政策工具视角下国内护理卫生政策的文本分析

doi:10.3761/j.issn.0254-1769.2023.07.011

摘要/Abstract

摘要：

目的研究1978年—2020年护理卫生政策中政策工具使用情况，探讨现有政策工具的分布情况及框架结构，为后续政策的制定及落实提供参考。方法基于Rothwell & Zegveld构建的政策工具分析框架，采用内容分析法，构建X维度（基本政策工具）及Y维度（政策发展阶段）的二维分析框架，对现有护理卫生政策文本进行编码整理和量化分析。结果最终纳入24篇政策文件，共整理378条政策分析条目。X维度中，供给型、需求型、环境型政策工具所占比例分别为24.60%、14.02%、61.38%。Y维度中，萌芽探索期、补充完善期、成熟提升期政策工具占比分别为23.02%、31.75%、45.24%。结论目前国内护理卫生政策工具总体使用不协调，供给型政策工具较关注人才培养，科技研究和信息化建设有待增加；需求型政策工具应用较少，缺乏有效拉动作用；环境型政策工具使用过于频繁，内部工具比例有待调整。建议可进一步把握护理卫生政策演化的规律性，提升政策实施的实效性，强化政策组合的整体性。

关键词: 政策工具, 卫生政策, 政策分析, 护理管理研究

Abstract:

Objective To study the use of policy instruments in nursing and health policies from 1978 to 2020，and to explore the distribution and framework of existing policy instruments，so as to provide references for the formulation and implementation of subsequent policies. Methods Based on Rothwell & Zegveld’s theory of policy instruments，this paper uses the content analysis method to construct a two-dimensional analysis framework of dimension X（basic policy instrument） and dimension Y（policy development stage），collating and quantifying the existing nursing health policy texts. Results 24 policy documents were finally included，and a total of 378 policy items were coded. In the X dimension，supply-oriented，demand-oriented，and environmental-oriented policy instruments accounted for 24.60%，14.02%，and 61.38%，respectively. In the Y dimension，the policy instruments in the budding exploration period，the supplementary improvement period，and the mature promotion period account for 23.02%，31.75%，and 45.24%，respectively. Conclusion At present，the overall use of nursing and health policy instruments in China is not coordinated. Supply-oriented policy instruments pay more attention to personnel training，and scientific and technological research and information construction need to be increased. Demand-oriented policy instruments are less applied and lack effective pulling effect. Environmental policy instruments are used too frequently and the internal ratio needs to be adjusted. It is suggested to further grasp the evolution rules of nursing health policy，improve the effect of policy implementation，and strengthen the integrity of policy.

Key words: Policy Instruments, Health Policy, Policy Analysis, Nursing Administration Research

余舒欣, 林荣, 祝雪花. 政策工具视角下国内护理卫生政策的文本分析[J]. 中华护理杂志, 2023, 58(7): 843-849.

YU Shuxin, LIN Rong, ZHU Xuehua. Textual analysis of China’s nursing and health policies from the perspective of policy instruments[J]. Chinese Journal of Nursing, 2023, 58(7): 843-849.

图/表 3

表1 纳入政策的基本特征（n=24）

Table 1 Basic characteristics of the included literature（n=24）

表2 基本政策工具分布情况（n=378）

Table 2 Distribution of policy instruments（n=378）

表3 政策发展不同阶段护理卫生政策工具数量（n=378，条）

Table 3 Number of nursing and health policy instruments at different stages of policy development（n=378，piece）

