Investigation and Analysis of Factors Influencing the Quality of Community Nursing Services in Laishan District,Yantai City

Objective:The purpose of this study is to conduct an in-depth investigation and analysis of the factors affecting the quality of community nursing services in Laishan District,Yantai City,and provide suggestions for improving the quality of the services.Method:The community nursing services in Laishan District,Yantai City were investigated through questionnaires and on-site observations.Result:The content of nursing services was correlated with the professional titles of the staff.The guidance given to patients and caregivers was significantly correlated with the educational level of community nursing personnel.Therefore,this indicates that the professional titles and educational backgrounds of the community nursing personnel have a significant impact on the quality of service provided.Conclusion:The role of professional title evaluation can be optimized,further enhancing the educational level of nurses in surrounding communities,optimizing service content and methods,etc.,in order to improve the quality of community nursing services in the region.

The level of patients’ satisfaction and perception on quality of nursing services in the Renal unit, Kenyatta National Hospital Nairobi, Kenya

Introduction: Renal failure is on the increase and patients have to identify with renal services and centres where services for renal replacement therapies are rendered. This calls for health care workers to offer services that are perceived as quality and satisfying in order to meet the biophysical and psychological needs of the patients. Study design: This was a descriptive cross-sectional study undertaken at the Renal unit of Kenyatta National Hospital (KNH). Purpose: The study aimed at determining the level of satisfaction and perception of the quality of nursing services in the Renal unit. Methodology: The study population included all patients who were seeking dialysis services during one month period of data collection. The sample size was 151 following data collection. Data collection tools consisted of semi-structured questionnaires which were administered with the aid of research assistants as well as checklists which were self administered. Data analysis and results: Analysis of data was performed using the statistical package of social sciences (SPSS) version 16. Results of data analysis were presented in form of descriptive statistics which included mean, standard deviation and percentages. Regression analysis, t-test and ANOVA were conducted to determine demographic predictors of patient satisfaction with the nursing services. The results of the study revealed that patients in the Renal unit were generally satisfied with the nursing services. The aggregate mean score for all patients on Likert scale was 71.2 out of 105, with a standard deviation of 16.8. Level of satisfaction was 67.8%. The findings also showed that there was no association between demographic characteristics with the levels of satisfaction with the nursing services. Recommendation: The hospital should keep the patients’ level of satisfaction high and maintain it through the provision of more dialysis machines and hiring more nurses.

Improvement in Patient Mobility Following Short-Term Rehabilitation in Skilled Nursing Facilities

Background: Mobility in older adults can be impaired after acute illness or hospitalization, and the level of severity can be used as a predictor of one’s ability to return to independent living. Patients are often referred to skilled nursing facilities in hopes of improving their mobility. We wanted to prove that rehabilitative services at Skilled Nursing Facilities improve overall outcomes. Methods: We conducted a retrospective analysis of data from 4612 patients admitted for short-term rehabilitation in a large nursing home chain in California. Our aim was to determine whether patients’ mobility scores, as measured by rehabilitative staff, significantly improved by time of discharge compared to their scores at admission. Mobility scores were rated from 1 to 6, with 1 being the most dependent on aid and 6 being the most independent, over a variety of tasks at admission and compared to scores at discharge. Pearson’s correlations were performed to determine if there were significant relationships in the data: the Pearson’s correlation coefficient was used to describe the relationships between patient admission to a skilled nursing facility and medical improvement upon discharge. Results: The study demonstrated a statistically significant improvement in patients’ mobility scores upon discharge, with Medicare insured patients showing on average 57% improvement and Managed Care insured patients showing on average 59% improvement. Additionally, admission scores appeared to be predictive of the patient’s outcome at discharge. Conclusions: The values and consistency of improvement support the use of acute rehabilitative services in skilled nursing facilities. An equation can be formulated that evaluates patients’ estimated mobility statuses upon discharge from facilities based on their conditions on their arrivals. With this, new interventions can be studied and compared to the current standard of care by using these measurements. They can determine if further improvements can be made to increase patient outcomes.

