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Article(id=1322936902428524594, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936901946179634, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.10.023, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1745510400000, receivedDateStr=2025-04-25, revisedDate=1770912000000, revisedDateStr=2026-02-13, acceptedDate=null, acceptedDateStr=null, onlineDate=1793342336517, onlineDateStr=2026-10-30, pubDate=1779638400000, pubDateStr=2026-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793342336517, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793342336517, creator=13701087609, updateTime=1793342336517, updator=13701087609, issue=Issue{id=1322936901946179634, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='10', pageStart='1617', pageEnd='1808', issueExtLink='null', onlineDate='null', pubDate='1779638400000', pubDateStr='2026-05-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793342336403, creator='13701087609', updateTime=1793343127243, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940219045052525, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936901946179634, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940219045052526, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936901946179634, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1769, endPage=1774, ext={EN=ArticleExt(id=1322936902655017011, articleId=1322936902428524594, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Difficulties and countermeasures of hospice care services in nursing homes, columnId=1220689488284668633, journalTitle=Chinese Nursing Research, columnName=Comprehensive Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the shortcomings of hospice care services in nursing homes and to propose corresponding countermeasures.

Methods

Based on grounded theory,textual analysis was conducted on 82 hospice care medical records(from 2020 to 2023) in a nursing home in Qinzhou city using Nvivo 12.0.

Results

The study identified some issues in service implementation,namely a lack of clear functional positioning of the nursing home,an imperfect referral mechanism,homogenization of services,and underutilization of social resources.

Conclusions

It is essential to accurately position the functions of nursing homes and enhance the skill levels of personnel,to improve referral mechanisms and integrate collaborative production systems,to implement service differentiation strategies and leverage the service advantages of nursing homes,to fully integrate social resources and promote the development of integrated medical and elderly care services.The aim is to meet the growing demands for end-of-life care.

, authors=Yuwei CAO1, Lidan QI1, Jingyi WEI2, Zehuan HUANG1, Yizhan HE3, Zhao LI4, Yang ZHAO5, 6, Shaofeng PENG7, authorsList=Yuwei CAO, Lidan QI, Jingyi WEI, Zehuan HUANG, Yizhan HE, Zhao LI, Yang ZHAO, Shaofeng PENG, authorCompany=null, correspAuthors=Zhao LI, Yang ZHAO, Shaofeng PENG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322936902994755636, articleId=1322936902428524594, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=护理院安宁疗护服务困境及对策建议, columnId=1220689488938980091, journalTitle=护理研究, columnName=综合研究, runingTitle=null, highlight=null, articleAbstract=
目的

探讨护理院在安宁疗护服务中存在的不足，并提出相应对策。

方法

基于扎根理论，运用Nvivo 12.0对钦州市某护理院2020—2023年的82份安宁疗护病历进行文本分析。

结果

护理院在服务实施中存在护理院职能缺位、转介机制不完善、服务呈现趋同化、社会资源未能充分利用的问题。

结论

应准确定位护理院职能并强化人员技能水平，健全转介机制并贯通合作生产体系，实施服务差异化策略并挖掘护理院服务优势，充分整合社会资源并推进医养融合服务发展，满足人民日益增长的临终护理需求。

, authors=曹雨薇1, 戚栎丹1, 韦精艺2, 黄泽欢1, 何亦詹3, 黎赵4, *, *, 赵洋5, 6, *, *, 彭绍凤7, *, *, authorsList=曹雨薇, 戚栎丹, 韦精艺, 黄泽欢, 何亦詹, 黎赵, 赵洋, 彭绍凤, authorCompany=null, correspAuthors=黎赵, 赵洋, 彭绍凤, authorNote=

曹雨薇，硕士研究生

, correspAuthorsNote=
黎赵，E-mail：
赵洋，E-mail：
彭绍凤，E-mail：
LI Zhao, E-mail:
ZHAO Yang, E-mail:
PENG Shaofeng, E-mail:
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曹雨薇，硕士研究生

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label=Table 1, caption=

Number of chronic disease patients in nursing homes

, figureFileSmall=null, figureFileBig=null, tableContent=
自由节点案例来源（例）参考点（个）参考点举例
1种66李某脑血管病恢复期、高血压……
2种77利某脑梗死后遗症、低蛋白血症、高血压3级……
≥3种5858黄某脑梗死后遗症、高血压、重度营养不良；翁某脑积水、贫血、多发腔隙性脑梗死、颈椎间盘突出、脑疝……
), ArticleFig(id=1322936909953106047, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936902428524594, language=CN, label=表1, caption=

