abstract

Community nursing is a systematic holistic nursing that centers on health and provides prevention, health care, medical treatment, rehabilitation, health education and family planning technical guidance for individuals, families and people in the community. It is an important part of community health service. Community nurses should be familiar with and master the basic concept, necessity, main contents, service objects and common measures of community nursing, and make clear the particularity of community nursing in object and subject, so as to guide the prevention, protection and promotion of community and improve the quality of community nursing.

Keywords community; Nursing work; speciality

Community nursing adapts to the health needs of community residents and develops gradually with the needs of community health services. Therefore, community nursing is an important part of community health service. The development history of community nursing is not long. From an academic point of view, it is not only a branch of nursing specialty, but also a new discipline combining public health with nursing. Through the theoretical study of general practice and community nursing, the author deeply realized that as a qualified community nurse, he should be familiar with and master the basic concepts of community nursing and understand its particularity, which has important practical significance for improving the quality of community nursing.

1 Basic concept of community nursing;

1. 1 The basic meaning of community nursing is to provide health-centered and systematic holistic nursing services for individuals, families and people in the community, integrating prevention, health care, medical treatment, rehabilitation, health education and family planning publicity and guidance.

1.2 the necessity of community nursing: firstly, with the change of population structure, the concept of healthy aging has brought many corresponding community health care needs; The second is the change of disease spectrum, and the demand for community nursing of chronic diseases increases; Third, with the implementation of the national family planning policy and the expansion of family structure, a couple has to take care of four elderly people, which requires "simple, convenient and cheap" community nursing services; Fourthly, the current high medical expenses are unbearable for residents, and the phenomenon of difficulty in seeing a doctor and hospitalization still exists objectively, which makes the demand for community nursing more and more urgent.

1.3 The main contents of community nursing mainly include prevention, protection and promotion.

(1) Prevention refers to the prevention of diseases and injuries, which is embodied in nursing services such as community clinics and family beds, and participation in health care activities such as regular physical examination, disinfection, epidemic prevention and vaccination;

(2) Protection refers to protecting residents from harmful substances in the environment. It is embodied in undertaking health management work such as signing service contracts in the community, establishing family health records, prohibiting smoking in public places, inspecting drinking water and food hygiene, and limiting environmental pollution in community room decoration;

(3) arrange some activities to promote the health of community residents, which are embodied in organizing community residents to carry out some beneficial activities of national fitness and publicize family planning and some health care knowledge.

1.4 The service object of community nursing is everyone, every family, every group and every public health place in the community.

1.5 at present, there are three main modes of community health service in China: one is the mode of community service station, that is, a certain number of medical personnel are sent by local hospitals to establish community health service stations in community neighborhood committees to undertake the tasks of medical treatment, prevention, health care and rehabilitation of neighborhood committees; The second is the community service center type, which refers to the establishment of community service centers in local hospitals to undertake the community health service work of neighborhood committees in the jurisdiction; Three, social participation refers to the primary health care station, led by street offices such as urban areas, guided by people in primary hospitals, composed of neighborhood committees, retired medical staff, short-term service trainers, community volunteers, etc.

There are three common measures in community nursing: one is to take educational measures. Education is to provide information to residents and encourage them to change their lifestyle voluntarily and develop healthily. For example, educate residents how to choose a diet and physical exercise that meets health requirements; The second is to take planning measures. Planning is a powerful way of persuasion, that is, through some nursing activities to reduce the risk factors in the environment. Such as preventive injection diseases, disinfection inspection of tableware in restaurants, etc. The third is to take compulsory measures. Coercion is the method of using coercion. If the law prohibits the abuse of the elderly and children, isolation of infectious diseases and inhalation of harmful chemicals. Community nursing should use these three measures to protect residents, prevent diseases and disabilities and promote health.

2 the particularity of community nursing work:

2. 1 Particularity of community nursing objects

2. 1. 1 Going deep into the society, the object of community service is community nursing at the grass-roots level, which is a kind of public service. It is different from hospital care. The object of hospital care is patients, while the object of community care is every household, everyone and some public places. Therefore, community medical personnel go deep into the grassroots of society and directly face the community residents.

