护理学报 ›› 2025, Vol. 32 ›› Issue (2): 31-36.doi: 10.16460/j.issn1008-9969.2025.02.031
老年人自立支援照护模式的照护技巧及启示
陈玉英1,2, 王海彦1, 陈思颖1, 杨雪娟1
- 1.昆明医科大学 护理学院,云南 昆明 650500;
2.云南省老年病医院,云南 昆明 650011
摘要： 目的 总结自立支援照护技巧、阻碍护士充分优化老年人独立功能的各种环境,为自立支援环境营造、建立健全适合我国国情的自立支援照护模式提供借鉴。方法 通过文献研究法整理分析了自立支援照护模式的实施方法、辅具及环境营造、组织环境及资质培训,介绍了养老院和住院环境下自立支援实施情况。基于自立支援四大基本照护原则,总结了国内外自立支援照护技巧、实施效果和存在问题。结果 有效实施自立支援照护模式包括5个关键策略。护士在使老年人能够优化其活动和独立功能方面发挥着关键作用,建议为护理人员提供互动式学习。结论 自立支援照护模式最重要的是老年人的主动参与,老年人应充分运用四大基本照顾原则。自立支援护理模式是一项高度跨专业整合的照顾模式,未来应从老年人身体、家务协助、辅具应用、空间改善等多维角度提升自立支援实施效果。
中图分类号:
- R473.59
| [1] 桂世勋. 高度关注低龄老人适度“参与”对健康老龄化的影响[J].华东师范大学学报:哲学社会科学版, 2022, 54(4):9. DOI:10.16382/j.cnki.1000-5579.2022.04.015. [2] 吉田康行, 飯野なみ, 西野貴志, 等. 高齢者の自立支援介護における遠隔技術を用いた知識·データ融合の実践と分析[J].情報処理学会論文誌, 2022,63(1):116-128. DOI:10.20729/00215716. [3] 野田博也. 日常生活自立支援事業における福祉サービス利用援助事業の展開とその特質[J]. 愛知県立大学大学院人間発達学研究科, 2022,13:47-59. DOI:10.15088/00004897. [4] 张虹, 沈军, 喻秀丽, 等. 基于自立支援照护理念的养老机构轻度失能老人饮水干预研究[J]. 护理学杂志, 2020,35(3): 1-4.DOI:10.3870/j.issn.1001-4152.2020.03.001. [5] 杨民君, 虞晓芸, 周祎祎, 等. 老年人复能照护的研究进展[J]. 护理学杂志, 2024,39(15):125-129.DOI:10.3870/j.issn.1001-4152.2024.15.125. [6] Kok S, Schoonhoven L, Vernooij L M, et al.The effectiveness of Function focused care among patients acutely admitted to hospital: a stepped wedge cluster trial[J]. Int J Nurs Stud,2024,160:104893.2024,160.DOI:10.1016/j.ijnurstu.2024.104893. [7] Chang SH, Yu CL, Chiang MH.Function-focused care for cognitive impairment training among formal caregivers in long-term care facilities in taiwan: a cluster randomized controlled trial[J]. J Gerontol Nurs, 2024, 50(7):43-50.DOI:https://doi.org/10.3928/00989134-20240618-07. [8] Kok S, De Man-Van GJ, Verstraten C, et al. Function focused care in hospital: a mixed-method feasibility study[J]. Int J Nurs Stud Adv, 2021, 3:100045. DOI:10.1016/j.ijnsa.2021.100045. [9] Resnick B, Galik E, Boltz M.Function focused care approaches: literature review of progress and future possibilities[J]. J Am Med Dir Assoc, 2013,14(5): 313-318.DOI:10.1016/j.jamda.2012.10.019. [10] Lee SJ, Park MS, Chang SO.Capturing key function-focused care problems, nursing diagnoses, and interventions for nursing home patients using a web-based case management system[J]. Int J Nurs Knowl, 2024,35(1): 93-104.DOI:10.1111/2047-3095.12420. [11] Belue R, Kuzmik A, Dix M, et al.An exploration of the cultural appropriateness of the family-centered function-focused care intervention[J]. Dementia (London), 2024,23(1): 7-22.DOI:10.1177/14713012231206288. [12] Tasaka Y, Takamasu T.Patient self-reliance support患者の自立支援[J].Nihon Shoni Arerugi Gakkaishi The Japanese Journal of Pediatric Allergy and Clinical Immunology, 2020,34(1): 78-81.DOI:10.3388/jspaci.34.78. [13] 小林裕介. 自立支援型移乗補助具の開発(第4報):展開機構の電動化[J]. 精密工学会学術講演会講演論文集, 2012,2012: 943-944.DOI:10.11522/pscjspe.2013S.0.975.0. [14] 林金立, 余彥儒. 