社区卫生站护士对医院-社区-家庭慢性病一体化管理体验的质性研究

摘要

Objective To explore district nurses' experience with hospital-community-family integrated management of chronic diseases.Methods Fifteen district nurses were interviewed by semi-structured interviews,and data were analyzed by Colaizzi's seven-step method.Results Three themes emerged:Theme 1,integration of chronic diseases was accepted by patients gradually,but collaboration with tertiary hospitals was needed;theme 2,government's guidance contributed to the development of integrated management of chronic diseases;theme 3,integrated management of chronic diseases still faced challenges.Theme 3 contained four sub-themes:limited self-preparedness;limited community medical resources and authority;unsatisfied residents' medical service and dispensing;imperfect information sharing platform.Conclusion Integrating existing medical resources,enhancing collaboration with tertiary hospitals,solving conflicts between residents' needs and primary health care resources,enhancing competency of district nurses are main tasks for advancing management of chronic disease.%目的 了解社区护士对开展医院-社区-家庭慢性病一体化管理的体验.方法 对15名社区卫生站护士进行半结构式访谈,并用Colaizzi七步法分析资料.结果 提炼出3个主题:主题1为慢性病一体化逐步得到患者的认可,但还需三级甲等医院的配合;主题2为政府的引导促进了慢性病一体化管理的发展;主题3为慢性病一体化管理依然存在挑战.其中主题3包括4个次级主题:护士自身储备不完善;社区医疗资源不足,治疗权限受限;居民就医难、配药难诉求未完满解决;共享信息平台不完善.结论 整合现有医疗资源,提升三级甲等医院在慢性病管理中的配合度,解决居民需求与基层医疗资源及权限之间的矛盾,提高站点护士的岗位胜任力是慢性病管理继续发展的主要任务.