脑卒中个案管理师准入标准和工作职责方案的构建

doi:10.3761/j.issn.0254-1769.2020.05.002

摘要/Abstract

摘要：

目的构建脑卒中个案管理师准入标准和工作职责,为制订符合中国国情的脑卒中个案管理师人才培养方案和工作标准提供参考依据。方法基于文献研究、脑卒中患者管理现状调查、专家会议讨论和预咨询,构建准入标准和工作职责初稿;采用德尔菲专家咨询法,对全国8个省市的20名专家进行问卷咨询。结果 2轮专家咨询的问卷有效回收率分别是95.2%和100.0%。第2轮咨询中,专家权威系数为0.910,准入标准和工作职责的一、二、三级指标专家意见的肯德尔和谐系数分别为0.193、0.155、0.141（P<0.05）和0.445、0.156、0.134（P<0.05）。最终形成的脑卒中个案管理师准入标准包括一级指标3项（基础条件、专业能力、综合能力）,二级指标7项,三级指标17项。工作职责包括一级指标4项（评估、计划、实施、评价）,二级指标17项,三级指标79项。结论经专家咨询确定的脑卒中个案管理师准入标准和工作职责方案具有较好的科学性、实用性、可行性和创新性,能为脑卒中个案管理护理实践提供理论依据。

关键词: 脑卒中, 个案管理, 护理管理研究, 德尔菲技术

Abstract:

Objective To establish eligibilities and responsibilities for stroke case managers,and to provide references for training programs and work standards for stroke case managers in accordance with China’s national conditions. Methods Based on literature research,investigation of status of stroke patients management,expert meeting discussions and pre-consultations,a preliminary draft of eligibilities and responsibilities was constructed. Twenty experts from 8 provinces were consulted by Delphi expert consultation method. Results The effective recovery rates of the two rounds of expert consultations were 95.2% and 100%,respectively. In the second round of consultation,the authoritative coefficient of experts was 0.910,and the coordination coefficients of the first,second and third-level indicators of eligibilities and responsibilities were 0.193,0.155,0.141（P<0.005） and 0.445,0.156 and 0.134（P<0.005）,respectively. The final eligibilities for stroke case managers included three first-level indicators（basic conditions,professional ability,comprehensive ability）,seven second-level indicators and 17 third-level indicators. Responsibilities included four first-level indicators（assessment,planning,implementation,evaluation）,17 second-level indicators and 79 third-level indicators. Conclusion The eligibilities and responsibilities of stroke case managers determined by expert consultations are scientific,practical,feasible and innovative,which can provide theoretical basis for nursing practice of stroke case management.

Key words: Stroke, Case Management, Nursing Management Research, Delphi Method

邓娟, 罗青, 纪玉桂, 黎蔚华, 谢红珍. 脑卒中个案管理师准入标准和工作职责方案的构建[J]. 中华护理杂志, 2020, 55(5): 652-658.

DENG Juan, LUO Qing, JI Yugui, LI Weihua, XIE Hongzhen. Construction of eligibilities and responsibilities for stroke case managers[J]. Chinese Journal of Nursing, 2020, 55(5): 652-658.

