(Health Times reporter Wang Zhenya Wang Aibing) "An elderly man was admitted to the hospital after suffering a stroke in 2020, and his son went to work during the day and accompanied him at night. It lasted for more than a year, and on the day of the old man's death, his son suddenly suffered a cerebral hemorrhage, and he died after being rescued by the hospital. At the Fifth Session of the 12th Anhui Provincial Committee of the Chinese People's Political Consultative Conference in 2022, when Yao Huaifang, a member of the Anhui Provincial Committee of the Chinese People's Political Consultative Conference and chief physician of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, submitted a proposal on "Suggestions on Solving the Problem of Difficulty in Accompanying Inpatients", this story touched many people.
In traditional Chinese concepts, the elderly and children are regarded as filial piety as a matter of course. "However, time, money, and energy are all problems for inpatient companions.
In March 2023, the Cardiovascular Disease Hospital Affiliated to Xiamen University assisted patients to visit their family members who are inconvenient to come to the hospital, realizing "seeing the screen as if meeting".
One person was hospitalized, and the whole family was affected.
The case told by Yao Huaifang is a story that happened around her.
It is too stressful for a person to work during the day and accompany at night, taking care of the patient's food and drink for more than a year, "if the hospital can arrange the escort uniformly, the tragedy may not happen."
After the patient is hospitalized, the difficulty of accompanying the patient has become another pain for the patient's family.
In 2023, such a case has also attracted attention: a Beijing citizen was hospitalized in several hospitals for about 70 days, and after being reimbursed by medical insurance, he paid more than 10,000 yuan for medical expenses, and the cost of a nurse was higher than the medical fee, as high as 1More than 70,000 yuan.
Today, more than 70% of all hospitalized patients in hospitals need to be accompanied by people who are seriously ill, disabled, postoperative, postpartum, elderly, infants and young children, and those who cannot take care of themselves due to illness. Nowadays, the escorts are basically directly involved in the family or temporary caregivers, and many families are facing the problem of 'one person is sick, and the whole family is tired and paralyzed'. Yao Huaifang introduced with her actual work experience in the front line that most hospitals today often lack management authority for nurses, and the nursing team can only achieve basic companionship and care because of its high mobility, low education level and lack of professional training.
The old man's lumbar spine is not good, and he needs surgery**, I took a two-week leave to accompany my younger siblings to Beijing for surgery, I thought that the two of them would change to take care of the elderly, but I had a fever as soon as I came, and I couldn't accompany them, so I could only accompany my younger siblings in the hospital day and night. Wang Huan (pseudonym) from Shanxi recounted the embarrassment of a companion who recently came to Beijing, "Fortunately, this time my younger brother and sister came together, if it was only me, I really didn't know what to do." ”
What is the difficulty of hospitalized companionship? The difficulty is that family members have no time to accompany them, and sometimes they can only hire nurses; The difficulty is that the fees of the caregivers are chaotic and high, and the family members can hardly bear it; It is also difficult that the professionalism of some caregivers and family members is insufficient, and the quality of escort is uneven, which may even lead to a sense of hospitality.
How to resolve the difficulty of accompanying nurses has attracted a lot of attention, and many hospitals are also trying to explore new nursing models.
The essence of unaccompanied care is quality care.
On December 28, 2023, at the Cardiovascular Hospital Affiliated to Xiamen University, the nutritious meals of patients with three meals a day were delivered to the bedside by the delivery staff. Photo by Wang Aibing.
"Unaccompanied care" is based on the premise of canceling the patient's own escort, and the work characteristics of close cooperation with nursing staff are to reduce the flow of non-medical personnel in the ward and the hospital, and reduce cross-infection in the hospital.
In other words, the care of patients during their stay in the hospital is carried out by a professional and skilled nursing team, and there is no need for family members to accompany them. Regardless of disease observation, treatment, psychological care, health education, life care, and fast nutrition, including nutritious meals, they are all provided by professional and specialized people, so that families can rest assured and patients are happy.
In October 2019, the Cardiovascular Hospital Affiliated to Xiamen University became the first hospital in China to carry out hospital-wide unaccompanied management without increasing the financial burden of the city. "The wards are full of people, and there are generally more family members than patients. During ward rounds, because there are many family members in the ward, it is often impossible to hear what the patients are saying, and it is often seen that the meals brought by the family members to the patients are unhealthy ......Dai Cuilian, director of the Fifth Department of Cardiology of the Cardiovascular Hospital Affiliated to Xiamen University, recalled the previous ward and said that the management mode of the traditional inpatient department is very unsuitable for the recovery and recuperation of the patient's body.
Chen Yuan, vice president of the Cardiovascular Hospital Affiliated to Xiamen University, said, "At that time, we found a ward in internal medicine and surgery to carry out a pilot without escort, and the pilot effect was very good. ”
The hospital once admitted a university professor, the elderly family is good, but they do not trust the unaccompanied service, or hope to have a family or ask a nurse to take care of them, at first very emotional. Wang Yan, president of the Cardiovascular Hospital Affiliated to Xiamen University, said that after we provided meticulous unaccompanied care services for the elderly, we also completely convinced the elderly and greatly changed their views on this management model.
