,基于关怀教育理论系统设计的课程思政教学能够有效提升高职护生的人文关怀能力,有助于坚定其职业信念,强化育人效果。

基础型社区养老服务供给对老年人生活满意度的影响——自评健康变化的中介作用

基于2018年中国老年健康影响因素跟踪调查(CLHLS 2018)数据,运用多元线性回归、逐步回归、Bootstrap等研究方法分析基础型社区养老服务供给对老年人生活满意度的影响,并引入自评健康变化作为中介变量,探讨了其影响机制。研究发现:基础型社区养老服务供给对老年人生活满意度具有正向影响,且通过老年人自评健康变化对其生活满意度可以产生间接影响效应。在社区养老服务体系建设过程中,应重视基础型社区养老服务的作用,充分发挥政府购买公共服务的优势。

藏区重症监护病房首例耐碳青霉烯类鲍曼不动杆菌感染患者相关环境污染及患者感染情况

目的 调查藏区某院新建重症监护病房(ICU)中首例耐碳青霉烯类鲍曼不动杆菌(CRAB)感染患者相关环境污染及患者感染情况,分析传播风险。方法 从2021年11月15日检出的首例CRAB患者入住ICU开始至第60天期间,对入住ICU>48 h的所有患者进行CRAB主动筛查;在首例CRAB感染患者入住ICU第30天高频开展诊疗活动2 h后未消毒前、第60天消毒后未开展医疗活动前的环境分别采样,CRAB显色培养基培养。结果 主动筛查的13例患者中1例CRAB阳性,该病例于11月19日由三级医院ICU转入该院ICU,入住ICU第40天出现发热、吸痰需求增加并检出CRAB,药敏谱与首例病例相似,且安置于首例病例邻床。采样环境标本64份,CRAB阳性9份,阳性率14.06%,其中高频诊疗活动后洗手池、门把手、床栏等8个采样位点CRAB阳性,常规消毒后洗手池水槽检出CRAB。结论 在民族地区基层ICU CRAB防控工作中,对入科患者进行风险评估,高风险患者入科即采取集束化防控措施是可行的;应重点关注洗手池、门把手、床栏等区域污染及洗手池水槽消毒的有效性。