自立支援照顧的臺灣實踐[J]. 長期照護雜誌, 2017,21:15.DOI:10.6317/LTC.21.15. [15] 林艷君, 黃璉華. 高齡者自立支援之照護模式[J]. 護理雜誌, 2018,65(2):4.DOI:10.6224/JN.201804_65(2).04. [16] Sidani S, Streiner D, Leclerc C.Evaluating the effectiveness of the abilities-focused approach to morning care of people with dementia[J]. Int J Older People Nurs, 2012,7(1): 37-45.DOI:10.1111/j.1748-3743.2011.00273.x. [17] Wells DL, Dawson P, Sidani S, et al.Effects of an abilities-focused program of morning care on residents who have dementia and on caregivers[J]. J Am Geriatr Soc, 2000,48(4):442-449.DOI:10.1111/j.1532-5415.2000.tb04704.x. [18] Nolan BA, Mathews RM, Harrison M.Using external memory aids to increase room finding by older adults with dementia[J]. Am J Alzheimers Dis Other Demen, 2001,16(4): 251-254.DOI:10.1177/153331750101600413. [19] Kolanowski AM, Litaker M, Buettner L.Efficacy of theory-based activities for behavioral symptoms of dementia[J]. Nurs Res, 2005,54(4): 219-228.DOI:10.1097/00006199-200507000-00003. [20] Kolanowski A, Litaker M, Buettner L, et al.A randomized clinical trial of theory-based activities for the behavioral symptoms of dementia in nursing home residents[J]. J Am Geriatr Soc, 2011,59(6): 1032-1041.DOI:10.1111/j.1532-5415.2011.03449.x. [21] Ho SY, Walsh LJ, Pradhan A, et al.Perspectives of oral health therapists on the barriers to oral care provision in nursing homes in Singapore: a qualitative analysis[J]. Spec Care Dentist, 2024,44(1):157-165.DOI:10.1111/scd.12833. [22] Ho SY, Walsh LJ, Pradhan A, et al.Interprofessional collaboration utilizing oral health therapists in nursing homes: Perceptions of oral health therapists and nursing home staff in Singapore[J]. Spec Care Dentist, 2023,43(6): 795-805.DOI:10.1111/scd.12765. [23] Shanti C, Johnson J, Meyers AM, et al.Evaluation of the restorative care education and training program for nursing homes[J]. Can J Aging, 2005,24(2): 115-126. [24] Resnick B, Petzer-Aboff I, Galik E, et al.Barriers and benefits to implementing a restorative care intervention in nursing homes[J]. J Am Med Dir Assoc, 2008,9(2): 102-108.DOI:10.1016/j.jamda.2007.08.011. [25] Liu W, Galik E, Nahm ES, et al.Optimizing eating performance for long-term care residents with dementia: testing the impact of function-focused care for cognitively impaired[J]. J Am Med Dir Assoc, 2015,16(12): 1062-1068.DOI:10.1016/j.jamda.2015.06.023. [26] Liu W, Galik E, Boltz M, et al.Factors associated with eating performance for long-term care residents with moderate-to-severe cognitive impairment[J]. J Adv Nurs, 2016,72(2): 348-360.DOI:10.1111/jan.12846. [27] 熊仿杰,袁惠章.老年介护教程[M].