参考文献 21

[1]	郝模, 王志锋, 等. 卫生政策学[M]. 北京: 人民卫生出版社, 2005.
	Hao M, Wang ZF. Health policy[M]. Beijing: People’s Medical Publishing House, 2005.
[2]	曹琦, 崔兆涵. 我国卫生政策范式演变和新趋势:基于政策文本的分析[J]. 中国行政管理, 2018(9):86-91.
	Cao Q, Cui ZH. Paradigm shift and new tendency of health policy in China:based on content analysis of policy discourse[J]. Chin Public Adm, 2018(9):86-91.
[3]	孟雯, 李雪梅, 刘梦佳, 等. 我国1949年以来护理卫生政策演变及分析[J]. 中国社会医学杂志, 2018, 35(4):337-339.
	Meng W, Li XM, Liu MJ, et al. Study on the evolvement of nursing health policy since 1949 in China[J]. Chin J Soc Med, 2018, 35(4):337-339.
[4]	Hood C. The tools of government[M]. London:Macmilan, 1983:2-10.
[5]	克鑫峰, 杨赐然, 崔丹. 政策工具运用视角下健康建设规划内容解构与层级异同研究[J]. 中国卫生经济, 2022, 41(4):5-9.
	Ke XF, Yang CR, Cui D. Research on the content deconstruction and level comparison of health promotion planning based on the perspectives of policy tools application[J]. Chin Health Econ, 2022, 41(4):5-9.
[6]	Rothwell R, Zegveld W. Industrial innovation and public policy:preparing for the 1980s and the 1990s[M]. London: France Printer,1981.
[7]	国务院. 中共中央国务院关于深化医药卫生体制改革的意见[EB/OL]. (2009-04-08) [2022-03-17]. http://www.gov.cn/test/2009-04/08/content_1280069.htm.
	State Council. Opinions of the Central Committee of the Communist Party of China and the State Council on deepening the reform of the medical and health system[EB/OL].(2009-04-08) [2022-03-17]. http://www.gov.cn/test/2009-04/08/content_1280069.htm.
[8]	国家卫生和计划生育委员会. 国家卫生计生委关于印发全国护理事业发展规划(2016-2020年)的通知[EB/OL].(2016-11-18) [2021-07-15]. http://www.nhc.gov.cn/yzygj/s3593/201611/92b2-e8f8cc644a899e9d0fd572aefef3.shtml.
	National Health and Family Planning Commission. Notice of the National Health and Family Planning Commission on printing and distributing the national nursing development plan(2016-2020)[EB/OL]. (2016-11-18) [2021-07-15]. http://www.nhc.gov.cn/yzygj/s3593/201611/92b2e8f8cc644a899e9d0fd572aefef3.shtml.
[9]	车峰. 基于政策工具视角的我国健康服务业政策分析[J]. 大连理工大学学报(社会科学版), 2018, 39(6):75-81.
	Che F. Health service industry policies in China from the perspective of policy instrument[J]. J Dalian Univ Technol Soc Sci, 2018, 39(6):75-81.
[10]	国家卫生健康委. 关于学习贯彻习近平总书记重要指示精神进一步加强护士队伍建设的通知[EB/OL]. (2020-05-26) [2021-07-19]. https://www.gov.cn/zhengce/zhengceku/2020-05/26/content_5515100.htm.
	National Health Commission. Notice on studying and implementing the spirit of General Secretary Xi Jinping’s important instructions and further strengthening the construction of nursing teams[EB/OL]. (2020-05-26) [2021-07-19]. https://www.gov.cn/zhengce/zhengceku/2020-05/26/content_5515100.htm.
[11]	尚少梅, 王翠, 董旭, 等. 对我国高等护理教育近20年发展的回顾与思考[J]. 中国护理管理, 2021, 21(9):1292-1295.
	Shang SM, Wang C, Dong X, et al. Review and reflection on the development of higher nursing education in China in recent 20 years[J]. Chin Nurs Manag, 2021, 21(9):1292-1295.
[12]	Violante MG, Vezzetti E. Design and implementation of 3D Web-based interactive medical devices for educational purposes[J]. Int J Interact Des Manuf, 2017, 11(1):31-44. DOI URL
[13]	沈志莹, 钟竹青, 丁四清, 等. 我国护理管理信息化的研究进展[J]. 中华护理杂志, 2020, 55(3):397-401. DOI
	Shen ZY, Zhong ZQ, Ding SQ, et al. Research progress on informationization of nursing management in China[J]. Chin J Nurs, 2020, 55(3):397-401.
[14]	国家卫生健康委员会, 国家发展和改革委员会, 教育部, 等. 关于印发促进护理服务业改革与发展指导意见的通知[EB/OL]. (2018-06-21) [2022-01-15]. http://www.gov.cn/zhengce/zhengce-ku/2018-12/31/content_5435177.htm.
	National Health Commission, National Development and Reform Commission, Ministry of Education, et al. Notice on print-ing and distributing guiding opinions on promoting the re-form and development of the nursing service industry[EB/OL]. (2018-06-21) [2022-01-15]. http://www.gov.cn/zhengce/zhengce-ku/2018-12/31/content_5435177.htm.
[15]	廖唯峥, 王菁, 李慧, 等. 我国长期护理保险制度的发展现状及对策[J]. 护理学杂志, 2019, 34(13):99-101.
	Liao WZ, Wang J, Li H, et al. Analysis of the current situation of long-term care insurance system in China[J]. J Nurs Sci, 2019, 34(13):99-101.
[16]	保罗·J,. 费尔德斯坦. 卫生保健经济学[M]. 费朝晖等译. 北京: 经济科学出版社, 1998:12.
	Feldstein PJ. Healthcare economics[M]. Fei ZH et al translated. Beijing: Economic Science Press, 1998:12.
[17]	郑军, 刘亚孔. 我国建立长期护理保险制度的原则设想[J]. 卫生经济研究, 2018(11):42-45.
	Zheng J, Liu YK. The principles of establishing long-term nursing insurance system in China[J]. Health Econ Res, 2018(11):42-45.
[18]	马玉霞, 张园园, 王玉坦, 等. 临床护理分类系统在护理实践中的应用进展及启示[J]. 中华护理杂志, 2021, 56(1):132-136. DOI
	Ma YX, Zhang YY, Wang YT, et al. The application and enlightenment of clinical care classification system in nursing practice[J]. Chin J Nurs, 2021, 56(1):132-136. DOI
[19]	丁珊妮, 潘红英, 虞雪琴, 等. 神经系统疾病标准化护理评估术语的构建[J]. 中华护理杂志, 2018, 53(8):962-966.
	Ding SN, Pan HY, Yu XQ, et al. Establishment of the standardized neurological nursing assessment terminology system[J]. Chin J Nurs, 2018, 53(8):962-966.
[20]	唐钧, 李军. 健康社会学视角下的整体健康观和健康管理[J]. 中国社会科学, 2019(8):130-148,207.
	Tang J, Li J. The concepts of overall health and health management from a health sociology perspective[J]. Soc Sci China, 2019(8):130-148,207.
[21]	郭燕红. 实施健康中国战略推动护理事业发展[J]. 中华护理杂志, 2018, 53(1):5.
	Guo YH. Implementing healthy China strategy to promote the development of nursing[J]. Chin J Nurs, 2018, 53(1):5.