图/表 2

参考文献 28

[1]	王陇德, 刘建民, 杨弋 , 等. 《中国脑卒中防治报告2017》概要[J]. 中国脑血管病杂志, 2018,15(11):611-617.
[2]	国家卫生健康委员会. 关于进一步加强脑卒中诊疗管理相关工作的通知[EB/OL]. (2018-04-26)[2018-08-15]. http://www.nhc.gov.cn/yzygj/s7659/201804/d79dfff31feb4ab7960f827a5ea27d26.shtml.
[3]	国家卫生健康委员会. 国家卫生计生委办公厅国家中医药管理局办公室关于印发脑卒中综合防治工作方案的通知[EB/OL]. (2016- 12- 09)[2019-08-15]. http://www.nhc.gov.cn/jkj/s5879/2016-12/cef09e0c26744df38fa710d3c0da75ce.shtml.
[4]	温俊程, 曹春水 . 我国脑卒中社区管理中存在的问题及对策探讨[J]. 中国全科医学, 2019,22(20):2482-2487.
[5]	邓娟, 纪玉桂, 罗青 , 等. 从脑卒中患者管理现状看个案管理师介入空间[J]. 医学与哲学(B), 2018,39(10):73-77.
[6]	陈煌, 黎蔚华, 罗青 , 等. 脑卒中早期康复现状的调查与分析[J]. 广东医学, 2018,39(2):278-282.
[7]	Sun MC, Hsiao PJ . In-hospital case management to increase anticoagulation therapy for stroke patients with atrial fibrilla-tion: a hospital-based registry[J]. J Formos Med Assoc, 2013,112(5):263-268. DOI URL PMID
[8]	Barlinn J, Barlinn K, Helbig U , et al. Organized post-stroke care through case management on the basis of a standardized treatment pathway:results of a single-centre pilot study[J]. Nervenarzt, 2016,87(8):860-869. DOI URL PMID
[9]	Prior PL, Hachinski V, Unsworth K , et al. Comprehensive cardiac rehabilitation for secondary prevention after transient ischemic attack or mild stroke I:feasibility and risk factors[J]. Stroke, 2011,42(11):3207-3213. DOI URL PMID
[10]	韩英, 林华, 陈少琴 , 等. 个案管理模式在脑卒中后功能障碍患者康复护理中的应用[J]. 海南医学, 2015,26(10):1559-1560.
[11]	关锐, 吕雪梅, 路红霞 , 等. 个案管理对脑卒中合并糖尿病患者治疗依从性的影响[J]. 河南大学学报(医学版), 2015,34(3):160-162.
[12]	Gray FC, White A, Brooks-Buck J . Exploring role confusion in nurse case management[J]. Prof Case Manag, 2013,18(2):66-78. DOI URL PMID
[13]	ANCC. our-certifications/nursing-case-management.[EB/OL].[2019-08-22]. https://www.nursingworld.org/our-certifications/nursing-case-management/.
[14]	ACMA. ACM handbook[EB/OL].[2019-08-22]. http://www.acma-web.org/forms/ACMA_ACMhandbook.pdf.
[15]	CCMC. Certification Guide to the CCM Examination[EB/OL].[2019-08-22]. https://ccmcertification.org/get-certified/certification/guides.
[16]	共和国中央人民政府. 国务院办公厅印发《全国医疗卫生服务体系规划纲要（2015-2020年）》[EB/OL]. (2015-03-30)[2019-04-14]. http://www.gov.cn/xinwen/2015-03/30/content_2840331.htm.
[17]	龚雪 . 糖尿病专科护士首次认证评价指标体系的构建[D]. 广州:暨南大学, 2014.
[18]	樊落 . 急诊专科护士核心能力评价指标体系的构建[D]. 上海: 第二军医大学, 2011.
[19]	姚晖 . PICC专科护士核心能力评价指标的构建及临床调查分析[D]. 上海:第二军医大学, 2012.
[20]	丁昌慧, 祁新辉, 蔡辉 . 卫生服务评价中权重系数的测量[J]. 交通医学, 2001,15(5):484-486.
[21]	刘翔宇, 谌永毅, 周钰娟 , 等. 住院患者护理服务满意度评价指标体系的构建[J]. 中华护理杂志, 2015,50(1):18-21.
[22]	穆欣, 李娟, 刘瑞荣 , 等. 首发脑卒中患者自我管理行为及影响因素的研究[J]. 中华护理杂志, 2016,51(3):289-293.
[23]	商之涵, 朱梦兰, 林榕 , 等. 急性缺血性脑卒中患者不同时期照护需求的质性研究[J]. 解放军护理杂志, 2018,35(18):19-23.
[24]	蔡憐环, 庞书勤, 王宝莲 , 等. 脑卒中患者康复促进因素的研究[J]. 中华护理杂志, 2017,52(7):785-788.
[25]	Bodechtel U, Barlinn K, Helbig U , et al. The stroke East Saxony pilot project for organized post-stroke care:a case-control study[J]. Brain Behav, 2016,6(5):e00455. DOI URL PMID
[26]	Munce SEP, Perrier L, Shin S , et al. Strategies to improve the quality of life of persons post-stroke:protocol of a systematic review[J]. Syst Rev, 2017,6(1):184. DOI URL PMID
[27]	Costa ÉS, Hyeda A . Chronic case management:clinical (1992)governance with cost reductions[J]. Rev Assoc Med Bras, 2016,62(3):231-235. DOI URL PMID
[28]	Joo JY, Huber DL . An integrative review of nurse-led community-based case management effectiveness[J]. Int Nurs Rev, 2014,61(1):14-24. DOI URL PMID