医养结合模式下我国养老机构护理人力需求-能力模型及其策略研究

China is experiencing the world’s largest and fastest ageing process, and a massive group of disease-afflicted, disable or half-disable older adults are in great need of persistent, comprehensive, and professional medical and nursing care, besides life-assisted care. A large number of elder care agencies working on “medical-nursing combined care model” emerge as the times require. However, nursing manpower allocation in current elder care agencies is unreasonable, and there is a vacancy of geriatric nurses; reports on the connotation, definition, accreditation of geriatric nurses are in a scarcity, which have jeopardized the professional development of elder care service under medical-nursing combined care model. .This study, based itself on researchers’ full understanding of China’s current elder care service, defines a series of elder care concepts, puts forward an issue of nurses’ competency matching with elder care service demands using qualitative and quantitative approaches. The study further looks into the elder care service demands and establishes a hierarchy of elder care service and professional competency standards for elder care agencies working on “medical-nursing combined care model”. The study also tries to build up a needs-competency model, and digs into the strategies that bridge the gap between elderly care needs and competency levels by using person-vocation fit theory, in an attempt to form a laddered placement system of geriatric nurse specialists, geriatric nurses, clinical nurses, and geriatric nurse assistants, minimize the strain of manpower shortage, and improve professional levels of geriatric nursing staff. Through these results, the study expects to provide important references for China’s future reform and decision-making of the elder care system.

我国正经历着世界历史上规模最大、速度最快的老龄化进程，大量患病、失能、半失能老人除了生活照料外，急需持续、综合、专业的医疗康复护理服务，使医养结合成为必然。而养老机构护理人力配置不合理，养老专业护士匮乏，且目前尚无对养老专业护士内涵、定义、资格准入等相关文献报道，严重制约医养结合模式下养老护理专业化的发展。.本课题采用质性与量性结合的方法，在深入分析我国养老护理服务现状的基础上，对养老护理相关概念进行界定，提出养老护理需求与能力的匹配问题，通过老年护理需求评估，建立医护型养老机构老年护理分级标准和护理人员专业服务能力层级标准；构建养老护理需求-能力模型，应用人-职匹配理论分析法等，寻求养老护理需求-能力匹配策略，形成养老护理专家、养老专科护士、临床护士和养老护理员等不同层次之间的联动机制，缓解养老护理人力不足，提升养老护理人员专业化水平，为深化我国养老服务改革提供重要的理论支撑和决策依据。

我国人口老龄化程度不断加深，老年人口数不断攀升，传统以家庭照护为主的养老模式已不能满足大量患病、失能、半失能、失智的老年人，需要持续综合的医疗、康复、护理服务，医养结合是社会养老的发展趋势。而医养结合养老机构服务质量、护理人力配置、养老护理人员专业能力等问题有待进一步研究。.本研究对医养结合型养老机构管理者、护理人员和老年人进行访谈，明确当前医养结合型养老机构及护理人力资源的现状及存在的问题，了解老年人对护理服务的感知情况；展开全国调研，通过问卷调查了解医养结合养老机构照护质量、人力配置现状和老年人的健康状况及需求满足情况。构建养老护理需求-能力匹配模型，并建立养老护理人员价值取向、专业能力标准和配置标准，提出相关的政策建议。.本研究结果显示，目前各种类型的医养结合型养老机构均存在一定的优势和不足，机构照护质量整体处于合格水平，高质量机构较少。养老护理人员不足，持证上岗率较低，部分养老护理人员对未来充满信心和期待，但也有部分养老护理员这一职业认知不足，认同感低。多数老年人存在一定的健康问题，老年人家务料理和生活照护的需求满足程度较好，但陪伴、亲密关系、信息的需求满足程度较差。老年人对居住环境和服务态度满意度较高，但对医疗服务和饮食的满意度较低。老年人的感知需求与养老护理人力资源配置存在不匹配现象。.本研究提示医养结合型养老机构有待进一步改善，医疗与养老应更好地融合，鼓励护士多点执业，增加养老机构护士数量，以满足老年人的信息需求；改善社会对养老行业的认识，鼓励从事这一行业，并通过加速培养、经验转化等项目缩短培训时长；保证养老护理人员培训，树立正确的职业价值观，提高其专业水平，以便为老年人提供更优质的服务，需加强心理护理和人文关怀的相关知识，以满足陪伴等心理需求。