医联体内开展专科护士多点执业的态势分析

doi:10.3761/j.issn.1672-9234.2023.06.003

摘要/Abstract

摘要：

该研究利用态势分析法综合分析了医联体内专科护士多点执业的内部环境（优势、劣势）和外部条件（机会、威胁）。其中，在医联体内开展专科护士多点执业的优势包括专科护士多点执业的态度积极、专科护士专业能力突出、容易融入其他执业医院、便于破除第一执业单位的限制；劣势包括部分下级医院医疗条件有限、专科护士的精力有限、第一执业单位成本高；机会包括政策的大力支持、医联体发展的需要、专科护理的发展、患者的需求；威胁包括医院的管理难度增加、相关配套政策不完善、多点执业发展不成熟、患者对多点执业缺乏了解。提示在实践过程中需要政府、医联体、医院三方协同合作，从不同层面助力医联体内专科护士多点执业的实施。

关键词: 医联体, 专科护士, 多点执业, 态势分析

Abstract:

SWOT analysis method was used to comprehensively analyze the internal environment（strengths and weakness） and external conditions（opportunity and threats） of multi-point practice of specialty nurses in medical consortium in this paper. The strengths of multi-point practice of specialty nurses in the medical consortium include positive attitude towards multi-point practice of specialty nurses，outstanding professional ability of specialty nurses，easy integration into other practicing hospitals，and easy to break the restrictions of the first practicing unit. The weakness include limited medical conditions in some lower-level hospitals，limited energy of specialty nurses，and high cost of the first practice unit. The opportunity include policy support，development of medical consortiums and specialized care，and patient needs. The threats include increased difficulty in hospital management，incomplete supporting policies，immature development of multi-site practice，lack of patient understanding of multi-site practice. It indicated that the government，the medical consortium and the hospital need to cooperate with each other to help implement the multi-point practice of specialty nurses in the medical consortium from different levels in the process of practice.

Key words: Medical consortium, Specialty nurse, Multi-point practice, SWOT analysis

魏黎华,郑莉兰,甘青文. 医联体内开展专科护士多点执业的态势分析[J]. 中华护理教育, 2023, 20(6): 655-660.

WEI Lihua,ZHENG Lilan,GAN Qingwen. SWOT analysis of multi-point practice of specialty nurses in medical consortium[J]. Chinese Journal of Nursing Education, 2023, 20(6): 655-660.

