AIM:To construct key quality indicators for aged care facilities in China.BACKGROUND:Evaluating the care quality in aged care facilities is problematic. Evaluation of nursing care quality is important for improving nursing and self-supervision in aged care facilities. However, a few regulations and studies regarding care quality evaluation have been implemented in China.DESIGN AND METHOD:This two-tier Delphi study aimed to achieve consensus on key quality indicators for aged care facilities in China. The entry pool was determined by literature review and research team discussion, followed by a discussion by a panel of experts to establish the items of the Delphi study. Finally, key care quality indicators were established through a two-round Delphi study. This study followed the SQUIRE 2.0 guidelines.RESULTS:The initial 16 quality indicators of the entry pool was developed based on a literature review and a group discussion. Sixteen quality indicators were reduced to eight after the expert discussion. After two rounds of expert consultation, the eight quality indicators became nine, which were then evaluated for importance, formula rationality, and operability using Kendall's harmony coefficients (first round: 0.150, 0.143 and 0.169, respectively; second round: 0.209, 0.159 and 0.173, respectively).CONCLUSIONS:Key quality indicators provide quantifiable evidence for evaluating the care quality in aged care facilities, but their applicability needs continuous improvement.RELEVANCE TO CLINICAL PRACTICE:Nine key quality indicators were selected from numerous indicators for measuring the care quality in aged care facilities, supporting the evaluation of the care quality and self-supervision for aged care facilities.ELDERLY OR PUBLIC CONTRIBUTION:No elderly or public contribution.

AIMS AND OBJECTIVES:To investigate the use of physical restraints in aged care facilities(ACFs)and analyse its associated risk factors.BACKGROUND:Physical restraints have been widely used in ACFs worldwide, but they can cause physical and mental harm to older people. It is important to regulate the use of physical restraint.DESIGN:A cross-sectional observational and correlational multicentre study.METHODS:By convenience sampling method, we selected eight ACFs in four representative regions of Hunan province, China, for this study. The ACF-related information was obtained by interviewing the managers and reviewing records. We conducted investigation and observation on the elderly in the ACFs to understand the use of physical restraints at three different times: 9:30-11:30, 16:00-18:00 and 19:30-21:30 on a working day. The STROBE checklist was followed for this cross-sectional study.RESULTS:This study found that the utilisation rate of physical restraints was 23.2%. The critical risk factors affecting the use of physical restrains include the following: (1) the ratio of nursing staff to the elderly residents; (2)whether there is a dementia care unit at the facility; (3) the number of elderly residents in each room; (4) the elderly residents' age, degree of education, marital status, care dependence and cognitive impairment; (5) whether the elderly has suffered from a stroke or senile dementia; (6) whether the elderly carries medical catheters.CONCLUSION:There is a lack of standardisation in the use of physical restraints in ACFs of central China. Chinese ACFs should develop guidelines and reduction measures to standardise the use of physical restraints, basing on the key factors affecting the use of physical restraints.RELEVANCE TO CLINICAL PRACTICE:The use of physical restraints in ACFs is threatening the safety of the elderly residents. Understanding the implementation of physical restraint in ACFs can provide reference for reducing the use of physical restraint.

目的 了解养老机构管理者对老年人身体约束的认知和态度,以明确养老机构身体约束改进方向及阻碍因素,为规范和减少老年人身体约束提供参考.方法 采用现象学研究法,于2022年6-9月选取符合纳入标准的15名养老机构管理者作为研究对象进行半结构式深入访谈,并采用Colaizzi7步分析法对资料进行分析、归纳及主题提炼.结果 养老机构管理者对老年人身体约束认知和态度可归纳为4个主题,分别为:养老机构管理者从理论和实际出发对身体约束进行认识;养老机构管理者对身体约束使用持不同态度;合理、规范地实施身体约束是养老机构身体约束改进方向;改善养老机构身体约束使用面临来自各方的阻碍.结论 养老机构老年人身体约束的使用目前存在诸多问题,养老机构管理者应不断提升约束认知水平,积极发挥自身在约束管理过程中的重要作用,同时社会各方应给予老年人身体约束更多的关注和支持力度.

