A Study on the Quality of Life of Elderly Nurses in Two Selected Elderly Care Institutions in Shandong Province

Objective: To comprehensively understand the impact of the quality of life of elderly nurses in two selected elderly care institutions in Zibo city, Shandong province, and to provide a scientific basis for improving the professional quality of life of elderly nurses. Methods: The convenient sampling method was used to investigate the professional quality of life (proQOL) questionnaire Version 5 and the self-designed demographic data of 82 elderly nurses working in two elderly care institutions. Result: From this score, it can be seen that the occupational burnout problem of elderly nursing staff in the two nursing homes is the most significant, with empathy and secondary trauma emergency at a moderate level. After controlling the demographic variables, the working hours and monthly income level had a significant impact on nurses’ job burnout. Conclusion: Due to the particularity and high intensity of elderly nurses’ work, their physical and mental health faces many challenges, which affect their quality of life. At present, efforts will be made to reduce work pressure, increase wages and benefits, and thereby improve the quality of life.

Exploration on the Implementation of the Integration of Medical and Preventive Model in China’s Primary Health Care Institutions

Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interviews,and other methods the implementation status was evaluated to systematically study the main experience and effect of implementing medical and preventive integration services in pilot areas.Results and Conclusion At present,there are three implementation modes of medical-prevention integration,namely,vertical mode based on the medical community,internal mode with optimized service process,and internal mode with great service capabilities.The three medical-prevention integration modes have their respective focuses,but they need to be further improved in terms of policy support,technical staffing,information system construction,and drug use.

The impacts of national essential medicine policies on the rational use of medicines in China: A cross-sectional study in primary health care institution

Irrational use of medicines is a major problem worldwide, and it is believed there would be positive correlation between the National Essential Medicines Policies(NEMPs) and the level of rational use of medicines(RUMs). Though there is some early evidence on the NEMPs’ effects on RUMs in China, the evidence is scarce, and conclusions vary. In the present study, we aimed to evaluate the impacts of the NEMPs of China on the RUMs in the primary health care institutions(PHCs). A cross-sectional survey was conducted in 2010. A total of 201 PHCs from six provinces of China were selected, and 39 181 prescriptions were extracted from January to June, 2010. Six indicators were used and tested by independent-samples T test. We found that the average number of drugs per prescription in PHCs with NEMP implementation(the treatment group) was significantly higher than that of the group without NEMP implementation(the control group)(3.37 vs. 2.83, P<0.01). There was no significant difference in the average cost per prescription(81.43 vs. 75.02). The percentage of prescriptions, including an antibiotic(53.40% vs. 36.48%, P<0.01) or an injection(40.54% vs. 27.94%, P<0.01), was higher in the treatment group, and the percentage of drugs prescribed by general name was significantly lower(83.71% vs. 93.11%, P<0.01). For the percentage of drugs prescribed from essential medicines list, the treatment group exhibited the higher ratio(76.12% vs. 53.45%, P<0.01). From this study, the NEMPs were not likely to have a positive impact on RUMs. China still needed efforts to improve the selection, the absence of physicians’ active involvement, and the patients’ habits of irrational medication use.

Socially Excluded Children： Listening to the Experiences of the Inmates of the Institutional Care

Children without parents are not only among the most vulnerable members of society--their care and protection also present a major child-care policy challenge. In spite of this, they are all but doomed to have their special needs ignored and their rights abused in many cases. Children without a biological family, who are cared for in some forms, also run the risk of a life which holds fewer possibilities for healthy development and a supportive environment than that of their peers with families. The range of threats is wide, from extreme neglect （lack of access to education, medical care, a balanced diet, etc.） to social stigmatization and marginalization and the fact that the loss of a family represents a serious trauma that stays with a person throughout his/her life and can potentially be seriously damaging if the person has not had any support in coping with it in childhood. The present study is conducted among the inmates （children） admitted in the ashrams （orphanages） who come from underprivileged socio-economic backgrounds. Information was collected from two orphanages of Sambalpur district situated in the western part of Odisha. These are Dhankauda Kanyaashram （for girls） and Dhankauda Balashram （for boys）. The paper examines a wide range of care interventions for orphans, including family care, institutional care, community-based care, and rights-based care. A lack of direction, inadequate care, ignorance, and discrimination can make the trauma experienced by orphans more intense and ultimately ensure that they really do not succeed.