Core competencies and perceived training needs of nurses in the background of Internet plus nursing service:a qualitative descriptive study

Background:The Internet plus nursing service program is being piloted in China,which has become a new home nursing service model led by nurses.To enable safe and effective homecare service delivery,nurses working in the program need a high level of competency.However,the content of these core competencies and the training needs of nurses for Internet plus nursing services are still unknown.Aim:To describe nurses’perceptions of core competencies and training needs to work in the Internet plus nursing service program,thereby providing a reference for the development of training programs.Methods:A qualitative descriptive study using semi-structured interviews was conducted on 15 nurses with experience of working in the Internet plus nursing service program.Interviews were audio-recorded and transcribed verbatim,and the data were analyzed using thematic analysis.Results:Core competencies involved comprehensive assessment competence,direct care practice competence,health education and consulting competence,risk estimation and response competence,and communication competence.Training needs involved complex operational items,knowledge of chronic disease management,professional communication,risk identification and response,nursing standards,norms,and procedures,and utilization of information technology.Conclusions:The training system may be developed based on nurses’core competencies and their training needs to promote professional development of the Internet plus nursing service.

Analysis of the Current Situation of“Internet Plus Nursing Service”

In the era of“Internet Plus,”technologies like big data,the Internet of Things,and cloud computing have revitalized nursing services in China,leading to the emergence of the“Internet Plus Nursing Services”model.This model facilitates on-site nursing care for discharged patients and special groups with mobility challenges,further advancing the construction of a Healthy China and enabling more people to access high-quality and continuous nursing services.Governments at all levels should actively improve the systems related to“Internet Plus Nursing Services”and simplify the appointment and operation processes.It is also essential to standardize the medical waste disposal process to ensure the quality of on-site nursing services,protect the legitimate rights and interests of both caregivers and patients and safeguard patient privacy and security.Additionally,building a robust“Internet Plus”platform to promote“online appointment of nurses”services,integrate nursing resources,and foster the healthy development of“Internet Plus Nursing Services”is crucial.

Effectiveness of Comprehensive Nursing Management in Enhancing Blood Donation Outcomes and Donor Experience: A Comparative Study

Objective:To assess the management effect of comprehensive nursing management on blood donation services in blood stations.Methods:Sixty-four individuals who donated blood at a blood station between September 2021 and September 2023 were selected and randomly assigned into two groups of 32 each.The first group received comprehensive nursing management,while the second group received routine nursing management.Blood donation indexes and observational indexes such as adverse reactions were compared between the groups.Results:The total blood donation volume and qualified blood donation volume were higher in the first group than in the second group.The amount of discarded blood and the rate of blood discards were lower in the first group compared to the second group(P<0.05).Additionally,the adverse reaction rate in the first group was lower,the blood donation comfort scores were higher,the psychological state scores were lower,and the quality of care scores were higher than those in the second group(P<0.05).Conclusion:Comprehensive nursing management can improve the efficiency of blood donation,reduce the rate of blood discards,decrease the incidence of adverse reactions,alleviate negative psychological states of blood donors,and enhance both the comfort level of blood donation and the quality of care provided.

Public satisfaction with the quality of First Health Facility Services in Indonesia: Does sociodemographic matter?

Objective:To investigate individual characteristics related to satisfaction with the quality of First Health Facility Services(FHFS)in Indonesia.Methods:This cross-sectional study analyzes national representation data.Meanwhile,the study involved 9846 representative respondents in 2019.Respondent’s satisfaction with FHFS based on the five dimensions of service quality(SERVQUAL)is a dependent variable.Independent variables consist of sex,marital status,age,education,employment,insurance ownership,and economics.The study used multivariate logistic regression to explain the relationship between individual characteristics and FSHS quality.Results:77.3%Respondents were satisfied with FHFS,with the highest order of satisfaction dimensions being assurance(59.4%),empathy(57.3%),reliability(53.6%),responsiveness(52.7%),and then tangibility(49.1%).Multivariate logistic analysis showed that divorce was 1.48 more likely than never-married to be satisfied(95%CI 1.17-1.87).Employees were 0.77 less likely than the unemployed to get satisfied(95%CI 0.70-0.86).Respondents with higher education was 0.82 less likely than those with primary education to be satisfied(95%CI 0.67-0.99).Meanwhile,respondents who had government-run insurance were 1.61 more likely than uninsured to be satisfied(95%CI 1.42-1.80).Moreover,the rich were 0.82 less likely than the poor to get satisfied(95%CI 0.73-0.92).Conclusions:Community satisfaction with FHFS is generally high,though some areas could be improved.Demographic factors are still strongly related to satisfaction ratings.The government can assess the quality of services in accordance with standards and disseminate information about service standards for primary facilities to all levels of society,ensuring that service satisfaction is rated as good by all groups.

