压力性损伤居家老年患者医院-社区-家庭三元联动护理实践  

The hospital-community-family linkage nursing practice of elderly patients with stress injury at home

作　　者：王巍[1] 张欣[2] 李越[3] 聂志红 张冬梅[4] WANG Wei;ZHANG Xin;LI Yue;NIE Zhihong;ZHANG Dongmei

机构地区：[1]首都医科大学附属北京同仁医院外科,北京市100730 [2]首都医科大学附属北京同仁医院伤口治疗中心,北京市100730 [3]首都医科大学附属北京同仁医院护理部,北京市100730 [4]北京市东城区社区卫生服务管理中心

出　　处：《中华护理杂志》2021年第8期1225-1229,共5页Chinese Journal of Nursing

基　　金：首都卫生发展科研专项(2020-3-1182)。

摘　　要：总结压力性损伤居家老年患者医院-社区-家庭三元联动护理实践经验。护理要点包括:明确医院及社区职责,成立医院-社区联动护理合作团队,加强组织管理;加强社区医护人员培训,提高伤口管理能力;制订压力性损伤居家老年患者评估记录单,提高社区医护人员伤口评估能力;及时会诊,指导社区医护人员进行伤口管理;建立医院-社区双向转诊,实施分级治疗;加强多学科协作,促进伤口愈合;开展延续性居家护理,提高患者及其照护者配合治疗、护理的依从性。经医院-社区-家庭三元联动护理,30例压力性损伤居家老年患者中,治愈26例,好转4例,治愈率达86.67%。We summarized the nursing experience of the hospital-community-family nursing model in the treatment of elderly patients with stress injury at home.The key points of nursing care were clarifying the responsibilities of the hospital and community,establishing hospital-community linkage nursing cooperation teams,and strengthening organization and management;strengthening the training of community medical staff in wound management skills to improve wound management capabilities;formulating home assessment scale for elderly patients with pressure injury to improve the wound assessment ability of community medical staff;timely consultations to guide community medical staff in wound management;establishing hospital-community two-way referrals and implementing hierarchical treatment;strengthening multidisciplinary collaboration and promoting wound healing;carrying out continuous home care,and improving the compliance of patients and caregivers with treatment and nursing.Among 30 patients with elderly pressure injury at home in this group,26 of them achieved wound healing and 4 improved,with a cure rate of 86.67%.

关 键 词：压力性损伤 老年人 社区卫生服务 转诊和会诊 护理 

分 类 号：R473.6[医药卫生—护理学]