The importance of continuous nursing

The combination of medical care and nursing care is an important support for building a health service system for the elderly, and it is also an internal demand for improving the quality of life of the elderly. Continuous nursing is an important bridge between hospital and family for the elderly. What are the current modes of continuous nursing? What is the significance of continuous nursing care for the family rehabilitation of patients with chronic diseases? With these questions, the reporter interviewed Li, president of Yunnan Caring for the Elderly Association.

The concept was born early and developed slowly.

Dean Li told reporters that continuous nursing is to ensure that patients get coordinated and continuous care from different specialties in different medical and health care places (such as from hospital to home) and the same medical and health care place (such as different departments of the hospital) through a series of actions. It usually refers to the continuity from hospital to family, including the hospital's discharge rehabilitation plan, referral, and continuous follow-up and guidance after patients return to their families or communities. The concept of medical service first appeared in 1947 and was put forward in a research report of the United States Joint Commission. With the deepening of social aging, continuous nursing service is the requirement of the government for the reform of nursing service industry, and it is also a concrete and effective measure for the nursing industry to implement the "Healthy China 2030 Plan".

We can compare continuous nursing to a bridge, and its two ends are medical service and old-age service respectively. Continuous nursing does not emphasize direct long-term care for discharged patients, but helps patients and their families improve their self-care ability. The guidance for patients is based on evidence, which usually includes medication guidance (drug name, adverse drug reactions, medication methods, drug coordination, etc.). ); Dietary guidance (provide personalized guidance according to the patient's condition, eating habits, ability to pay, etc.). ); Symptom management and identification (identification and response of worsening symptoms after discharge); Family environment guidance (providing corresponding suggestions, the use of assistive devices, rehabilitation training, etc.). ); Utilization of community resources; Help patients in need and their families to contact family care and social workers.

Continuous nursing was first put forward in China in 1990s, and now it has been listed as one of the assessment items for hospital medical staff. However, due to the shortage of medical resources, there is not enough manpower and material resources to carry out continuous nursing from hospital to community. Anyway, the medical staff are too busy. At the same time, there is also the problem of practicing authority and the limitation of experience and professional ability.

Continuous nursing is an important "bridge" to realize the combination of medical care and nursing.

There are many modes of continuous nursing.

According to many years' working experience, Dean Li will take us further to understand what continuous nursing is and how to do it well. She pointed out: Continuous nursing refers to continuous care and nursing for patients and their families through communication and cooperation during hospitalization or after discharge, so as to improve the treatment effect or recovery speed. The usual continuous nursing probably has the following modes:

Telephone follow-up. This is a kind of continuous care that cancer patients' families will basically accept. There is a doubt in everyone's heart, why is it the family and not the patient? As mentioned above, the objects of continuous care include both patients and their families. Although telephone follow-up is only a simple greeting to patients and their families, it is not only a direct way for doctors to grasp the recent state of patients, but also can make patients feel concerned after discharge, which has the function of soothing patients' hearts and guiding patients to maintain a healthy lifestyle.

Establish a hospital WeChat public platform. Today, with the popularization of information technology, this method is often adopted by hospitals and loved by patients, which is convenient and fast.

Set up a nurse information desk. Most hospitals in China have nurse consultation desks, and the First Affiliated Hospital of Kunming Medical University has nursing clinics such as wound stoma, PICC, diabetes health consultation, pain care, etc., and accepts consultation from discharged patients.

Form a patient club. Patients' clubs are generally organized by hospitals. In this club, patients and their families can share the joys and sorrows, share the experience of disease resistance and encourage each other. At the same time, some nursing knowledge competitions will be organized to improve the knowledge level of patients and their families on disease rehabilitation nursing. The Third People's Hospital of Kunming regularly holds "Death Cafe" activities to educate patients and their families about life.

Establish a continuing care service center. In recent years, Southern Medical University, zhujiang hospital and others have successively set up "Continuing Care Service Center for discharged patients".

Other ways of continuing nursing include: evaluating the risk of readmission, making special rehabilitation plans for patients, establishing a registration form for nursing return visits, giving certain technical guidance to community medical staff, and carrying out community health education. Dean Li admits that due to the shortage of medical staff, relying on the hospital model can still be implemented, but the continuous care in the community is relatively scarce. The most common ones are free clinics and lectures, which are not targeted and systematic. The biggest difference in the service of "Didi Nurses Entering the Community" in our province lies in the one-on-one contact between nurses and patients, which improves the pertinence of health guidance in the process of getting familiar with each other.

Continuous nursing is an important "bridge" to realize the combination of medical care and nursing.

Significance of continuous nursing for family rehabilitation of patients with chronic diseases

Maintaining continuous diagnosis and treatment nursing, understanding comprehensive knowledge of family nursing and improving patients' health literacy and quality of life are the significance of continuous nursing for family rehabilitation of patients with chronic diseases. The head nurses and nurses who participated in the "Drip Nurses into the Community" activity all said so.

For patients with chronic diseases, it is usually necessary to toss and turn at home, hospitals and other places for a period of time. Continuous nursing can ensure that patients' treatment will not be interrupted or suspended because of environmental changes. Through continuous nursing, medical staff can inform patients and their families of basic nursing knowledge in detail, such as what they can eat more and eat less in daily life, whether they can do exercise, etc. If necessary, you can also teach patients and their families some basic nursing skills. Jason, a nurse in charge of endocrinology at the First People's Hospital of Guangdong Province, told the reporter: "In reality, most patients cannot form good living habits on their own after discharge. The reasons are as follows: weak self-control, lack of relevant knowledge, and negative mentality. Medical research has proved that through continuous nursing, patients can develop reasonable eating habits, go to bed early and get up early, and exercise moderately under the supervision of medical staff. " Zhi Juan, head nurse of rehabilitation department of Kunming Hospital of Traditional Chinese Medicine, pointed out that in order to realize pre-illness prevention and post-illness prevention, continuous nursing can only be realized by going deep into the community and the families of the elderly.

Continuous nursing is an important "bridge" to realize the combination of medical care and nursing.

President Li of Yunnan Geriatric Nursing Association has a deeper thinking on the accessibility of continuous nursing. She believes that it is unrealistic to rely solely on hospitals to arrange medical staff to enter the community to provide continuous care. In the Internet era, continuous nursing urgently needs to rely on new carriers to establish service interfaces with unified technical standards, which can allow more health service providers to participate in activities and realize the marginal effect of institution-oriented, community-assisted and society-linked. Let more and more comprehensive resources enter this industry and develop together (such as the "excellent care+"continuous nursing service platform being used by major hospitals), promote the accessibility of the combination of medical care and nursing, and alleviate the shortage of medical resources. "Continuing nursing service in internet plus" is the trend of medical and health reform. Using information technology can alleviate the shortage of human resources for nurses to carry out health education. Take the project of "Didi nurses entering the community" in our province as an example. 20 nurses provide services for 60 elderly people, and 5 light consultations enjoyed by each elderly person are completed through the "excellent care+"community port.

Yunnan net reporter Yang Lei photo report