参考文献 38

[1]	新华社. 上海医改重要一步:首个区域医疗联合体签约组建[EB/OL]. (2011-01-28)[2020-11-24]. http://www.gov.cn/jrzg/2011-01/28/content_1794622.htm.
[2]	赵汝成, 胡滨. 医联体背景下医务人员对开展多点执业的意向调查研究[J]. 中国全科医学, 2018, 21(14):1738-1743. doi: 10.3969/j.issn.1007-9572.2018.14.020
[3]	熊莉娟, 徐玉兰, 谭蕾, 等. 医联体背景下护理帮扶专科联盟的构建与实施[J]. 护理研究, 2021, 35(21):3834-3838.
	Xiong LJ, Xu YL, Tan L, et al. Construction and implementation of specialty nursing assistance alliance under the background of medical treatment combination[J]. Chin Nurs Res, 2021, 35(21):3834-3838.
[4]	祝乃娟. 护士多点执业助力新医改[N]. 21世纪经济报道, 2015-05-13(4).
[5]	余思萍, 杨春梅, 潘碧, 等. “互联网+护理服务”SWOT分析[J]. 护士进修杂志, 2021, 36(3):203-205.
	Yu SP, Yang CM, Pan B, et al. SWOT analysis of “Internet plus nursing service”[J]. J Nurses Train, 2021, 36(3):203-205.
[6]	施小青, 潘红英, 王海芳, 等. 苏州市三级医院专科护理门诊护士执业现状及多点执业意愿调查[J]. 护理学杂志, 2019, 34(17):47-50.
	Shi XQ, Pan HY, Wang HF, et al. Current nursing and willingness towards multi-sites practice among nurses in nurse-led clinics from tertiary hospitals in Suzhou[J]. J Nurs Sci, 2019, 34(17):47-50.
[7]	江静云, 祖百法, 王秀丽, 等. PICC与伤口造口专科护士多点执业认知及意愿调查[J]. 护理学杂志, 2019, 34(18):68-71.
	Jiang JY, Zu BF, Wang XL, et al. Perceptions and willingness to multi-site practice among certified PICC and wound ostomy nurses[J]. J Nurs Sci, 2019, 34(18):68-71.
[8]	李瑶, 刘维维, 关欣. 专科护士对护士多点执业的认知与准备度现状研究[J]. 护理管理杂志, 2019, 19(7):479-483.
[9]	赵炳南. 沈阳市护士多点执业意愿与认知情况的调查研究[J]. 中国实用护理杂志, 2018, 34(27):2086-2090.
[10]	於舒, 马建芬. 护士多点执业的现状分析与发展建议[J]. 护理研究, 2019, 33(10):1806-1807.
	Yu S, Ma JF. Analysis of state quo and development suggestions on nurse’ multi-sites practice[J]. Chin Nurs Res, 2019, 33(10):1806-1807.
[11]	薛小静, 曾丹. 基于岗位管理的基层医院专科护士使用及考核的现状调查研究[J]. 护士进修杂志, 2020, 35(6):572-575.
	Xue XJ, Zeng D. Investigation and study on the current situation of the use and assessment of specialized nurses in primary hospitals based on post management[J]. J Nurses Train, 2020, 35(6):572-575.
[12]	方茗依, 丁莎莎, 陈榆婧, 等. 杭州市“互联网+家庭护理”服务在家庭和社区的需求调研[J]. 医学信息, 2018, 31(14):120-121,125.
[13]	丁炎明, 吴欣娟, 王秀英, 等. 我国地市级以上护理学会专科护士培训的调查研究[J]. 中华护理杂志, 2020, 55(5):747-750. doi: 10.3761/j.issn.0254-1769.2020.05.023
	Ding YM, Wu XJ, Wang XY, et al. Investigation on training of specialized nurses developed by nursing associations at all levels in China[J]. Chin J Nurs, 2020, 55(5):747-750. doi: 10.3761/j.issn.0254-1769.2020.05.023
[14]	丁舒, 黄静, 李婷婷, 等. 护理专科门诊护士执业现状调查[J]. 中国护理管理, 2017, 17(10):1302-1306.
[15]	Buerhaus P, Perloff J, Clarke S, et al. Quality of primary care provided to medicare beneficiaries by nurse practitioners and physicians[J]. Med Care, 2018, 56(6):484-490. doi: 10.1097/MLR.0000000000000908 pmid: 29613873
[16]	孙迪, 张旭, 侯秀欣. 护士多点执业认知的质性研究[J]. 护理学杂志, 2018, 33(12):52-55.
	Sun D, Zhang X, Hou XX. Nurses’ knowledge of multi-site practice:aqualitative research[J]. J Nurs Sci, 2018, 33(12):52-55.
[17]	刘秋霞, 余思萍, 孙鸿燕, 等. 我国护士多点执业影响因素的鱼骨图分析[J]. 护理学报, 2020, 27(18):25-28.
[18]	高凤莉. 推动医联体模式下优质护理资源向基层辐射[J]. 中国护理管理, 2017, 17(5):577-579.