护理院慢性病病人数量

, figureFileSmall=null, figureFileBig=null, tableContent=
自由节点案例来源（例）参考点（个）参考点举例
1种66李某脑血管病恢复期、高血压……
2种77利某脑梗死后遗症、低蛋白血症、高血压3级……
≥3种5858黄某脑梗死后遗症、高血压、重度营养不良；翁某脑积水、贫血、多发腔隙性脑梗死、颈椎间盘突出、脑疝……
), ArticleFig(id=1322936910024409216, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936902428524594, language=EN, label=Table 2, caption=

Nursing needs of hospice care patients

, figureFileSmall=null, figureFileBig=null, tableContent=
自由节点案例来源（例）参考点（个）参考点举例
一级护理3636曾某入院后立即予一级护理；何某予一级护理；黄某予一级护理；银某予一级护理……
二级护理33王某予二级护理；红某予内科二级护理；黄某予内科二级护理……
对症护理3435吴某予头孢哌酮钠舒巴坦钠抗感染及氨溴索化痰等对症支持治疗；徐某予上丹参改善循环，予阿托伐他汀稳固斑块，予补液加强营养对症治疗，待病情平稳后行中医康复理疗；黄某予对症支持治疗，病人因长期卧床需要定时翻身叩背，预防压力性损伤形成，促进痰液排出，待获取检查结果后再行进一步治疗……
), ArticleFig(id=1322936910099906689, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936902428524594, language=CN, label=表2, caption=

安宁疗护病人的护理需求

, figureFileSmall=null, figureFileBig=null, tableContent=
自由节点案例来源（例）参考点（个）参考点举例
一级护理3636曾某入院后立即予一级护理；何某予一级护理；黄某予一级护理；银某予一级护理……
二级护理33王某予二级护理；红某予内科二级护理；黄某予内科二级护理……
对症护理3435吴某予头孢哌酮钠舒巴坦钠抗感染及氨溴索化痰等对症支持治疗；徐某予上丹参改善循环，予阿托伐他汀稳固斑块，予补液加强营养对症治疗，待病情平稳后行中医康复理疗；黄某予对症支持治疗，病人因长期卧床需要定时翻身叩背，预防压力性损伤形成，促进痰液排出，待获取检查结果后再行进一步治疗……
), ArticleFig(id=1322936910167015554, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936902428524594, language=EN, label=Table 3, caption=

Self-care ability of patients

, figureFileSmall=null, figureFileBig=null, tableContent=
自由节点案例来源（例）参考点（个）参考点举例
基本自理44黄某四肢肌力、肌张力正常；陈某四肢肌力粗测4级，肌张力均正常……
部分自理4950谢某双上肢肌力约3级，双下肢侧肢肌力2级；民某四肢发育畸形，右踝关节处可见陈旧性压力性损伤瘢痕……
不能自理2424黄某四肢痛觉减弱，四肢肌张力增高，肌力0级；李某左侧肌力肌张力0级，生理、病理反射不佳……
), ArticleFig(id=1322936910238318723, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936902428524594, language=CN, label=表3, caption=

病人自理能力

, figureFileSmall=null, figureFileBig=null, tableContent=
自由节点案例来源（例）参考点（个）参考点举例
基本自理44黄某四肢肌力、肌张力正常；陈某四肢肌力粗测4级，肌张力均正常……
部分自理4950谢某双上肢肌力约3级，双下肢侧肢肌力2级；民某四肢发育畸形，右踝关节处可见陈旧性压力性损伤瘢痕……
不能自理2424黄某四肢痛觉减弱，四肢肌张力增高，肌力0级；李某左侧肌力肌张力0级，生理、病理反射不佳……
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护理院安宁疗护服务困境及对策建议
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曹雨薇 1 , 戚栎丹 1 , 韦精艺 2 , 黄泽欢 1 , 何亦詹 3 , 黎赵 4, *, * , 赵洋 5, 6, *, * , 彭绍凤 7, *, *
护理研究 | 综合研究 2026,40(10): 1769-1774
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护理研究 |综合研究 2026 , 40 (10) : 1769 -1774
护理院安宁疗护服务困境及对策建议
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曹雨薇1, 戚栎丹1, 韦精艺2, 黄泽欢1, 何亦詹3, 黎赵4, *, * , 赵洋5, 6, *, * , 彭绍凤7, *, *
作者信息
  • 1广西科技大学人文艺术与设计学院，广西 545006
  • 2广西大学公共管理学院
  • 3山东大学公共卫生学院
  • 4厦门大学公共事务学院
  • 5新南威尔士大学乔治全球健康研究院
  • 6墨尔本大学人口与全球健康学院
  • 7钦州红枫叶护理院
通讯作者:
黎赵，E-mail：
赵洋，E-mail：
彭绍凤，E-mail：
LI Zhao, E-mail:
ZHAO Yang, E-mail:
PENG Shaofeng, E-mail:
作者简介:

曹雨薇，硕士研究生

Difficulties and countermeasures of hospice care services in nursing homes
Yuwei CAO1, Lidan QI1, Jingyi WEI2, Zehuan HUANG1, Yizhan HE3, Zhao LI4 , Yang ZHAO5, 6 , Shaofeng PENG7
Affiliations
  • 1School of Humanities, Arts and Design, Guangxi University of Science and Technology, Guangxi 545006 China
  • 2School of Public Administration, Guangxi University
  • 3School of Public Health, Shandong University
  • 4School of Public Affairs, Xiamen University
  • 5The George Institute for Global Health,The University of New South Wales
  • 6School of Population and Global Health, The University of Melbourne
  • 7Qinzhou Red Maple Leaf Nursing Home
出版时间: 2026-05-25 doi: 10.12102/j.issn.1009-6493.2026.10.023
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摘要
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目的

探讨护理院在安宁疗护服务中存在的不足，并提出相应对策。

方法

基于扎根理论，运用Nvivo 12.0对钦州市某护理院2020—2023年的82份安宁疗护病历进行文本分析。

结果

护理院在服务实施中存在护理院职能缺位、转介机制不完善、服务呈现趋同化、社会资源未能充分利用的问题。

结论

应准确定位护理院职能并强化人员技能水平，健全转介机制并贯通合作生产体系，实施服务差异化策略并挖掘护理院服务优势，充分整合社会资源并推进医养融合服务发展，满足人民日益增长的临终护理需求。

慢性病  /  老年人  /  安宁疗护  /  护理院
Objective

To explore the shortcomings of hospice care services in nursing homes and to propose corresponding countermeasures.

Methods

Based on grounded theory,textual analysis was conducted on 82 hospice care medical records(from 2020 to 2023) in a nursing home in Qinzhou city using Nvivo 12.0.

Results

The study identified some issues in service implementation,namely a lack of clear functional positioning of the nursing home,an imperfect referral mechanism,homogenization of services,and underutilization of social resources.

Conclusions

It is essential to accurately position the functions of nursing homes and enhance the skill levels of personnel,to improve referral mechanisms and integrate collaborative production systems,to implement service differentiation strategies and leverage the service advantages of nursing homes,to fully integrate social resources and promote the development of integrated medical and elderly care services.The aim is to meet the growing demands for end-of-life care.