Stress perceptions of nurses serving in home healthcare services during the COVID-19 pandemic:A qualitative research

Objective:To investigate the stress perceptions of nurses serving in home healthcare services during COVID-19.Methods:This study was qualitative research with a phenomenological design.Data were collected and recorded through in-depth interviews with 6 nurses working in MuşState Hospital,Home Healthcare Services Unit using a form consisting of 12 questions on an online platform between May 2021 and July 2021.The audio recordings were transcribed by the researcher and content analysis was performed by creating codes,categories,and themes.Results:The interviews yielded 10 categories and 59 sub-codes.These codes were addressed under the theme of"COVID-19 pandemic".Under this main theme,nurses expressed the problems they experienced in issues such as stress,support mechanisms,and family and social problems during COVID-19.They mentioned that they experienced high stress in this process,as well as social isolation and negative thoughts of society about them and that they could not spare time for themselves and their families.Conclusions:Nurses working in home healthcare services frequently express negativities such as high stress,isolation from society,and increased workload.Therefore,actions should be taken to raise awareness of society on these issues,increase the number of personnel,conduct more research,and share the results with the public.

我国社会保险经办服务体系的发展成就与转型升级

在对我国社会保险经办服务体系30年来的发展历程和取得的成就回顾与总结基础上,对经办服务体系存在的问题及其成因进行梳理:当前各级社会保险经办机构超编现象十分普遍;专业技术人员比例逐年下降;经办费用投入难以满足数字化转型的需求。鉴于此,提出加快社会保险经办服务体系高质量发展的改革思路:全国社会保险经办系统实行人员编制动态调整机制;全面提高人力资本水平;全面推进数字化转型;社会保险经办投入列入社会保险基金成本。

我国养老服务产业优化发展策略研究

我国正处在人口老龄化进程加速发展的关键期,对养老服务产业提出了庞大需求。文章探索养老服务产业发展的优化策略,为政府决策提供现实依据。通过实地调研、访谈等方式调查国内养老服务产业的需求和供给现状,查找养老服务产业发展过程中的难点,结合对美国、澳大利亚、日本和德国等国家养老服务产业的文献分析,总结其成功的经验。基于上述分析研究,提出增加制度供给引导行业有序发展、鼓励参与主体公平竞争、建立多渠道筹资机制、探索长期护理保险制度、完善养老服务服务人才培养体系、建立资格准入制度、搭建人才发展平台等方面提出具体对策。

我国药学服务收费探索与现状分析

目的 总结中国药学服务收费的探索历程及现状,并结合国外实践进行分析,为中国药学服务收费相关政策的进一步完善提供参考。方法 检索国家及各省卫生健康委员会、医疗保障局的官方网站,归纳中国药学服务收费相关政策的变革及各省最新的药学服务收费政策。同时检索中国国家知识基础设施(CNKI)、维普中文科技期刊数据库、Pubmed等数据库,总结关于药学服务收费相关研究。结果 国内关于药学服务成本测算和收费标准的研究较多,但多集中在药房调剂服务,对具体药学服务的技术劳务价值探讨较少,国外这方面研究相对较多。目前国内共8个省和1个直辖市公布了药学类医疗服务价格项目,收费项目、收费标准、医疗保险支付比例及监测评估指标各有差异。结论 将药学服务收费纳入国家医疗服务价格体系是对药学服务转型和药师价值的认可,但尚在起步阶段,仍有完善和改进空间。