[19]	唐喻莹, 徐杉, 李娜, 等. 护士多点执业的利弊分析与建议[J]. 中华护理杂志, 2017, 52(1):119-122.
	Tang YY, Xu S, Li N, et al. Insights and analysis on nurse’s multiple-sites practice[J]. Chin J Nurs, 2017, 52(1):119-122.
[20]	何鹤, 陈银海, 何井华, 等. 我国医联体进展现状研究[J]. 实用医学杂志, 2017, 33(24):4193-4196.
[21]	杜宁, 王仁秀, 邹振亚, 等. 专科护士多点执业的研究进展及启示[J]. 护理学报, 2020, 27(21):23-26.
	Du N, Wang RX, Zou ZY, et al. Research progress and enlightenment of multi-point practice of specialist nurses[J]. J Nurs China, 2020, 27(21):23-26.
[22]	王咏梅, 鞠永和, 苗木. 医联体下医师多点执业的机遇与困境[J]. 现代医院管理, 2018, 16(2):55-57.
[23]	“十三五”全国卫生计生人才发展规划[EB/OL].(2017-07-20). https://www.ndrc.gov.cn/fggz/fzzlgh/gjjzxgh/201707/t20170720_1196850.html.
[24]	广东省卫生计生委, 广东省中医药局. 广东省持续改善护理服务重点工作方案[EB/OL].(2015-05-11)[2018-06-05]. http://www.gdwst.gov.cn/a/zcwj/2015051513562.html.
[25]	严慧芳. 护士“多点执业”能否破解居家养老难题[N]. 南方日报, 2018-05-09(B02).
[26]	北京市卫生和计划生育委员会. 北京市护理事业发展实施方案(2017—2020年)[EB/OL]. (2017-03-16)[2018-06-05]. http://wjw.beijing.gov.cn/zwgk/ghjh1/201703/t20170323_212522.htm.
[27]	李秀华委员呼吁出台专科护士培训制度及《护士法》[J]. 中华护理教育, 2016, 13(5):401.
[28]	丁宁, 陈稳, 胡豫, 等. 跨区域专科医联体建设的实践探索与思考[J]. 中国医院管理, 2019, 39(9):68-69.
[29]	纪京昀, 吴芳琴, 李靖. 护士多点执业认知的调查与分析[J]. 中华护理杂志, 2017, 52(1):115-118.
	Ji JY, Wu FQ, Li J. Cognitive analysis on nurses’ multiple-sites practice from nurse groups[J]. Chin J Nurs, 2017, 52(1):115-118.
[30]	王静, 孙瑞玲. 从供给侧结构性改革视角看三级医院医疗资源下沉[J]. 中国医院管理, 2016, 36(11):30-32.
[31]	杨婧怡, 冯跃林. 重庆市医务人员分级诊疗制度认知现状调查[J]. 医学与社会, 2018, 31(4):4-6,26.
[32]	陈晓琳, 项琴, 苏思铭, 等. 病人对护士多点执业政策的认知与需求调查[J]. 护理研究, 2019, 33(18):3218-3222.
	Chen XL, Xiang Q, Su SM, et al. Survey on patients’ cognition and requirements on nurses’ multi-site practice policy[J]. Chin Nurs Res, 2019, 33(18):3218-3222.
[33]	童佳佳, 葛云霞, 刘晓蓉. 伤口造口专科护士联合居家护理平台上门助诊护理模式的实践[J]. 中西医结合护理(中英文), 2018, 4(5):12-15.
[34]	董敏, 杨旭红, 郑敏, 等. 慢性伤口患者对专科联盟基层医院卫生服务需求调查[J]. 护理学杂志, 2020, 35(1):55-56,69.
	Dong M, Yang XH, Zheng M, et al. Patients’ demands for chronic wound services provided by primary hospitals joined in professional wound leagues[J]. J Nurs Sci, 2020, 35(1):55-56,69.
[35]	Catania K, Askew T, Birkhimer D, et al. From unit based to population focused:transforming the role of oncology clinical nurse specialists[J]. Clin Nurse Spec, 2012, 26(2):103-106. doi: 10.1097/NUR.0b013e31824590d0
[36]	徐倩, 张燕, 盛芝仁, 等. “网约护士”上门服务真实工作体验的现象学研究[J]. 中华现代护理杂志, 2020, 26(31):4317-4322.
	Xu Q, Zhang Y, Sheng ZR, et al. Phenomenological study on real work experience of “online nurses” door-to-door services[J]. Chin J Mod Nurs, 2020, 26(31):4317-4322.
[37]	Huang RD, Xu M, Li XT, et al. Internet-based sharing nurse program and nurses’ perceptions in China:cross-sectional survey[J]. J Med Internet Res, 2020, 22(7):e16644. doi: 10.2196/16644
[38]	王丽婷, 唐浪娟, 岳丽春, 等. 护士从事互联网居家护理服务工作体验的研究[J]. 中华护理杂志, 2020, 55(7):1067-1071. doi: 10.3761/j.issn.0254-1769.2020.07.020
	Wang LT, Tang LJ, Yue LC, et al. The study on work experience of nurses in Internet home-care service[J]. Chin J Nurs, 2020, 55(7):1067-1071. doi: 10.3761/j.issn.0254-1769.2020.07.020