Remuneration Reforms in Public Sector： A Case of Russian Healthcare

In 2008 remuneration reform for public sector was introduced in Russia. Its main idea was to implement P4P principle well-known in business, including more flexible approach to wage setting. This paper presents an attempt to estimate an influence of the new remuneration system （NRS） on earnings level, inequalities and job motivation. The estimates are based on microdata of monitoring survey of healthcare economic problems conducted in Russia in 2009 and 2010. The extended specification of Mincer earning equation and probit-models were used. One could observe increasing wage rates and earning inequalities within healthcare institutions adopted NRS though worker＇s experience and regional economic differences remain significant wage determining factors. As it occurs, NRS is widely adopted by large regional and central hospitals while smaller health care institutions show less enthusiasm in implementing reform. Obviously, the larger institutions have more money and better educated administrative staff to introduce the new system. Those chief physicians who adopted NRS point out a positive correlation between earnings and individual input. At the same time, those committed to old principles of wage setting more often note declining job turnover. This latter result could possibly indicate negative personnel sorting, less productive workers tending to stay with employer who doesn＇t assess their performance. As concerns anticipated NRS results such as increasing motivation and quality of health services, the evidence is still ambiguous.

Research on the Construction of Pharmacy Organization and the Development of Pharmaceutical Services in China’s Primary Medical and Health Institutions—Based on the Survey of 5 Provinces

Objective To explore the current situation and problems of the pharmacy organization and pharmaceutical services in primary medical and health institutions so as to provide a reference for improving relevant policies.Methods Multi-stage stratified random sampling was used to collect questionnaires from primary medical and health institutions in 5 provinces,and 102 questionnaires were distributed.Then Excel 2016 and IBM SPSS 21.0 software were applied for descriptive statistical analysis,chi-square test and multiple response analysis.Results and Conclusion A total of 92 primary medical and health institutions participated in the survey,and 92 valid questionnaires were recovered.The survey shows that 54.1%of the institutions have established more than 8 pharmaceutical administration regulations.63.5%and 31.8%of the institutions have formulated pharmaceutical administration and pharmacotherapy team charters(or management systems).29.7%of institutions have pharmacy personnel in accordance with relevant regulations.The higher proportion of pharmacy services are prescription review and adjustment,medication guidance,collecting and reporting adverse reactions,medication errors and medication hazard information.Primary medical and health institutions still need to further improve their pharmaceutical administration system,organizational structure,pharmacy professional training and clinical pharmacy service.

我国社区居家养老服务政策的变迁:历程、逻辑与展望——基于历史制度主义的分析

完善社区居家养老服务政策既是健全基本养老服务体系的内在要求,也是在“好好过日子”文化语境下实现“老有所养”的重要抓手。基于历史制度主义分析发现,我国社区居家养老服务政策经历了初步探索期、逐步成型期、快速发展期、提质增效期的变迁历程。从演变逻辑来看,制度背景催生了社区居家养老服务政策设立,关键节点影响了社区居家养老服务政策变迁,路径依赖驱动了社区居家养老服务政策强化。未来需要通过政策迭代升级,彰显社区居家养老服务作为准公共产品的社会性、公共性与生活性,推动社区居家养老服务高质量发展。

机构养老的合法化:家庭与机构的协作

通过实地调查,本文探讨了机构养老何以被人们所接受。研究发现,家庭与机构的协作促成了养老观念的改变,若仅靠一方努力,机构养老的合法化将难以实现:一方面,养老家庭亲子双方均持续为机构养老争取合法性,重建对养老机构的认知并应对外界的污名;另一方面,养老机构也在通过争取专业性、制度政策性和社会文化性认可来回应外部偏见。最终,在代际情感及功能交换被强化的同时,机构养老获得了承认。本文通过梳理家庭成员作为个体行动者与机构作为组织行动者的行动以及二者之间的关系,阐释了机构养老在孝道文化深厚的中国社会被接受的机理,弥补了养老观念研究对养老机构行为的忽视,打破了既有文献重家院对立、轻家院合作的局面,将对家庭与机构二元分野的弥合提升到了认知层面。

基于DEA-Malmquist模型的养老机构供给效率研究

目的 评价国内养老机构服务供给效率,了解国内养老机构服务供给现状。方法 应用数据包络分析法对2016—2020年的国内养老机构相关数据进行分析,评估国内养老机构服务供给效率。结果 2016年国内养老机构服务供给的综合技术效率、纯技术效率和规模效率分别为0.872、0.891和0.976,2020年分别为0.940、0.959和0.980。2016—2020年全要素生产率指数均值为0.988,综合技术效率上升2.2%,纯技术效率上升2.0%,技术进步均值下降3.3%。结论 养老机构的整体管理和技术水平是影响服务供给综合技术效率的主要因素。服务供给效率省际发展不均衡,区域间服务供给效率差距有所减小。技术进步是影响养老机构服务供给效率的主要因素。建议提高对养老机构管理水平的重视程度,合理配置养老机构资源,通过加强技术研发、加强养老人才队伍建设等方式提高国内养老机构服务供给效率。