我国养老产业发展“拐点”研判——基于多案例研究的典型事实

随着人口老龄化进程加速,我国的养老需求结构正在从生存型向发展型转变,这将为养老产业的发展带来广阔的市场空间,但当前我国养老产业发展相对滞后,仍面临严重的发展困境。我国养老产业发展的“拐点”何时到来?为回答好这个问题,本文以案例研究和实证分析相结合的研究框架,首先,以法、德、日、美四国为例,系统梳理其养老产业发展历程,总结归纳出养老产业发展“拐点”出现的共性特征;其次,聚焦日本养老产业发展轨迹,重点关注其介护险实施前后养老产业相关重要指标变化;最后,选取九个养老产业相关指标,基于指数平滑、灰色模型等方法对中国养老产业未来情况进行预测,并与日本可比时期指标情况进行比较,判断中国养老产业“拐点”出现的可能时间。研究发现:养老产业发展“拐点”的出现具有四个共性特征,分别是三支柱养老金体系改革、长护险制度全面实施、多元化服务助推医养结合、代际转换背后的产业增量机会,而中国养老产业发展“拐点”可能出现的窗口期将在2026—2030年间。

基于Kano模型的三级中医院住院患者中医护理服务需求属性研究

[目的]分析三级中医院住院患者的中医护理服务需求属性,为提升三级中医院中医护理服务提出策略。[方法]基于Kano模型设计三级中医院住院患者中医护理服务需求调查问卷,对天津市某三级中医院469例住院患者进行调查,采用定量与定性的方法确定三级中医院住院患者中医护理服务需求属性分类及优先级排序。[结果]通过Kano模型和Better-Worse二维矩阵图进行需求分析,最终获得三级中医院住院患者中医护理服务必备属性需求14个,魅力属性需求9个,期望属性需求6个。[结论]三级中医院医院管理者应依据住院患者中医护理服务需求优先级顺序精准施策,保障必备型需求项目供应,加大期望型需求投入,同时发展创新魅力型需求,确保中医护理服务需求与供给高效匹配。

术后患者自控镇痛:北京协和医院30年临床管理经验

术后疼痛严重影响患者的康复进程,从而导致住院时间延长,照护成本增加。合理应用患者自控镇痛装置可有效缓解围术期急性疼痛。北京协和医院于1994年引入患者自控镇痛技术,并于2004年成立了急性疼痛服务工作组,以麻醉医生为指导、手术室疼痛专科护士为基础,联合实施基于患者自控镇痛的全流程、规范化管理,并不断改进和创新工作方法,为术后疼痛管理的发展奠定了坚实基础。本文从临床工作重点、护理管理经验、疼痛治疗理念的推广与传播、新形势下急性疼痛服务模式的发展等方面对该项工作进行系统回顾与总结,以期为全面加强患者诊疗过程中的疼痛管理、提升患者围术期镇痛服务满意度提供有价值的参考。

急诊护士突发公共卫生事件应对能力现状的多中心调查研究

目的了解急诊护士突发公共卫生事件应对经历及能力现状,为改善突发公共卫生事件应急能力提供参考依据。方法采用便利抽样法,于2023年3月—4月选取来自全国16个省市、119所医疗单位的1603名护士为调查对象,采用一般资料调查问卷、急诊护士突发公共卫生事件应急能力量表进行问卷调查。结果急诊护士突发公共卫生事件应急能力得分为[215.00(180.00,244.00)]分。多元线性回归分析结果显示,应急演练及培训经历、发热门诊轮转、性别、工作科室、年龄是急诊护士突发公共卫生事件应急能力的影响因素(P<0.05)。结论急诊护士突发公共卫生事件应急能力处于中等水平,针对突发公共卫生事件应急管理的不同阶段、根据不同层级护士的突发事件应对能力要求,按层次、按梯队开展持续、有计划的教育培训。

Automated Actuarial Data Analytics-Based Inflation Adjusted Frequency Severity Loss Reserving Model