After several years of exploration, the Cardiovascular Hospital Affiliated to Xiamen University has determined the "6+1" unaccompanied care model, including the procedural hospitalization process, the first-class meal provision, the institutionalization of visit management, the systematization of medical caregiver training, and the maximization of medical and nursing participation management; In addition, on the basis of the "six modernizations" management, the hospital has expanded the "unaccompanied care+" model to deepen the exploration in enriching the connotation of care and improving high-quality care.
The essence of unaccompanied care is quality care. ”
On October 21, 2022, the "Xiamen Pilot Work Plan for "Unaccompanied Wards" requires that the pilot of "unaccompanied wards" be carried out in the city's ** public hospitals, and establish a service specification, operation and guarantee mechanism for patients hospitalized "without escort".
I don't need to be accompanied by my family, and my heart is more relaxed."
In addition to reducing the burden on the patient's family, the unaccompanied mode also reduces a lot of psychological burden for the elderly and patients who are afraid of troublesome family.
Mom, how are you doing in the hospital? Or I'll accompany you. "Ms. Fan, 54, was recently hospitalized with heart problems**.
Ms. Fan's son is in graduate school, and she doesn't want him to be distracted by his illness. She told reporters, "I have not been in good health, I have been hospitalized several times for more than ten years, and each time I have to touch my brothers and sisters in advance who have time to trouble my family. ”
Ms. Fan said that with the unaccompanied model, she no longer has to worry about causing too much trouble to her family. "The last time my sister accompanied me to the hospital, every time she made an appointment for me to have an appointment, she had to ask a lot of people, and she was in a hurry. Ms. Fan told reporters with a smile.
Wang Yan said that the vast majority of hospitals abroad are not accompanied by family members, and this model is also in line with the needs of an aging society.
In the unaccompanied mode, in order to strengthen the management of nursing staff, the Cardiovascular Hospital Affiliated to Xiamen University has introduced a third-party nursing staff management team with rich experience, and the nursing staff team of the hospital adopts the dual management of the hospital and the nursing staff company, and establishes a first-class management system composed of the nursing team leader, nursing manager and nursing department. Nursing staff must be trained by the company and the nursing department of the hospital, and can only take up their posts after they are qualified.
Fang Nurse, from Heze, Shandong Province, has been working as a nurse since 2014. In 2019, she joined the nursing team of the Cardiovascular Hospital Affiliated to Xiamen University. Nowadays, wearing uniform white overalls and work shoes, and speaking and behaving in a standardized manner, it is difficult to hide her pride, she said, "Now I can also wear white clothes similar to doctors and teachers, I am a nurse, and my professionalism is different from that of a nurse." ”
It is imperative to solve the difficulty of inpatient companionship, and multi-department collaboration may be the way to solve it.
At present, hospitals in economically developed countries generally do not need family members and self-hired nurses to accompany the phenomenon, all nursing care during hospitalization is arranged by the hospital, and family members only need to sign, pay money, and visit at the specified time. With the gradual improvement of China's economy and people's living standards, medical care is in line with the world, and the nursing problem needs to be solved urgently. Yao Huaifang introduced.
Zhu Tongyu, a member of the National Committee of the Chinese People's Political Consultative Conference (CPPCC) and vice president of Shanghai Medical College of Fudan University, also proposed at the two sessions that he suggested learning from the international practice of zero escort, taking life care as a part of the patient's first and incorporating it into the overall care category, and the hospital should carry out unified management.
To solve these problems, we must first improve the construction of the practice system of nursing staff. According to the different work content and responsibilities, the nursing system is divided into different levels such as nursing staff, assistants, medical scientists, and nursing science researchers. For daily life care, it should be undertaken by the caregiver; Low-tech, low-risk basic medical care can be undertaken by assistants. The quality of the work of the nursing staff and the assistant is managed by the responsibility, and the nursing staff is included in the overall team of the nursing team, forming a post system of nursing staff, clinical care, and research, so as to realize the matching of the work connotation of life care, medical care, and nursing innovation. Zhu Tongyu introduced.
Yao Huaifang suggested that the relevant departments should pay attention to it, and on this basis, it should be comprehensively promoted from public hospitals, so that all inpatients are cared for by the hospital according to the level of care, and all life care and medical care are arranged by the hospital in a unified manner; In addition, the hospital has a doctor who determines the level of care according to the condition of the inpatient, and charges different nursing fees according to the level of care. The medical insurance department and the price department shall review and standardize the nursing fee standards, and clarify the self-pay items in the nursing items.
In the future, the promotion and implementation of the unaccompanied care model in public hospitals requires the coordinated participation of multiple departments, the National Health Commission formulates standards, and the medical insurance department and the hospital, and the patient share the cost. In Wang Yan's view, the unaccompanied care model is very suitable for implementation in China, and this is more in line with the appearance of modern hospitals in an aging society, which still has a long way to go.
In December 2023, an elderly man in his 70s was admitted to the cardiology department of the hospital. As soon as he entered the door of the inpatient area, the nursing staff stepped forward to take over the old man's daily necessities, held the old man's hand, and entered the ward, without the need for family members to work hard to accompany him, which was a warm scene in the unaccompanied ward.