论我国孝道传统下老年人长期照护制度的构建

确立于儒家孝道思想下的以子女为义务主体的传统老年人照护模式,因日益严峻的人口情势而难以维系,亟待建立一整套完善的老年人长期照护体系。基于此,一方面要积极学习和借鉴西方发达国家业已形成的、成熟有效的相关制度,另一方面要继承在我国流传了两千多年的儒家孝道思想。在不动摇传统子女赡养模式的前提下,通过将子女和国家共同作为老年人长期照护的义务主体、积极推进国家出资保障长期照护底线、设立强制性的专门的长期照护保险金制度等制度构建,建立起富有中国特色的老年人长期照护制度。

积极老龄化视角下农村互助养老模式的功能分析

从健康、参与、保障等3个方面对农村互助养老模式的功能进行分析,认为农村互助养老模式有利于增进农村老年人健康、促进农村老年人多方面的参与、提升农村老年人的保障水平,指出制度化是农村互助养老模式持续发展的基本条件,建议从探索相关法律法规依据、强化资金保障机制建设、加强安全管理机制建设、加强考评机制建设等方面进行制度化安排。

山东省基层妇幼保健机构资源效率的空间分布

目的 研究山东省县(区、市)级妇幼保健机构资源效率的空间分布特征及聚集性,为妇幼保健机构资源效率的提升提供科学依据。方法 用ArcGIS 10.5软件进行Moran’s Ⅰ空间自相关分析和Getis-Ord G~*热点分析。结果 目前,山东省还有13家(占9.42%)基层妇幼保健机构没有开展门诊服务,41家(占29.71%)未开展住院服务。山东省基层妇幼保健机构的日均住院工作负担和床位使用率呈空间正相关(Moran’s Ⅰ=0.194,P=0.001;Moran’s Ⅰ=0.223,P < 0.001)。Getis-Ord Gi~*热点分析显示,日均门急诊工作负担、日均住院工作负担和床位使用率均存在热点和冷点聚集区域。其中,热点区域主要分布在临沂、潍坊和烟台等市,冷点区域主要分布在济南市、青岛市、东营市和菏泽市。结论 山东省基层妇幼保健机构的资源使用效率指标具有空间异质性,应密切关注冷热点区域,分类指导、统筹规划,提高妇幼保健资源的利用效率。

我国社会组织参与居家照护服务供给问题研究——基于组织合法性的视角

社会组织参与居家照护服务供给是满足失能老年人居家照护需求的重要途径。从组织合法性的视角来看,现阶段我国社会组织参与居家照护服务供给严重不足,面临着诸多合法性问题。在规制合法性方面,政府缺少清晰、明确的政策和激励措施;在规范合法性上,“他者”对社会组织参与居家照护服务的角色期待与实践存在偏差,社会组织缺乏主体意识;在文化—认知合法性层面,社会组织参与居家照护服务的老龄社会文化尚未形成。基于此,社会组织参与居家照护服务供给的合法性亟待提升。其途径是制定明晰的社会组织参与居家照护政策,构建社会组织参与居家照护的社区治理共同体,培育社会组织参与居家照护的老龄社会文化。

日本构建“地域综合照护体系”政策理念的提出及其制度化

在财政恶化、少子老龄化、家庭看护功能弱化及雇佣的非正式化背景下,为建设能够提供高质高效服务的社会养老保障体制,基于连续性照护为目标的社区居家服务的照护理念,日本政府提出了以构建"地域综合照护体系"为政策理念的社会养老保障制度改革。通过对社会保障制度相关法律的改革,使构筑"地域综合照护体系"政策理念得以制度化。目前,各地方政府及公共团体在日本厚生劳动省的推动下依据《护理保险法》及本地特点,正在从充实强化护理保险服务、强化与医疗的合作、推进护理预防、确保生活支援服务、完善居住环境等方面推进"区域综合照护体系"的构筑。