2. 1.2 relations are diverse, and the community service objects are relatively stable. Because community residents play a variety of social roles, they have different social division of labor and social status. At the same time, the age structure and health status of community residents are different, and their nursing needs are also different. Therefore, the above situation determines the diversity of interpersonal relationships in community nursing. This diversity is different from the temporality, short-term and individuality of the relationship between doctors and patients in hospital nursing, but it is long-term, stable, repetitive and holistic. Therefore, the enthusiastic service, hard work and perseverance of community medical staff are particularly important.

2. 1.3 The difference is general, and the community service object should be focused. Because of the aging of the world's population, the physical function of the elderly is declining, and the chance of getting sick is greater. Once the illness is more serious; Children, especially young children, have poor self-care awareness and are prone to injury and illness; Disabled people have always been cared for by the whole society because of their mobility difficulties; A few low-income poor people in the community have a hard life, and their health problems should be concerned by the government and society. In this regard, the World Health Organization put forward three principles that must be followed in community nursing work, one of which is to "give priority to the vulnerable groups (the elderly, the weak and the disabled) in the community". Because women's health directly affects children's health, patients with chronic diseases, mental illness and other key nursing patients need community nursing comfort and help services in addition to hospital treatment. Therefore, the elderly, women, children, the disabled, poor families and the above-mentioned key nursing patients should be the key targets of community nursing services.

2. 1.4 preventive health care expands the connotation of community nursing service. Because community nursing is health-centered, family-oriented, and oriented to maintaining and promoting the overall health of residents, long-term nursing activities are carried out. Therefore, community nursing is not only medical care, but also the organic combination of medical treatment, prevention, rehabilitation, health care and health education, and the integration of individual health care and group health care, thus providing comprehensive, continuous, convenient, fast, economical and high-quality health care services for residents.

2.2 particularity of community nursing discipline

2.2. 1 Taking health as the center, community nursing institutions are required to be "multifunctional". The main duty of community nursing is to treat the population as a whole, and directly provide coordinated and continuous care for individuals, families and groups in the community by means of health promotion, health maintenance and health education, so that residents can achieve health. Community nursing centers on maintaining and promoting human health. Hospital clinical nursing mainly focuses on restoring people's health, while community nursing does not simply treat nursing patients, but provides comprehensive services such as prevention, health care, rehabilitation, health education and family planning technical guidance, and is entrusted by the health administrative department to undertake public health management functions within its jurisdiction. Community nursing generally has the service functions of community health education, infectious disease prevention, environmental and occupational health management, home care, children's health care, women's health care, elderly health care, mental health and psychological health care, hospice care service for patients, and pre-hospital first aid for patients.

2.2.2 Community nurses are required to become "general nurses". The basic duty of community nursing is to treat people as a whole, not just individuals and families. Therefore, community nursing should collect and analyze the health status of the population, and then solve the main health problems of this group. Even if community nurses take care of individuals and families, they are also helping the whole people solve their health problems. The task of community nurses is to expand from one patient to take care of the whole population.

Therefore, this puts forward higher professional quality requirements for community nurses. A qualified community nurse should be able to care, educate, consult, organize, manage, coordinate, cooperate, observe and learn. In different situations, different occasions and different time conditions, what effect a community nurse can play as a role depends on her knowledge, skills and flexible use.

2.2.3 Based on "independence", community nurses are required to have autonomy. Hospital nurses often work under the advice of doctors, while community nurses are often in a state of doing their own things and performing their tasks alone because of their low management level and wide scope of work. A lot of work, from preparation to operation, from implementation to completion, must be grasped by ourselves. Therefore, community nurses should have strong independence and autonomy.

2.2.4 "People-oriented" requires community nurses to improve their interpersonal and communication skills. In addition to patients, hospital nurses are mainly hospital medical staff. However, community nurses should not only cooperate with medical staff, but also contact many people such as local administration, welfare, education, enterprises and residents. Only by respecting the opinions of others and actively cooperating with relevant departments and personnel can we do a good job in community nursing. Therefore, a community nurse should not only have theoretical knowledge of clinical nursing and certain community work experience, but also have strong humanistic feelings and persistent professionalism.

