Abstract
Community nursing is to carry out health-centered, systematic and holistic nursing care to individuals, families and populations in the community, integrating prevention, health care, medical treatment, rehabilitation, health education and family planning technical guidance, and it is an important part of community health services. Community nurses should be familiar with and master the basic concepts, necessity, main contents, service objects, common measures of community nursing, and make clear the specificity of community nursing in terms of object and subject, so as to guide the community in terms of prevention, protection, and promotion, and to improve the quality of community nursing work.
Keywords community; nursing work; particularity
Community nursing is adapted to the health needs of community residents, accompanied by the gradual development of the community health service needs, therefore, community nursing is an important part of the community health service. Community nursing its development history is not long, if you look at it from the academic point of view, it is both a sub-discipline of the nursing profession, but also an emerging discipline that combines public **** health and nursing together. The author through the theory of general medicine and community nursing learning, combined with their own engaged in more than 20 years of hospital care and community nursing practice in recent years of comparison, y appreciate that, as a qualified community caregiver, should be familiar with and master the basic concepts of community nursing, understand the specificity of community nursing work, which has important practical significance to improve the quality of community nursing work.
1 Basic concepts of community nursing:
1.1 The basic meaning of community nursing Community nursing is to carry out health-centered, systematic and holistic nursing services within the community, providing individuals, families, and populations with a collection of preventive, health care, medical care, rehabilitation, health education, and family planning publicity and guidance as a whole.
1.2 Necessity of Community Nursing First, with the demographic changes, the concept of healthy aging, bringing many corresponding community health care needs; second, the changes in the spectrum of disease, the increase in the demand for community care of chronic diseases; third, the implementation of the national policy of family planning, the expansion of the family structure, a couple should take care of the four old people, which requires "simple, inexpensive" community care services, and the need for "simple, inexpensive" community care services, and the need to provide a comprehensive and comprehensive care services, Convenient, inexpensive" community care services; Fourth, the current high cost of medical care, residents can not afford, coupled with the phenomenon of difficult to see a doctor, difficult to hospitalization still exists objectively, which is the demand for community care has become more and more urgent.
1.3 The main content of community nursing work mainly includes prevention, protection and promotion of three aspects.
(1) prevention refers to the prevention of diseases and injuries, specifically in the community outpatient and family beds and other nursing services and participation in the cycle of physical examination, disinfection, epidemic prevention, vaccination and other health care activities;
(2) protection refers to the protection of residents from the environment of the invasion of harmful substances. Specifically embodied in the community to undertake the signing of service contracts, the establishment of family health records, prohibit smoking in public **** places, inspection of drinking water and food hygiene, limiting the environmental pollution of community room decoration and other health management;
(3) to arrange for some activities to promote the health of the community residents, specifically embodied in the organization of the community to carry out a number of community residents of the overall fitness of the beneficial activities as well as the propaganda of family planning and health care knowledge. The first is to organize some activities to promote the health of the community residents.
1.4 The service targets of community nursing are every person, every family, every group and every public **** health place in the community.
1.5 The main mode of community health services in China At present, there are three main modes: First, the community service station type, refers to the direct leadership of the health administrative department, the local hospitals to send a certain number of medical personnel in-depth community committees to set up a community health service station, to undertake the committees of the medical treatment, prevention, health care and rehabilitation and other tasks; the second is the type of community service center, refers to the establishment of a community service center within the local hospital, to undertake the local residents of the area under their jurisdiction, the community service center. The second is the community service center type, refers to the establishment of community service centers in the local hospitals, to undertake the community health service work of the neighborhood committees in the area under their jurisdiction; the third is the social participation type, refers to the urban areas and other street offices to take the lead, the grassroots hospitals to send people to guide the primary health care station composed of the neighborhood committee staff, retired medical personnel, short-term service trainers and community volunteers.
1.6 Common Measures for Community Nursing There are three main types of measures: first, educational measures. Education is to provide residents with information to encourage them to voluntarily change their lifestyles towards healthization. For example, educating residents on how to choose dietary methods and physical exercise methods that meet health requirements; the second is to take planning measures. Planning is a stronger form of exhortation, that is, through some care activities to reduce the factors in the environment that lead to risk. For example, vaccination against diseases, sterilization inspection of eating utensils in restaurants; Third, the use of coercive measures. Coercion is the use of force. For example, laws against abuse of the elderly and children, isolation of infectious diseases, and prohibition of inhalation of harmful chemicals. Community nursing should use these three measures to protect residents, prevent disease and disability, and promote health.