In this paper, the Automated Actuarial Loss Reserving Model is developed and extended using machine learning. The traditional actuarial reserving techniques are no longer compatible with the increase in technological advancement currently at hand. As a result, the development of the alternative Artificial Intelligence Based Automated Actuarial Loss Reserving Methodology which captures diverse risk profiles for various policyholders through augmenting the Micro Finance services, Auto Insurance Services and Both Services lines of business on the same platform through the computation of the Comprehensive Automated Actuarial Loss Reserves (CAALR) has been implemented in this paper. The introduction of the four further types of actuarial loss reserves to those existing in the actuarial literature seems to significantly reduce lapse rates, reduce the reinsurance costs as well as expenses and outgo. As a matter of consequence, this helps to bring together a combination of new and existing policyholders in the insurance company. The frequency severity models have been extended in this paper using ten machine learning algorithms which ultimately leads to the derivation of the proposed machine learning-based actuarial loss reserving model which remarkably performed well when compared to the traditional chain ladder actuarial reserving method using simulated data.

长期护理保险经办服务与监督管理的国内外实践与启示

长期护理保险试点启动至今已有8年,如何推动其由点及面、全面施行是值得探究的现实问题。本文通过分析长期护理保险经办服务与监督管理的国内实践现状发现,当前存在政策覆盖范围不足、监管体系不充分以及现有护理资源供给不足等问题。因此,借鉴国外实践经验,从建立第三方监管机制、制定科学评定标准、促进政府跨部门协作与信息共享、强化人员技能培养等方面提出政策建议,以期为建立适应我国国情的长期护理保险制度提供启示。

家庭医生服务能力自我评估调查问卷的开发与应用

目的:开发并应用家庭医生服务能力自我评估调查问卷。方法:选取我国8469名已经或即将从事家庭医生工作的基层卫生机构医生为研究对象,采用自行开发的家庭医生服务能力自我评估调查问卷对其进行调查。结果:基本医疗服务能力7项职责中,家庭医生具备承担常见病、多发病诊治职责能力的比例最高,为94.69%,社区康复服务和合理用药、用械职责能力的比例相对较高,分别为90.94%和90.75%。基层医生具备承担危急重症应急处置、医疗服务协同等职责能力的比例较低,分别为53.74%和56.68%。73.27%的家庭医生基本医疗服务能力得分≥4分,东、中、西部地区的家庭医生基本医疗服务能力得分≥4分者分别占73.72%、77.03%、67.49%。农村地区的家庭医生基本医疗服务能力得分≥4分者占74.62%,高于城市地区(70.63%)。全科医生基本医疗服务能力得分为7分者占比最高(27.48%),执业医师占比为19.99%。结论:本研究构建的家庭医生服务能力自我评估调查问卷可行性和可靠性较高,家庭医生服务能力自我评估调查问卷的应用有利于识别基层医生服务能力短板,能够反映家庭医生实际能力水平,符合基层工作实际情况,城乡家庭医生和不同类别的家庭医生基本医疗服务能力存在差别。

中国社会医疗保险制度未来发展的挑战与创新建议

中国社会医疗保险制度发展至今,已覆盖了95%以上的人口,筹资和报销待遇都达到了与国民经济所处的中等收入国家地位相称的水平,但也存在不同人群待遇相差悬殊、医保基金使用效率不高的问题。未来需要从实现公平的国民待遇、进行科学的医保筹资规划、制定统一的医疗服务价格、设计合理的医保报销政策、明确划分中央与地方政府的职责等方面,正视挑战,创新发展,避免医保制度发展的中等收入陷阱。

连续性肾脏替代治疗预防非计划下机过程管理的最佳证据总结

目的 整合连续性肾脏替代治疗预防非计划下机过程管理的最佳证据,为医护人员提供规范、科学的预防及管理循证依据。方法 根据证据资源“6S”模型,系统检索临床决策系统、指南及专业医学会网站、循证数据库及综合数据库中有关连续性肾脏替代治疗预防非计划下机过程管理的相关文献,检索时限为2017年8月15日至2023年8月15日。由4名研究者筛选文献并进行质量评价,提取并汇总证据。结果 共纳入18篇文献,其中指南2篇、临床决策5篇、JBI推荐实践1篇、共识4篇、证据总结3篇、系统评价3篇。从组织管理、上机前管理、运行管理及停机后管理4个方面汇总,共形成30条证据。结论 总结的最佳证据具有科学性和实用性,对预防非计划下机过程管理有指导意义。