目的 探讨湖南省民办养老机构老年人身体约束使用现状及其影响因素,为规范我国民办养老机构老年人身体约束提供参考.方法 采用分层整群随机抽样的方法抽取湖南省3个区域内6家民办养老机构内814名老年人作为研究对象,应用养老机构老年人身体约束使用现状调查表、日常活动能力评定量表和简易精神状态评价量表进行调查.结果 湖南省民办养老机构身体约束使用率为23.8％,19:30-21:30使用身体约束的频次最高(占51.6％),身体约束实施的常用部位为双上肢(占36.4％),最常见体位为仰卧位(占48.2％),常用的工具为约束带(占51.8％％);身体约束使用前均征得了老年人或其家属的同意,但无约束使用相关记录.回归分析结果显示,养老机构是否有痴呆单元、护理人员与老年人比、老年人的年龄、文化程度、是否患有老年痴呆、日常活动能力、认知功能、有无胃管、有无导尿管、有无静脉留置针是身体约束使用的主要影响因素(均P＜0.05).结论 湖南省民办养老机构身体约束使用率较高,并且存在诸多使用不规范的情况,养老机构和相关管理部门需根据约束使用现状和影响因素制定更多的措施,以减少和规范我国民办养老机构身体约束使用.

目的 了解护理专业学生在参与养老志愿服务实践过程中所遇到的困难,为完善和发展养老志愿服务活动提供参考依据.方法 采用质性研究的方法对13名符合纳入标准的护生志愿者进行半结构式访谈,并使用Colaizzi现象学7步分析法进行资料的分析、归纳和总结.结果 提炼出护理专业学生在参与养老志愿服务中实践困境的4个主题:志愿服务活动组织协调性弱;志愿者与老人沟通交流存在障碍;养老志愿服务不被老人接受和认可;疾病所带来的服务挑战.结论 养老志愿服务活动需完善组织管理,并提升志愿者的服务能力和综合素质,社会各方可增强对养老志愿服务的关注和支持,以帮助解决志愿者在服务过程中遇到的困难,促进养老志愿服务活动稳定发展.

介绍Crisham的MORAL模型,从模型涉及的有关老年人身体约束决策的道德判断及其影响因素、道德反思及推理和基于模型构建的道德困境解决建议方面进行阐述,给国内研究者提供参考,以期改善我国养老机构护理人员对老年人身体约束使用伦理问题.

Objective:To systematically evaluate the attitudes and experiences of nursing assistants in nursing homes on physical restraint, so as provide a reference for regulating and reducing the physical restraint.Methods:Cochrane Library, PubMed, Embase, EBSCO, Web of Science, China Biology Medicine (CBM) , China National Knowledge Infrastructure, WanFang Data, VIP and other domestic and foreign databases were searched by computer. The retrieval time limit was from the establishment of the database to June 2021. The quality of the article was evaluated using the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center in Australia, and the Meta synthesis was used to summarize and interpret the results.Results:A total of 7 articles were included, and 58 results, 11 categories and four synthesis results were extracted. That was, the factors that affected the implementation of physical restraint (the elderly's own factors, the factors of nursing assistants, the influence of other personnel, the factors of elderly care institutions) , the attitude towards physical restraint (support attitude, opposition attitude and neutral attitude) , emotional experience and release methods (emotional experience and ways of release) , existing deficiencies and suggestions for restraint use (existing deficiencies, related suggestions) .Conclusions:The use of physical restraint in elderly care institutions is the result of many factors. Nursing assistants have positive, negative and neutral attitudes and emotional experiences in the implementation of physical restraint, and based on their rich clinical experience, they can find existing problems in restraint use and make relevant suggestions. Relevant departments need to fully consider the interests of all parties when formulating physical restraint norms and restraint reduction strategies, and effectively solve the problem of physical restraint abuse from the root cause.

目的 了解养老机构老年人对于衰弱的认知与体验,旨在为衰弱老年人护理干预策略的制订提供参考依据.方法 采用现象学研究法,选取2021年7—9月在长沙市某社会福利院15名衰弱老年人进行半结构式访谈,并应用Colaizzi 7步分析法进行资料分析、归纳及提炼主题.结果 养老机构老年人对衰弱认知和体验可归纳为4个主题:对衰弱认知的匮乏并存在误区;身心负担明显;生活质量下降;衰弱应对自我效能低.结论 老年人对衰弱的认知不足且其身体、心理、生活等方面存在诸多负担和需求,医护人员应密切关注老年人不良情绪和体验,给予针对性的心理疏导与多维度的支持.

文章对养老机构护士药物管理现状、药物管理错误的主要原因以及降低养老机构护士药物管理错误发生率的策略进行综述,并立足于我国现状提出相关建议,旨在为养老机构和有关部门管理者制定符合国情的养老机构药物管理相关措施提供参考,以期促进养老机构护士进行规范化的药物管理.