2 The special characteristics of community nursing work:
2.1 The special characteristics of community nursing in terms of object
2.1.1 In-depth social, community service object is the grass-roots level of the community Community nursing is a kind of public welfare-type service, which is different from the work of the hospital nursing, the object of the hospital nursing is the patient, and the object of the community nursing is the community of every household, every person and some public **** places. Therefore, community health care workers are deep into the grassroots of society, directly facing the community residents.
2.1.2 Relationships are diverse, and community service recipients are relatively stable Because community residents play a variety of social roles, with different social division of labor and social status. At the same time, community residents have different age structures and health conditions, and their nursing needs are also different. Therefore, the above situation determines the diversity of interpersonal relationships in community nursing. And this diversity is different from the temporary, short-term and individual nature of hospital care doctor-patient relationship, but with long-term, stability, recurrence and global. Therefore, the community health care personnel's enthusiastic service, hard work, perseverance and spirit is particularly important.
2.1.3 Distinguish between general, community service recipients should highlight the focus Due to the ageing of the world's population, coupled with the decline in the physical function of the elderly, the chances of illness are greater, and once the disease are more serious; children, especially young children, almost no sense of self-care, vulnerable to injury and disease; people with disabilities due to behavioral constraints, has historically been the care of the entire community; community a few A small number of poor people in the community with low income are living in difficulties, and their health problems deserve the attention of the government and society. In this regard, the World Health Organization (WHO) has put forward three major principles that must be followed in community care work, one of which is that "vulnerable groups (the elderly, the weak, the handicapped and the disabled) in the community should be prioritized as service recipients". Since women's health directly affects children's health, patients with chronic illnesses, patients with mental illnesses and other key care patients, in addition to receiving treatment in hospitals, they also need the comfort and help of community nursing services. Therefore, the elderly, women, children, disabled, special hardship cases and some key care patients mentioned above should be the focus of community nursing services.
2.1.4 Preventive health care, expanding the connotation of community nursing services As community nursing is health-centered, family-oriented, and the maintenance and promotion of the overall health of the residents as the direction of the long-term nursing activities. Therefore, community nursing is not only medical care, but the organic combination of medical care, prevention, rehabilitation, health care and health education, individual health care and group health care into one, so as to provide residents with comprehensive, continuous, convenient, fast, economical, high-quality health care services.
2.2 The specificity of the main body of community nursing
2.2.1 Health-centered, community nursing institutions are required to have "multi-functional" The main responsibility of community nursing is to regard the population as a whole, use health promotion, health maintenance, health education methods, directly to the community individuals, families and groups to provide coordinated and continuous care. The primary responsibility of community nursing is to provide a coordinated continuum of care directly to individuals, families, and groups within the community using health promotion, health maintenance, and health education methods to achieve health. Community nursing is centered on the maintenance and promotion of human health. Clinical care in hospitals is mostly focused on restoring people's health, while community care is not simply treating and caring for patients, but comprehensively providing services such as prevention, health care medical treatment, rehabilitation, health education and technical guidance on family planning, etc., and is commissioned by the health administrative department to undertake public ****health management functions within its jurisdiction. Community nursing generally has community health education, infectious disease prevention and control, environmental and occupational health management, family care, children's health care, women's health care, health care for the elderly, mental health and mental health care, end-of-life services for patients, and patients' pre-hospital emergency care and other service functions.
2.2.2 Group-oriented, requiring community nursing staff to become "general nurses" The basic responsibility of community nursing is to see the population as a whole, not just individuals and families. Therefore, community nursing work to collect and analyze the health status of the population, and then solve the main health problems in this group, even though community nurses care for individuals and families, but also to help the whole population to solve a work in health. The task of the community nurse extends from a single patient to caring for an entire population.
Therefore, this puts a high demand on the quality of practice of community nurses. A qualified community nurse should be able to act as care, education, consultation, organization, management, coordination, cooperation, observation, research and other roles. In different situations, different occasions, different time conditions, community nurses act as a role can play what effect, it depends on her knowledge, skills and flexible use of the situation.
2.2.3 "independent" as the main, requiring community nursing staff with autonomy Hospital nurses often work under medical advice, while community nurses because of the community nursing work of less management level, a wide range of work, and often in the situation of being alone, alone to carry out the task. Many work from preparation to operation, from implementation to the end, all rely on their own to grasp. Therefore, community nursing staff should have a strong "independence" and "autonomy".
