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

摘要：

目的 探索在医联体内实施慢性伤口联动管理中存在的障碍因素，为实施慢性伤口患者连续性照护提供参考。 方法 采用目的抽样法和滚雪球抽样法，于2023年12月—2024年1月选取北京市、上海市、浙江省、四川省等7个省（区、市）参与医联体慢性伤口联动管理的14名专科护士进行半结构式访谈，采用内容分析法分析资料。 结果 提炼出4个主题、8个亚主题：组织与管理层面（管理体系有待完善；医疗信息互认功能未完全实现）、护理人力资源与专科护理技术层面（基层医院慢性伤口护理资源较少；基层医院护士伤口专科护理能力有待提高）、患者与需求层面（患者信任度不足；患者观念固化）、信息化与技术支持层面（基层医院信息化建设滞后；信息系统智能化不足）。 结论 伤口专科护士在参与医联体内慢性伤口联动管理中，管理与组织体系不完善制约护理联动效能，资源与技术鸿沟影响伤口护理分级诊疗落地，患者信任不足与观念偏差加剧联动管理阻力，信息化建设滞后限制护理联动创新发展。

关键词: 难愈性创面, 慢性伤口, 伤口护理, 医联体, 质性研究