目的:采用网状Meta分析的方法评价约束教育相关干预对减少养老机构身体约束使用的效果.方法:计算机检索the Cochrane Library、PubMed、EMbase、Web of Science、中国生物医学文献数据库、中国知网、万方数据库,收集在养老机构内实施约束教育或约束教育联合其他方式进行干预的随机对照试验,检索时限为建库至2020年7月14日,并采用Stata 13.0软件进行网状Meta分析.结果:最终共纳入13篇文献,涉及15073例观察对象,4种约束教育相关干预方式包括单纯约束教育、约束教育+约束指南、约束教育+专家咨询、约束教育联合多种方式(包含专家咨询、使用约束替代工具、改变约束制度/策略等).网状Meta分析结果显示:在减少养老机构身体约束使用率方面,采取单纯约束教育[OR=0.49,95％CI(0.29,0.86)]、约束教育+约束指南[OR=0.46,95％CI(0.27,0.78)]、约束教育联合多种方式[OR=0.23,95％CI(0.13,0.41)]的干预效果均优于常规护理(P<0.05),且采取约束教育联合多种方式[OR=0.29,95％CI(0.13,0.65)]进行干预后的效果优于约束教育+专家咨询的干预(P<0.05).结果 排序图显示:约束教育联合多种方式>约束教育+约束指南>单纯约束教育>约束教育+专家咨询>常规护理.结论:当前证据表明,实施单纯约束教育、约束教育+约束指南、约束教育联合多种方式进行干预都可能是减少养老机构身体约束使用率的有效措施,建议我国养老机构从经济性、实用性等方面出发,根据自身实际情况实施约束教育相关措施,以降低养老机构内身体约束的使用率.

综述养老机构老年人身体约束和跌倒的研究进展,从高跌倒风险会增加老年人身体约束的使用、使用身体约束会增加跌倒的发生风险、减少或解除身体约束以及实施身体约束替代措施会减少跌倒的发生3个方面进行阐述,为养老机构最大限度减少身体约束提供参考.

Background With adverse events and injuries recurring in residential aged care facilities (RACFs), older adults' safety in residential age care settings has attracted extensive attention from governments, researchers, and healthcare providers. Risk management is of utmost importance in reducing risks and improving the quality of care for older adults in long-term care. Although previous studies have made great efforts to explore risk management methods and technologies in RACFs, little is known about how managers identify and respond to risks in practice. Purpose This qualitative study aimed to elucidate the perceptions and experiences of managers involved in risk management in RACFs in China. Participants and methods This study used a phenomenological research design. We conducted semi-structured interviews with 13 managers across 11 RACFs in Changsha City, Hunan Province, China. Data were analysed using Colaizzi's seven steps and NVivo 12 plus software. Results "Facilitation of an error-free culture" emerged as a central theme of managers' perceptions of risk management. Four sub-themes were revealed, namely "creating an age-friendly physical environment," "paying close attention to frail older adults," "improving the competence of nursing staff," and "building effective management programs." Conclusion Facilitation of an error-free culture was of prime importance in risk management. Managers' experiences can help RACFs to better manage risks, as well as provide new perspectives and approaches for RACFs to improve the quality and outcomes of care. This study developed initiatives for improving resident safety in RACFs and may foster interest in the developing these initiatives.

目的 探讨影响医学院校本科护生参与养老机构志愿服务的阻碍因素,以期为制定相应的干预策略提供研究支持.方法 2019年5月—6月,采用目的抽样法,选取19名长期参与养老机构志愿服务的某医学院校本科护生作为研究对象,运用现象学研究法对其进行半结构式访谈,并采用Colaizzi分析法指导资料的分析.结果 提炼出本科护生参与养老机构志愿服务阻碍因素的3个主题(含8个次主题):沟通交流障碍(语言沟通障碍、老年人负性情绪严重拒绝沟通、年龄代沟);志愿服务与护理学专业关联性低(志愿服务形式单一、实施中医护理存在困难);志愿团队欠缺组织和管理(志愿者流动性大、志愿服务时间安排欠缺合理、学校与养老机构缺乏有效沟通).结论 学校应注重培养护生志愿者的人文关怀和沟通技巧,并加强对其专业知识和技能的系统培训,提升护生志愿者的整体素质;基于老年人需求的基础上,尽量拓宽志愿服务内容和项目,同时建议相关部门构建志愿者服务保障机制,促进护理专业服务项目开展;学校应与养老机构进行联合管理,加强互动和信息共享,完善志愿者监督和激励机制,促进志愿服务的常态化和持续性.

尽管身体约束对老年人的身体、心理、社会适应能力等方面造成严重伤害,但身体约束在老年人照护过程中已成为一种常见护理操作.老年人随着年龄增长,身体机能下降,护理人员在对其使用身体约束时更需要关注老年人的安全和健康问题.为达到优质的老年照护目标,国外已有许多研究者呼吁减少对老年人身体约束的使用.基于国内外养老机构老年人身体约束的使用现状,从尊重和不伤害的原则,护理员的道德困境及家属的态度三个方面探讨身体约束在养老机构使用的伦理考虑,并分析身体约束在养老机构使用的法律考量.