上海:复旦大学出版社,2006. [28] Sharp S, Mcallister M, Broadbent M. The tension between person centred and task focused care in an acute surgical setting: a critical ethnography[J]. Elsevier, 2017(1).DOI:10.1016/j.colegn.2017.02.002. [29] Ouden MD, Kuk NO, Zwakhalen S MG, et al.The role of nursing staff in the activities of daily living of nursing home residents[J]. Geriatric Nursing, 2017,38(3): 225-230.DOI:10.1016/j.gerinurse.2016.11.002. [30] Parker M, Bergmark RE.Book review:restorative care nursing for older adults: a guide for all care settings[J]. Am J Alzheimers Dis Other Demen,2004.DOI:10.1177/153331750401900603. [31] Resnick B, Galik E, Boltz M.Function focused care approaches: literature review of progress and future possibilities[J]. J Am Med Direct Assoc, 2013,14(5):313-318.DOI:10.1016/j.jamda.2012.10.019. [32] Hell-Cromwijk MV, Metzelthin SF, Schoonhoven L, et al.Nurses' perceptions of their role with respect to promoting physical activity in adult patients: a systematic review[J]. J Clin Nurs, 2021,30(17/18): 2540-2562.DOI:10.1111/jocn.15747. [33] Benjamin K, Edwards N, Ploeg J, et al.Barriers to physical activity and restorative care for residents in long-term care: a review of the literature[J]. J Aging Phys Act, 2014,22(1): 154-165.DOI:10.1123/JAPA.2012-0139. [34] Lee SJ, Kim MS, Jung YJ, et al.The effectiveness of function-focused care interventions in nursing homes: a systematic review[J]. J Nurs Res, 2019,27(1): 1-13.DOI:10.1097/jnr.0000000000000268. [35] 王二娇, 白玺, 肖树芹, 等. 日本失能老年人恢复自立照护的介绍及启示[J]. 中华护理杂志, 2023,58(3): 380-384.DOI:10.3761/j.issn.0254.1769.2023.03.017. [36] 田中等. 高齢期の心を活かす[M]. ゆまに書房, 2006. [37] Lee SJ, Kim MS, Jung YJ, et al.The effectiveness of function-focused care interventions in nursing homes: a systematic review[J].J Nurs Res,2019,27. DOI:10.1097/jnr.0000000000000268. [38] Paterson DH, Warburton DE.Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines[J]. Int J Behav Nutr Phys Act, 2010,7: 38.2010, 7(1):1-22. DOI:10.1186/1479-5868-7-38. [39] 赵永生. 《日本医疗保障制度与中日比较》专栏(11) 自立与社会融和——日本障害者自立支援医疗制度及其服务组织概览[J].中国医疗保险, 2009(12):26. [40] 华义. 日本养老倡导“自立支援”理念[J]. 家庭医药:快乐养生, 2017(8):1. DOI:CNKI:SUN:JTKL.0.2017-08-078. [41] 林金立, 余彥儒. 自立支援照顧的臺灣實踐[J]. 長期照護雜誌, 2017,21:15.DOI:10.6317/LTC.21.15. [42] 王二娇, 肖树芹, 白玺, 等. 养老机构自立支援实施影响因素的质性研究[J]. 护理学杂志, 2023,38(1): 92-96.DOI:10.3870/j.issn.1001-4152.2023.01.092. [43] 林艷君, 黃璉華. 高齡者自立支援之照護模式[J]. 護理雜誌, 2018,65.DOI:10.6224/JN.201804_65(2).04. [44] Rocco G, Affonso D, Mayberry L, et al.Center of excellence to build nursing scholarship and improve health care in Italy[J].Journal of Nursing Scholarship, 2015, 47.DOI:10.1111/jnu.12125. [45] 张虹, 沈军, Xiao Lily Dongxia, 等. 个性化饮水量图谱在养老机构失能老年人中的适用性研究[J].中华护理杂志, 2021,56(1): 103-109.DOI:10.3761/j.issn.0254-1769.2021.01.017. [46] 陈秋, 沈军, 喻秀丽, 等. 基于“自立支援”理念的养老机构认知功能障碍老年人经口饮食照护方案构建及应用[J]. 重庆医学,2022,51(7):1156-1160.DOI:10.3969/j.issn.1671-8348.2022.07.015. [47] 陈秋. 基于“自立支援”理念的养老机构失能老人经口饮食照护方案构建及应用[D]. 重庆:重庆医科大学, 2022. |
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