Abstract:

Objective To investigate the current status and barriers to implementing non-accompanied care services in medical institutions in Zhejiang Province，and to provide a basis for the improvement of standardized management of such services. Methods A self-designed questionnaire was conducted from September to October 2024 among all secondary and tertiary medical institutions in Zhejiang Province to assess the implementation status and barriers to non-accompanied care services. Results A total of 397 questionnaires were distributed，with 389 valid responses，yielding a valid response rate of 97.98%. Non-accompanied care services were implemented in 118 institutions（30.33%）. Among these，90 institutions（76.27%） had established management systems for non-accompanied wards；71 institutions（60.17%） had a medical nursing assistant-to-bed ratio lower than 1∶5；41 institu-tions（34.75%） provided tiered training for medical nursing assistants；93 institutions（78.81%） required patients to bear the full cost of the service. Compared with secondary medical institutions，tertiary medical institutions have more complete management system for non-accompanied care services.The main obstacles hindering the development of non-accompanied care services include an imperfect management system for non-accompanied wards，a shortage of medical nursing assistants，a lack of standardized training for such assistants，inconsistent charging standards，and low acceptance among patients and their families. Conclusion The promotion of non-accompanied care services in medical institutions in Zhejiang Province has achieved initial success. However，challenges persist，including incomplete management systems，uneven development across hospital tiers，and imperfect charging mechanisms. It is recommended that relevant authorities strengthen policy support，enhance standardized training for healthcare nursing assistants，refine cost-sharing mechanisms，and improve the quality and sustainability of non-accompanied care services through multi-party collaboration.

Key words: Medical Institutions, Non-Accompanied Care Services, Cross-Sectional Studies, Barrier Factors, Nursing Administration Research

摘要：

目的 调查浙江省医疗机构无陪护服务开展现状及障碍因素，为规范无陪护服务的管理提供依据。 方法 2024年9—10月，采用自制问卷对浙江省所有二级及以上医疗机构无陪护服务的开展现状及障碍因素进行调查。 结果 共发放397份问卷，回收有效问卷389份，有效问卷回收率为97.98%。118所（30.33%）医疗机构开展无陪护服务，其中90所（76.27%）医疗机构已制订无陪护病房管理制度，71所（60.17%）医疗机构的医疗护理员与床位数比< 1∶5，41所（34.75%）医疗机构对医疗护理员进行分层培训，93所（78.81%）医疗机构无陪护服务费用的支付方式为自费。与二级医疗机构相比，三级医疗机构的无陪护服务管理制度更完善。开展无陪护服务的主要障碍因素包括无陪护病房管理制度不完善、医疗护理员人力资源不足、医疗护理员缺乏同质化培训、收费标准不统一、患者及家属的接受程度偏低等。 结论 浙江省医疗机构无陪护服务的开展已取得一定成效，但存在管理制度尚未健全、不同等级医疗机构间发展不平衡、收费机制待完善等问题，建议相关部门加强协作，强化政策支持及医疗护理员规范化培训，完善费用分担机制，以提升无陪护服务的质量和可持续性。

关键词: 医疗机构, 无陪护服务, 横断面研究, 障碍因素, 护理管理研究