目的:基于CIRO培训评估模型构建继续护理学教育效果评价指标体系,以期为评价继续护理学教育效果提供科学、全面、可靠的工具.方法:以CIRO培训评估模型为框架,在文献回顾、半结构式访谈及小组讨论的基础上制定指标体系初稿,并编制完成专家函询问卷,采用德尔菲专家咨询法对17位专家进行2轮咨询,运用层次分析法明确各指标权重,并最终确定基于CIRO培训评估模型的继续护理学教育效果评价指标体系内容及各指标权重.结果:2轮函询问卷的有效回收率分别为100.0％和94.1％,专家权威系数分别为0.880,0.889,肯德尔和谐系数分别为0.423,0.576,差异具有统计学意义(P<0.01).最终形成的评价指标体系包括4项一级指标、12项二级指标和43项三级指标,其中背景评估包括2个二级指标和7个三级指标;输入评估包括4个二级指标及13个三级指标;反应评估包括4个二级指标及15个三级指标;输出评估包括2个二级指标及8个三级指标.结论:基于CIRO培训评估模型构建的继续护理学教育效果评价指标体系具有较好的科学性和可靠性,可为继续护理学教育效果评价及持续改进提供依据.

Objective:To explore the initial motivation of nursing students to engage in voluntary service for the aged, and to provide scientific basis for the formulation of strategies and measures of voluntary service for the aged.Methods:Totally 25 nursing students volunteers who regularly participated in the volunteer service for the aged in Changsha First Welfare Home were selected by objective sampling method for semi-structured in-depth interviews, and the data were analyzed by Colaizzi phenomenological 7-step analysis method.Results:Four themes of nursing students' initial motivation to participate in voluntary service for the aged were extracted: self-interest motivation, altruistic motivation, affinity motivation and achievement motivation. Among them, self-interest motivation included two sub-themes: enriching college life and life experience, improving one's own ability and gaining professional experience; altruistic motivation included two sub-themes: accompanying and helping the elderly and eliminating loneliness of the elderly; affinity motivation included two sub-themes: establishing emotional sustenance and making up for the lack of emotion; achievement motivation included two sub-themes: facing challenges bravely, acquiring a sense of achievement, serving society and others, and realizing one's own value.Conclusion:Nursing students have a clear initial motivation to participate in the voluntary service for the aged of the aged care facilities, and schools can strengthen the relevant education for students to participate in voluntary service in the training of nursing talents. The voluntary service for the aged can formulate corresponding development strategies and incentives according to the initial motivation of nursing students, so that promote the expansion and stability of the voluntary service for the aged team, and promote the development and improvement of voluntary service for the aged.

目的 探究养老机构护理员对老年人实施身体约束过程中的体验及应对方式,为养老机构管理者制定针对性的干预策略提供参考.方法 选取长沙市3家养老机构20名护理员进行半结构式深度访谈,运用现象学研究中的Colaizzi七步分析法进行资料分析.结果 共提炼3个主题:①身体约束实施对象;②护理员对老年人实施身体约束的情感体验,包括内疚自责、矛盾、同情、认为对老年人有益;③应对方式,包括补偿性行为、内心合理化、自我释放、同事间相互倾诉、获取领导支持.结论 养老护理员对老年人实施身体约束的情感体验以负性体验为主,能一定程度上合理应对;养老机构管理者应通过提升养老护理员身体约束知识与技能水平、积极寻求约束替代方案和创造支持性工作环境等方式帮助其积极应对.

ObjectiveTo investigate the status quo and influencing factors of care workers' moral disengagement in nursing homes.MethodsA General Data Questionnaire，Moral Disengagement Scale，Empathy Fatigue Scale，and Social Support Scale were used to investigate 318 care workers from 7 nursing homes in 6 districts and 2 counties of Changsha city.ResultsThe care workers' scores of moral disengagement，empathy satisfaction，job burnout，secondary traumatic stress and social support were （87.20±8.85），（29.45±3.99），（23.84±5.40），（26.03±3.83），and （39.09±10.84），respectively.The age and education level had an impact on the moral disengagement （P<0.05 or P<0.01）.The empathy satisfied and the social support had a negative prediction to moral disengagement.Job burnout and secondary traumatic stress positively predicted moral disengagement.ConclusionsThe care workers' moral disengagement was at a moderate level，which was affected by age and education level.The nursing homes should formulate corresponding intervention measures，pay attention to the care workers with low social support and heavy empathy fatigue，in order to promote the safety construction of the nursing homes and reduce the occurrence of social adverse events.