2.2.4 "people-oriented", requiring community nursing staff to improve interpersonal and communication skills Hospital nurses in contact with patients, in addition to the main hospital medical staff, but community nurses in addition to medical staff to cooperate with each other, community nurses have to work with the local administration, welfare, education, enterprises and community residents and so on. Many people contact. Only by respecting the opinions of others and taking the initiative to cooperate with the relevant departments and personnel can community nursing be done well. Therefore, a community nurse must not only have clinical nursing theoretical knowledge and a certain amount of community work experience, but also must have a strong humanistic feelings and persistent dedication.
3 Guidance on the specificity of community nursing:
3.1 Guidance on the preventive aspects of community nursing
3.1.1 Community nursing should conscientiously implement the tasks of health work deployed by the higher levels, and actively carry out various operational activities Take the initiative to strengthen contact with the health authorities, street offices, neighborhood committees, and regularly report on their work. Do all the registration, record keeping and statistical work. All information statements should be timely, accurate, complete report, and file management.
3.1.2 Establishment and improvement of community nursing regulations and systems In order to ensure the safety of nursing work, and effectively prevent the occurrence of errors and accidents and medical infections, it must be clear that all types of personnel to strictly implement the disinfection and isolation, on duty, shift handover, inspection, checking, errors and accidents prevention and registration and reporting system, drug management, resuscitation, management of infectious diseases and reporting, treatment management system. Institutionalization and standardization of community nursing.
3.1.3 Actively carry out community preventive work Clearly dedicated people are specifically responsible for the prevention of health epidemics, planned immunization, food-based, chronic diseases.
3.1.4 Normal development of community medical work Usually focus on the diagnosis and treatment of common and frequent diseases, if necessary, to carry out family hospital beds, home care and related service matters, and to do a good job of the critical patients before admission to the hospital preliminary first aid and transfer work.
3.1.5 Focus on rehabilitation and health education Community nursing staff should accurately grasp the basic health status of the community population, the establishment of residents' personal, family and community health records, and keep abreast of information on the rehabilitation management of chronic diseases, surgical patients and people with disabilities. Usually in the community visits, rounds, in a variety of forms of physiological, psychological and other closely related to health knowledge education, change the patients, healthy people are not conducive to the health of the various customary behaviors, to improve the residents' self-care ability.
3.2 Guidance on community care and protection
3.2.1 Timely development of health and epidemic prevention work First, infectious patients to carry out the management of infected places and epidemiological investigations, inspections and guidance of collective units of disinfection and isolation; second, timely and accurate grasp of the vaccination object, and urge them to be vaccinated on time; third, to carry out immunization effect monitoring activities.
3.2.2 Focus on the systematic management of maternal, infant and young children First, to do a good job of perinatal health care publicity and guidance; second, to organize community women's disease investigation and treatment; third, to do a good job of newborns in a timely manner to build a register of visits and breastfeeding guidance.
3.2.3 Focus on strengthening the community's health management First, in the community public **** place to do no smoking; Second, to strengthen the community's drinking water, food and food hygiene inspections, the strict implementation of the relevant health standards, and do a good job of the relevant inspection records, and found that the problem of timely rectification and reporting; Third, the correct guidance to limit the community residents to pollute the indoor and outdoor environments of all the decorative as well as the addition of furniture on the paint. Lead content must comply with national standards.
3.3 Guidance on community care promotion
3.3.1 Focus on strengthening health promotion and training in the community First, the community to actively carry out women's health care, family planning, eugenics, food hygiene, labor hygiene, publicity and guidance; secondly, to actively carry out health education and training for the community residents, health promotion and various consulting activities, the conditions permit the establishment of health clinics, health consultation clinics, and the establishment of a health clinic, the first is the establishment of a health consultation clinic, and the first is the establishment of a health consultation clinic. The conditions permit the establishment of health consultation clinics, hotlines and community health promotion associations.
3.3.2 Happy to carry out cultural and sports activities beneficial to physical and mental health According to the hobbies and habits of the community residents, the use of morning exercise and other opportunities to mobilize residents to participate in the practice of aerobics, fitness dance, tai chi and other activities.
3.4 Guidance for community care to improve the work of institutions and personnel training
3.4.1 Further strengthen the construction of community service institutions Due to China's late start in community care, the city is beginning to take shape, the residential district is being built, so some community care work is still stuck in the original level of medical services. Therefore, both the network construction of community care institutions, or community care of various systems, are yet to be established and improved.
3.4.2 Further strengthen the cultivation of community nursing personnel Due to the poor construction of community institutions, so there are few community nurses. Community nurses are usually converted from hospital nurses, but hospital nurses are temporarily difficult to adapt to the needs of community nursing. Therefore, the training of community nursing personnel should be increased, and various forms and ways should be adopted to train in-service nurses in the theoretical knowledge and practical ability of community nursing. At the same time, the use of colleges and universities to systematically cultivate a number of community nursing talents with specialist and undergraduate degrees, to improve the overall quality of the community nursing team, and to provide a guarantee for the development of the cause of community nursing.
