【作者】 王静；

【导师】 王君俏；

【作者基本信息】 复旦大学 ， 护理学， 2013， 硕士

【摘要】 目的探讨上海市养老机构老年人的生活质量及其影响因素,了解养老机构的架构与服务人员的服务能力,为实现养老机构老年人的优质生活提出有益的建议。方法本研究由量性研究和质性研究两部分组成。1.第一部分描述性研究。采用非概率抽样方法选取上海市徐汇区9家养老机构,并运用养老机构基本信息调查表了解9家养老机构的发展现状；采用非概率抽样方法选取9家养老机构中的515位老年人进行老年人一般情况问卷、Barthel指数评定、领悟社会支持评定量表、老年人服务质量感知量表、患者授权服务量表和护理院老人生活质量指数调查；运用养老机构护士基本信息调查表、养老机构护士服务能力自评表、养老机构护理员信息调查表和养老机构护理员服务能力自评表调查养老机构42名护士和168名护理员的服务能力。所得数据采用SPSS16.0进行统计分析。2.第二部分质性研究。采用深度访谈法访谈了12名养老机构长住老年人,更加深入探究养老机构老年人真实生活体验及其对优质生活概念的界定。研究采用目的抽样法,以最大差异法选择访谈对象。结果1.养老机构基本信息9家非营利性养老机构分为3种类型,包括政府办养老机构,公办民营养老机构和社会办养老机构。各机构的规模和软硬件条件各不相同。2.养老机构护士服务能力调查接受调查的养老机构护士平均年龄(39.76±10.35)岁,均为女性；其中,具有本科学历的仅4例(9.5%)：持有副高级职称者6例(14.3%)；护士护理服务能力自评量表平均得分为3.69±0.51(3-5分)。3.养老机构护理员服务能力调查168名养老机构护理员平均年龄(49.15±5.44)岁。文盲和仅具有小学学历的共100例,占了调查人数的59.5%；持中、高级技术等级证的仅12例,占了7.1%。养老机构护理员服务能力自评量表平均得分为3.60±0.41,最高分为5分,最低分为3分。得分最高的三个维度为协助用药管理、清洁卫生护理和对服务对象特征的认知；得分最低的三个维度为活动照护、精神照护和协助危险管理。多元逐步回归分析发现对职业的热爱程度、任职时间和文化程度是影响护理员护理服务能力的主要因素。4.养老机构老年人生活质量调查入选老年人平均年龄84.0±5.1岁；男性204例(39.6%),女性311例(60.4%)；接受一级护理和专护的人数达到了220例(42.7%)；Barthel指数平均得分为85.4±14.8分；合并疾病数超过两个的老年人达到259例(50.3%)；515位接受调查的老人中,从不和较少参加机构活动的为210例,占40.8%。参加交际活动需鼓励的有370例(71.8%)；515例受调查养老机构老年人的领悟社会支持得分的平均水平为46.9±6.6分,515例受调查老年人感知服务量表平均得分为72.53±10.45分。各维度的条目平均分从高到低依次为协助(3.54±0.46)、陪伴(3.42±0.49)、理解(3.22±0.47)和鼓励(2.29±0.63)；515例受调查老年人授权服务子量表平均得分的总体水平为3.07±0.25,非授权服务子量表的平均得分的总体水平为1.79±0.24。生活质量指数平均分的总体情况为18.17±1.95。多元逐步回归分析发现社会支持状况、老年人健康自评状况、Barthel指数得分、感知服务得分、家属探视情况、授权服务量表得分、年龄和老年人交际情况是影响其生活质量的主要因素。5.养老机构老年人真实生活体验本研究通过对资料的分析,最终提取了四个主题：冲突(群体生活和机构规章制度)、忧虑(自我价值、健康状况、丧失掌控和缺乏关怀)、适应(积极应对和消极妥协)和欣慰(生活保障、社交增加和子女减负)。结论1.机构养老总体发展较人口老龄化而言滞后,养老机构间的发展不平衡现象突出。2.机构活动开展频度和开展效果之间存在不平衡。3.养老机构护理服务团队整体素质不高,专业水平偏低,较难满足老年人较高层次的需求,造成了养老机构预估的服务质量与老年人感受到的服务之间存在差异。4.养老机构老年人生活质量处于中等水平,并受到了内部和外部多重因素的共同影响。更多还原