3. The guiding significance of the particularity of community nursing:

3. 1 To guide community nursing prevention.

3. 1.65438+ Do a good job in registration, recording and statistics. All data reports shall be timely, accurate and complete, and shall be filed and managed.

3. 1.2 Establish and improve various rules and regulations of community nursing. In order to ensure the safety of nursing work and effectively prevent accidents and iatrogenic infections, it must be made clear that all kinds of personnel should strictly implement the disinfection and isolation, duty, handover, patrol, inspection, error and accident prevention and registration reporting system, drug management, rescue, infectious disease management and reporting, treatment management system. Community nursing work is institutionalized and standardized.

3. 1.3 Actively carry out community prevention work, and designate specific personnel to be responsible for health and epidemic prevention, planned immunization, food-borne diseases, chronic diseases and other prevention work.

3. 1.4 Carry out community medical work normally, pay attention to the diagnosis and treatment of common diseases and frequently-occurring diseases at ordinary times, carry out family sickbeds, family nursing and related services when necessary, and do a good job in initial first aid and transportation of critically ill patients before admission.

3. 1.5 Attach importance to rehabilitation and health education. Community nurses should accurately grasp the basic health status of the community population, establish personal, family and community health records of residents, and timely grasp the rehabilitation management information of chronic diseases, surgical patients and disabled people. At ordinary times, in community rounds and rounds, physical and psychological knowledge education closely related to health is carried out in various forms to change all kinds of customs and behaviors harmful to the health of patients and healthy people and improve residents' self-care ability.

3.2 to guide the community nursing protection work.

3.2. 1 Carry out health and epidemic prevention work in time. First, carry out epidemic spot management and epidemiological investigation on infected patients, and inspect and guide the disinfection and isolation work of collective units; Second, timely and accurately grasp the vaccination targets and urge them to vaccinate on time; The third is to carry out immunization effect monitoring activities.

3.2.2 Pay attention to the systematic management of pregnant women and babies. First, do a good job in propaganda and guidance of perinatal health care; The second is to organize the investigation and treatment of community women's diseases; The third is to do a good job in filing visits and breastfeeding guidance for newborns in time.

3.2.3 Pay attention to strengthening community health management. First, smoking is prohibited in public places in the community; The second is to strengthen the sanitary inspection of drinking water, diet and food in the community, strictly implement relevant sanitary standards, make relevant inspection records, and timely rectify and report the problems found; Third, correctly guide all the renovations in the community that restrict residents from polluting the indoor and outdoor environment, and the lead content in furniture coatings must meet the national standards.

3.3 to guide the promotion of community nursing

3.3. 1 Pay attention to the publicity and training of community health. First, actively carry out publicity and guidance on women workers' health care, family planning, prenatal and postnatal care, food hygiene and labor hygiene in the community; Second, actively carry out health education and training, health knowledge publicity and various consulting activities for community residents. Conditional can establish health consultation clinics, hotlines and community health promotion associations.

3.3.2 Willing to carry out sports activities beneficial to physical and mental health, you can use morning exercises and other opportunities to mobilize residents to participate in aerobics, dancing, playing Tai Ji Chuan and other activities according to the hobbies and habits of community residents.

3.4 to guide community nursing to improve institutions and personnel training.

3.4. 1 Further strengthen the construction of community service institutions. Due to the late start of community nursing in China, cities have begun to take shape, residential quarters are under construction, and some community nursing work still stays at the original medical service level. Therefore, both the network construction of community nursing institutions and the various systems of community nursing need to be established and improved.

3.4.2 Further strengthen the training of community nurses. Because the construction of community institutions is not perfect, there are few community nurses. Community nurses are generally transformed from hospital nurses, but it is difficult for hospital nurses to adapt to the needs of community nursing work for the time being. Therefore, we should strengthen the cultivation of community nursing talents and adopt various forms and ways to cultivate the theoretical knowledge and practical ability of community nursing for on-the-job nurses. At the same time, colleges and universities are used to train a group of community nursing talents with college and undergraduate education in a planned way to improve the overall quality of community nursing team and ensure the development of community nursing.