With the continuous improvement of the people's requirements for the quality of medical services, patients and their families are increasingly demanding the professional ethics, technical level and service quality of nursing staff. In the daily nursing work appeared doctor-patient relationship tension, nurse-patient disputes and other phenomena. This paper discusses how to avoid the occurrence of disputes, and is reported as follows.
1 service attitude triggers conflict:
With the strengthening of medical ethics in the industry, nurse-patient disputes triggered by poor service attitude have been significantly reduced. However, there are still some nurses work in the use of service taboo, do not pay attention to the way of speaking and tone of voice, service attitude is hard, communication is not in place, the lack of sympathy for the patient, resulting in patient misunderstanding and cause conflict. Nurses should stand in the patient's point of view, for the sake of the patient, everywhere to understand, care for the patient, operation with more than one sentence of explanation, a little more patience when in doubt, observe the condition of a little more careful, work a little more responsible, for the safety of more than a reminder of a sentence, more than a sentence of blessing at the time of discharge.
2 cost problems cause conflicts:
When the doctor or nurse to the patient to urge money easily cause conflicts. After the patient is admitted to the hospital, doctors and nurses should explain in detail the approximate cost of medical treatment to the patient, so that the patient has a clear idea; when transferring money, the nurse should be strictly in accordance with the implementation of the fee standard, not indiscriminate charges; when the patient is in doubt about the cost, the nurse should be patient to explain, and if necessary, ask the relevant departments, until the patient or the family is clear.
3 communication is not in place to cause conflicts:
Currently occurring disputes, the reason is often caused by communication, this part of the dispute is completely preventable, and patient communication, according to the situation, flexible grasp of the proportion of speech and art, patience, admission introduction, health education and nursing-related content interpretation. And the seriousness of the patient's condition, prognosis and treatment, the results of the examination, the cost of medicine and other aspects of knowledge, should be asked to the physician in charge of the patient to make a detailed account, so as to avoid unnecessary disputes due to inappropriate or inconsistent with the physician's account.
4 weak legal awareness triggers conflict:
Some nursing staff have a weak legal concept, lack of legal common sense, there is a sense of chance, turn a blind eye to the rules and regulations of the hospital, work sloppily, and usually do not pay attention to business learning and knowledge updating, which leads to involvement in nurse-patient disputes [3]. To strengthen the study of legal knowledge, cultivate the spirit of prudence, enrich the legal awareness of nursing staff, so that the majority of nursing staff to seriously learn the law, abide by the law, use the law, and actively and proactively use legal means to safeguard the lawful rights and interests of both nurses and patients.
5 nursing knowledge lack of contradiction:
Many nursing staff poor theoretical knowledge, when the patient asked about disease precautions, diet, medication and other aspects of knowledge, can not correctly and comprehensively answer the patient, can not meet the patient's requirements and cause conflict. As a nursing worker, we should constantly learn new nursing concepts, knowledge, skills, to enrich themselves, optimize their knowledge ability, constantly improve their own business quality, practicing exquisite technology, to fundamentally reduce the occurrence of disputes.
6 violation of medical operating procedures and regulations to cause conflict:
Individual health care workers do not seriously implement the rules and regulations of the hospital, and even violation of medical operating procedures, so that in the process of disease diagnosis, treatment and care of medical errors, and even lead to medical accidents. To strengthen the study of various diagnosis and treatment and nursing routine, the low seniority nurses to strengthen the pre-service training and practical work in the guidance of the new technical projects should also strengthen the training, so that everyone mastered.
7 because of other problems caused by contradictions:
Ward, corridor, toilet lights do not work, sewerage, loss of valuables, venipuncture failure, bed arrangements unreasonable canteen meals do not meet the taste may cause conflicts. The nurse manager should do a good job of management, and with the administrative functions of the department to do a good job of coordination, so that nurses have a better working environment.
In short, nursing staff should seriously summarize the lessons learned to avoid the occurrence of nursing disputes, do a good job of self-prevention, in the service of the patient at the same time, first of all, to protect themselves, so that they can work better.
References
1 Xia Quanyuan. Community Nursing of Common Diseases. Nanjing: Southeast University Press, 2004, 1.
2 Zhou Ying. Introduction to Community Nursing. Nanjing: Southeast University Press, 2004, 8.