上海妇幼保健系统党员和业务骨干“双培养”工作现状与对策建议

目的调查当前上海市妇幼保健机构党员和业务骨干“双培养”工作现状,对本系统人才队伍建设提出对策建议,为打造一支政治过硬、业务精湛、作风优良的妇幼健康人才队伍打好基础。方法通过召开1场人才工作专题会,发放17张机构调查表和321份调查问卷,到3个区妇幼保健院(所)实地调研,收集17家机构工作总结等方式,了解2020—2022年上海市、区两级17家妇幼保健机构党员和业务骨干“双培养”工作情况。结果上海妇幼保健系统党员和业务骨干“双培养”工作在机制建设、思想引领和培养方式上已经取得一定成效,但在受访者中,仍有39.75%对该项工作不了解;57%的非党员业务骨干不愿意或不确定是否入党;82名非业务骨干党员认为自身与业务骨干在工作格局(27.27%)、管理能力(24.43%)、业务能力(14.2%)和人际沟通能力(11.93%)等方面存在差距。结论本市妇幼保健系统要进一步加强党员和业务骨干“双培养”工作的推进力度:一要立足“党管”、立足“精准”、立足“长远”;二要加强对业务骨干思想引领和文化引领;三要实现党员工作格局、职业素养和综合实力三方面超越,从而不断提升人才素质,夯实妇幼事业的人才基础。

基于新制度主义对我国社区照顾宁养患者的援助机制研究

作为制度存在的社区照顾与宁养服务,在理论层面具有契合的可能性,但在实践过程中却出现了制度拒斥现象,其根源于物质性实践与象征性符号的分疏。因此,在建构社区照顾宁养患者援助机制时,需基于新制度主义视角从政府规制、学术规范、实践融入及教育传递等方面,让社区照顾癌症患者的过程中纳入宁养服务的象征性符号。

制度化养老的意外后果及其风险分配——基于纵向多案例研究

论文采取多案例研究方法,分析为规避养老风险的制度可能存在的风险性问题,其中有养老制度本身所造成的直接风险,也有其他政治、经济、文化和社会制度所造成的间接风险。从多主体合作互补风险治理以及风险均衡分配角度,分别阐述和修正了多个主体的养老风险承担和养老责任,以达到符合社会正义原则的目的。

中国福利机构孤残儿童家庭寄养模式之探讨——以南昌市社会福利院为实证

生活在中国社会福利机构中的孤残儿童是一个特殊的群体。他们主要是无法定义务监护人的孤残儿童和查找不到亲生父母的社会弃婴。长期以来,儿童福利机构为这些孤残儿童的健康成长,做了大量艰苦细致的工作。但是,儿童福利机构作为家庭的替代形式集中为儿童提供照料时,在很大程度上并不能满足儿童成长中的情感需求,长期生活在福利机构中的儿童往往会出现性格孤僻、心理封闭、缺乏自制力与上进心、社会适应能力差等方面的问题。而实行家庭寄养则可以较好地弥补机构照料在这方面的缺欠,显现出满足儿童身心需要方面的明显优势。

外形化与扩散:制度环境变迁中的非营利养老服务机构

利用组织社会学的新制度主义理论分析在制度和市场环境变迁下养老服务组织形式选择。研究发现,出于合法性追求养老服务组织表现出较高的制度化倾向,同时在强福利制度逻辑作用下,非营利组织通过“外形化”策略在新兴的中低端养老服务领域迅速扩散并占据主导位置。在扩散过程中外形化的“分离”程度开始收敛,却也出现了更为隐蔽的“联合企业型”非营利养老服务机构。新的外形化模式受“经济人”惯习驱动,是在强福利制度逻辑作用下适应新制度环境的产物。建议对于非营利养老服务机构加强监管和规制,对于组织服务外包行为进行分类管理。

家庭参与老年人机构养老行为及意愿量表的研制及信效度检验

目的研制家庭参与老年人机构养老行为及意愿量表并评价其信效度。方法采用文献回顾法、半结构访谈法和2轮德尔菲专家咨询法形成量表初稿。对郑州市6家养老机构326名老年人家庭成员进行问卷调查检验量表的信度和效度。结果正式量表分为家庭参与机构养老行为和家庭参与机构养老意愿2个分量表,探索性因子分析2个分量表分别提取6个公因子,方差累积贡献率分别为66.054%和72.643%,2个分量表共有32个条目,Cronbach′sα系数分别为0.950和0.941,重测信度分别为0.905和0.960。结论家庭参与老年人机构养老行为及意愿量表具有较好的信效度,可用于评价我国家庭参与老年人机构养老的行为和意愿。