【Abstract】 ObjectiveTo explore Quality of life of the elderly residents in residential care facilities in Shanghai and the status quo and service capability of nuses and nursing assistants in the facilities so as to contribute to the development of residential care facilities.MethodsOur research compromises two main parts.Part 1:A cross-sectional study design was conducted in this part.9 residential care facilities and 515 elderly residents in these facilities were enrolled by non-probability sampling. Participants were interviewed by questionnaires including social demographic questionnaire, Barthel index of ADL, Perceived social support scale(PSSS), elderly residents’ perceived caring scale(EPCS), the patient empowerment scale(PES) and quality of life index-nursing home version. Also,168 nursing assistants and 42 nurses in these facilities were interviwed by caring ability questionnaire for nusing assistants and nursing capability questionnaire for nurses respectively. The data was analyzed by SPSS 16.0.Part 2:A qualitative study was conducted in the second part of our study.12 elderly residents were invited to take part in the personal in-depth interview about their real living experience in facilities and their defining of good residential life.Results1.Development of residential care facilitiesThe 9 residential care facilities in our research can be divided into 3 types, including governmental facilities, government-owned and society-run facilities and private facilites. These 9 facilites differs in their sizes and social envioronment.2.Nursing capability of nurses in residential care facilitiesThe average age of nurse in residential care facilites was 39.76+10.35 and 42 nurses interviewed were all female. However, the number of those who have a bachelor’s degree was only 4, accounting for 9.5% of them all and 6 out of 42 have got a senior vice title in profession.The total score of nursing capability questionnaire for nurses was 3.69±0.51 (ranged from 3-5)3.Caring ability of nursing assistants in residential care facilitiesThe age of the 168 nursing assistantas interviewed was 49.15±5.44, ranging from 3 to 5. They scored highest in medication management assistance, cleaning care and the familiarity of their service recipients, while scored lowest in activity caring, mental caring and danger management assistance.Linear multivariate regression analysis indicated that their love for their career, serving time and educational background were the mainly related factors of their caring abilities.4. Quality of life of elderly residentsElderly residents who participated in our research were aged 84.0±5.1, with 204 male residents and 311 female residents. The number of those who received grade one care and intensive care was 220, accounting for 42.7% of all. And the Barthel index scores were 85.4+14.8. Also,259 elderly residents have suffered from at least two chronic diseases.The 210 elderly participants never or rarely take part in residential social acitivities, accouting for 40.8% of all. And 71.8% of 515 elderly residents did not take initiative in social networking. Their perceived social support scale scores was 46.9+ 6.6.The score of EPCS was 72.53+10.45, from the highest score to the lowest of four dimensions were assistance, accompany, understanding and encouragement.The score of Quality of life Index was 18.17±1.95. And linear multivariate regression analysis indicated that social support, health self-evaluation, Barthel Index score, EPCS score, family visits, PES score, age and social networking were the maily related factors influencing Quality of life of the elderly residents.5. Real living experience in residential care facilitiesFour main themes emerged as:conflicts(including group living and rules of the facilities), anxiety(including selfe-evaluation, health status, loss of control and lack of caring), adaptation(including activie adapt and negative compromise) and comfort(including life guarantee, promotion in social networking and alleviation of their children’s burden).Conclusion1. The development of residential care facilities lags behind in regards to progression of population ageing and the developmental imbalance among different facilities has worsened.2. Residential care facilities tended to organize activities to enrich elderly residents’life, however, the elderly have not enjoyed residential acitivities to a satisfactory extent.3. The overall abilities and professional competence of the nursing team in residential care facilities were not competitive enough to meet higher level of demands from the elderly and have resulted in gap between care provided and care received.4. The quality of life of elderly residents was at a medium level and have been influenced by multiple-dimensional factors.更多还原