关键词: 难愈性创面, 慢性伤口, 伤口护理, 医联体, 质性研究

Abstract:

Objective To explore the barriers of implementing collaborative chronic wound management within medical consortium and provide references for ensuring continuous care for chronic wound patients. Methods Using purposive and snowball sampling methods，14 specialist nurses participating in chronic wound collaborative management across medical consortium in 7 provinces/municipalities（Beijing，Shanghai，Zhejiang，Sichuan，etc.） were selected for semi-structured interviews between December 2023 and January 2024. Data were analyzed via content analysis. Results Totally 4 themes and 8 subthemes were identified，including management and organizational level（the management system needs improvement；the function of medical information mutual recognition has not been fully realized），resource and technology level（there are insufficient nursing resources at the grassroots hospitals；the specialized nursing capabilities of wound nurses at grassroots hospitals need to be enhanced），patient and demand level（patients’ trust is insufficient；patients’ concepts are rigid），information technology and support level（the informatization construction of grassroots hospitals lags behind；the intelligence of information systems is insufficient）. Conclusion Wound specialist nurses encounter various difficulties when participating in the coordinated management of chronic wounds within the medical consortium. The management and organizational system constraints hinder the effectiveness of the nursing coordination；the resource and technology gap affects the implementation of graded wound care in the region；the lack of patient trust and misconceptions intensify the resistance to coordination；the lagging in information technology construction limits the innovative development of nursing coordination.

Key words: Refractory Wound, Chronic Wound, Wound Management, Medical Consortium, Qualitative Study