With the continuous improvement of people's requirements for medical service quality, patients and their families have higher and higher requirements for nurses' professional ethics, technical level and service quality. In daily nursing work, there are some phenomena, such as tense doctor-patient relationship and constant disputes between nurses and patients. This paper discusses how to avoid disputes, and the report is as follows.

1 service attitude causes contradiction:

With the strengthening of medical ethics in the industry, the disputes between nurses and patients caused by poor service attitude have been significantly reduced. However, there are still some nurses who use service taboos in their work, pay no attention to the way of speaking and tone, have a blunt service attitude, do not communicate in place, and lack sympathy for patients, which leads to misunderstandings and contradictions. Nurses should stand on the patient's point of view, think for the patient, understand and care for the patient everywhere, explain more when operating, be patient when asking questions, be careful when observing the illness, be responsible when working, remind more about safety and bless more when leaving the hospital.

2 cost problems lead to contradictions:

When doctors or nurses urge patients to ask for money, it is easy to cause conflicts. After the patient is admitted to the hospital, doctors and nurses should explain the approximate medical expenses to the patient in detail so that the patient can know fairly well; When nurses transfer money, they should strictly follow the charging standard and do not charge fees; When patients have doubts about the cost, nurses should explain patiently and ask relevant departments when necessary until the patients or their families are clear.

3 communication is not in place, causing contradictions:

The current disputes are often caused by poor communication, and these disputes can be completely prevented. When communicating with patients, we should master the discretion and art of speaking flexibly according to the situation, and patiently introduce the hospital, health education and nursing related content. It is used to know the severity, prognosis, treatment, examination results and medical expenses of patients. , should ask the competent doctor to explain the patient in detail, to avoid unnecessary disputes caused by improper explanation or inconsistent with the doctor's explanation.

4 weak legal awareness leads to contradictions:

Some nurses have a weak legal concept, lack legal common sense and take chances. They turn a blind eye to the rules and regulations of the hospital, work carelessly, and usually do not pay attention to business study and knowledge update, which leads to nurse-patient disputes [3]. It is necessary to strengthen the study of legal knowledge, cultivate the spirit of prudence and independence, enrich the legal awareness of nursing staff, make the majority of nursing staff seriously study the law, abide by the law and use it, and actively use legal means to safeguard the legitimate rights and interests of both nurses and patients.

5. Lack of nursing knowledge leads to contradictions:

Many nurses have poor theoretical knowledge, and when patients ask questions about matters needing attention, diet and medication, they can't answer the patients correctly and comprehensively, and can't meet the requirements of patients, which leads to contradictions. As a nursing worker, we should constantly learn new nursing concepts, knowledge and skills to enrich ourselves, optimize our knowledge and ability, constantly improve our professional quality, and practice exquisite skills to fundamentally reduce the occurrence of disputes.

6. Contradictions caused by violation of medical operation rules and regulations:

Individual medical staff do not seriously implement the rules and regulations of the hospital, or even violate the medical operation procedures, resulting in medical errors in the process of disease diagnosis, treatment and nursing, and even lead to medical accidents. It is necessary to strengthen the study of various diagnostic nursing routines, strengthen the pre-job training and practical work guidance for junior nurses, and strengthen the training of newly developed technical projects so that everyone can master them skillfully.

7 Conflicts caused by other problems:

The lights in wards, corridors and toilets are not on, the sewers are blocked, valuables are lost, venipuncture fails, beds are arranged unreasonably, and meals in the canteen are unpalatable, which may cause conflicts. The head nurse should do a good job in all kinds of management work, coordinate with various administrative departments, and let nurses have a better working environment.

In short, nurses should conscientiously sum up experiences and lessons, avoid nursing disputes, do a good job of self-prevention, and protect themselves first while serving patients, so as to carry out their work better.

refer to

1 summer. Nursing care of common diseases in community. Nanjing: Southeast University Press, 2004, 1.

Zhou Ying. Introduction to community nursing. Nanjing: Southeast University Press, 2004, August.