残疾人家庭医生签约护理服务可行性的质性研究  

A qualitative study on the feasibility of contracted nursing services for disabled persons

作　　者：丁兰[1] 王瑜 丁静[1] 蔡澍[1] 刘宇春 杜雪平[1] Ding Lan;Wang Yu;Ding Jing;Cai Shu;Liu Yuchun;Du Xueping(Yuetan Community Health Service Center,Fuxing Hospital,Capital Medical University,Xicheng District,Beijing 100045,China;Baizhifang Community Health Service Center,Xicheng District,Beijing 100054,China)

机构地区：[1]首都医科大学附属复兴医院月坛社区卫生服务中心,北京100045 [2]北京市西城区白纸坊社区卫生服务中心,北京100054

出　　处：《中华全科医师杂志》2022年第10期947-952,共6页Chinese Journal of General Practitioners

基　　金：北京市社会科学基金项目(18SRB005)。

摘　　要：目的了解《残疾人家庭医生签约服务指导手册》(简称《手册》)中社区护士提供的服务内容在残疾人服务实践中的可行性,以及对残疾人家庭医生签约服务的指导作用,为修改完善《手册》提供依据。方法2020年8—10月,采用目的取样法选取首都医科大学附属复兴医院月坛社区卫生服务中心和北京市西城区白纸坊社区卫生服务中心的社区护士为受访对象,采用半结构化访谈,由研究小组2名成员使用访谈大纲,根据信息饱和原则最终访谈12名社区护士。研究小组成员对访谈内容进行实地笔记、录音和转录、编码提炼主题,并与受访者反馈、确认主题的准确性。结果全部受访护士对《手册》中要求社区护士为残疾人提供建档、预约就诊、诊前诊后服务、家庭护理、残疾人及家属的康复护理指导、转介服务及延伸护理服务等基本医疗和基本公共卫生服务内容均表示基本可以完成;全部受访护士均表示《手册》对残疾人签约服务工作有指导作用;8名受访护士认为《手册》中的转介服务和康复护理技术指导内容尚不满足实际工作需要,需要补充完善;9名受访护士提出在服务实践中与各种类型残疾人沟通存在沟通不足的现象,特别是与视力、听力、精神障碍者及残疾儿童等在就诊过程中有沟通障碍,影响护理服务质量;7名受访护士表示难以长期持续免费为残疾人提供家庭护理。结论《手册》具有可行性,对残疾人签约服务有指导作用,能帮助社区护士关注残疾人的照护特点;手册需要增加转介服务、康复护理技术指导内容以及与各类残疾人的沟通知识,以提升对残疾人的服务能力。Objective:To investigate the feasibility of contracted nursing services for disabled persons.Methods:A qualitative study on the feasibility of contracted nursing services for disabled persons was conducted from August 2020 to October 2020 with the phenomenological method. Community nurses were selected with the purpose of sampling method from Yuetan and Baizhifang Community Health Service Centers in Beijing Xicheng District for semi-constructed interviews, and 12 community nurses were finally interviewed according to the principle of information saturation. The research team took field notes, audio recordings and transcriptions of the interviews, coded to refine the themes, and fed back with the respondents to confirm the accuracy of the themes.Results:All the interviewed nurses thought that the contents of basic medical and public health required by the Guidance manual of contracted services of family doctors for disabled persons (the manual) including basic documentation, appointments, pre-diagnosis and post-diagnosis services, home care, rehabilitation nursing guidance, referral services and extended nursing services for the disabled and their families could be completed. All interviewees said that the manual had a guiding role in contracted services for disabled persons. Eight interviewed nurses believed that the manual involved referral services and rehabilitation care, but the technical guidance content did not meet the actual work needs and it should be supplemented and improved;9 interviewees pointed out that there was a lack of communication with various types of disabled people in service practice, especially for those with vision, hearing, mental disabilities and disabled children;7 interviewees said that it the free home care for the disabled was not sustainable. Conclusion:The contracted nursing services for disabled persons are feasible and the manual has a guiding role for the practice,and some contents need to be added in the manual to further improve service capacity for disabled people.

关 键 词：护士 残疾人 社区卫生服务 定性研究 半结构化访谈 

分 类 号：R47[医药卫生—护理学]