chronic diseases  /  elderly  /  hospice care  /  nursing home
曹雨薇, 戚栎丹, 韦精艺, 黄泽欢, 何亦詹, 黎赵, 赵洋, 彭绍凤. 护理院安宁疗护服务困境及对策建议. 护理研究, 2026 , 40 (10) : 1769 -1774 . DOI: 10.12102/j.issn.1009-6493.2026.10.023
Yuwei CAO, Lidan QI, Jingyi WEI, Zehuan HUANG, Yizhan HE, Zhao LI, Yang ZHAO, Shaofeng PENG. Difficulties and countermeasures of hospice care services in nursing homes[J]. Chinese Nursing Research, 2026 , 40 (10) : 1769 -1774 . DOI: 10.12102/j.issn.1009-6493.2026.10.023
正文
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多重慢性病已成为威胁人们生命健康的重要公共卫生问题。目前，针对多重慢性病护理的研究主要集中在医疗卫生资源使用方面[1-2]，对于如何通过安宁疗护服务减轻终末期慢性病病人的负担和痛苦，尚缺少系统的研究证据和策略措施。国家卫生健康委员会颁布的《安宁疗护实践指南（试行）》将临终关怀、舒缓医疗、姑息治疗统称为安宁疗护。安宁疗护是一种为生命期有限的病人和病人家属提供的医疗及支持性护理服务，重点是满足身体、情感、社交和精神上的需求，最大限度地提高多重慢性病病人的生活质量[3]。其中，护理院作为提供专业照护服务的关键环节，在安宁疗护中扮演着至关重要的角色。目前，我国的安宁疗护服务体系尚未形成行之有效的长效运行机制，护理院在体系中缺乏合适的定位和发展之道，成为当前安宁疗护建设亟待解决的问题。现以钦州某护理院82个安宁疗护病历文本为基础，运用扎根理论并借助Nvivo 12.0进行编码分析，旨在探讨护理院在开展安宁疗护服务过程中面临的问题，以期推动护理院安宁疗护服务质量不断提升，为病人及家属提供更加温馨与专业的支持。
1　研究背景
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我国60~80岁的老年人群多重慢性病患病率较高且呈逐年增加趋势[4]。多重慢性病病人护理难度高且持续时间长，不仅病人本人会遭受心灵和身体的折磨，病人家属和医疗服务机构也面临着巨大压力。护理院安宁疗护作为一种提供综合医疗和护理支持的服务模式，可以为病人提供优质的照护和关怀，保障病人生命晚期生活质量，进一步补足我国安宁疗护服务体系建设过程中对全面性、综合性、个性化护理服务的需求。
近年来，我国正加快推进安宁疗护服务体系建设，在全国范围内实施安宁疗护试点工作，持续推动服务体系的标准化发展进程，积极应对日益严峻的多重慢性病病人医养服务供给问题。《“十四五”优质高效医疗卫生服务体系建设实施方案》提出，要加强健康教育、康复医疗、老龄人群的长期照护以及安宁疗护服务领域的建设，提升覆盖人生全周期的综合健康服务体系。国务院发布的《“十四五”老龄事业发展与养老服务体系规划》强调了逐步扩大安宁疗护试点项目及完善安宁疗护服务标准化和规范化的必要性。然而，在我国安宁疗护事业的实际发展过程中，护理院、养老院和医院作为安宁疗护服务的具体实施主体缺少紧密配合，未能通过构建合作关系最大化地发挥各自优势。已有研究结果显示，慢性病病人病情发展相对缓慢、疾病持续时间较长、机构的医保报销比例存在差异，导致病人对安宁疗护服务的需求不断发生变化，病人需在临终时于养老机构、家庭和医院之间转介，例如三者不能良好衔接，则易影响病人生活质量[5-6]。
护理院安宁疗护的服务周期与医院相比较长，医疗护理支持与养老院相比更加完善，它能够为罹患多重慢性病的失能或半失能病人提供更贴合需求的专业护理。重视护理院的作用，加强护理院与其他医养机构的合作共建，有利于调动医疗机构、养老机构、社工机构和政府的优势力量，促进多方共同参与服务方案的制定，实现构建一体化安宁疗护服务体系的目标。充分发挥护理院在养老机构与医院之间的过渡衔接作用，明确护理院在安宁疗护服务体系中资源置换的重要枢纽地位，通过护理院与社工机构、养老院和医院协作，有利于整合多方资源，为需要中长期护理却未达到医院救治级别的人群提供适宜的康复治疗、症状管理和照护服务，为病人及家庭构建一体化的安宁疗护服务网络，同时也有利于优化医疗资源配置，减轻医院及养老院负担，为病人及家属提供更加契合其需求的照护与支持。
2　研究方法
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2.1　数据来源
对2023年6月钦州市某护理院2020—2023年的82份安宁疗护病历进行整理和分析，内容主要包括入院记录、病历记录和死亡记录。根据2017年10月广西壮族自治区民政厅颁布的广西壮族自治区地方标准：《养老机构安宁（临终关怀）服务规范》（下称“规范”），该护理院的病人收住标准为：经医疗机构确诊为晚期/终末期癌症、处于疾病终末期或器官衰竭治疗无望，预计存活期不超过6个月，不以实施抢救措施和延续生命为目的的老年人。老年人入住护理院签订《临终关怀服务协议》《抢救治疗知情同意书》后接受医疗康复、护理、安宁疗护等服务。该护理院为国家第二批安宁疗护试点单位，具备《养老机构设立许可证》及《民办非企业单位登记证书》，内设一级医疗机构，与钦州市第一人民医院签订诊疗合作协议，是钦州市钦南区民政局备案的医养结合机构，院内独立设置临终关怀科，已运营4年，配备医生4人、护士8人、专业社会工作者2人，符合“规范”中对安宁疗护服务机构的要求。该护理院具备较强的医养综合服务实力，设老年公寓、护理院及居家养老3个综合医疗养老服务模块，老年公寓内含特护、康养、启智、护养以及托养五大养护专区；护理院内嵌老年病科、内科、外科、中西医结合科、康复科和安宁疗护科，多维度、全方位的医养、医护服务是其标志特色。
2.2　分析方法
Glaser等[7]在《扎根理论之发现：质性研究的策略》中较早提出了扎根理论研究方法，并对其进行了系统阐释。扎根理论的核心思想主要包括3个方面：1）从资料中产生理论，即自下而上对资料进行不断浓缩，逐步形成理论框架[8]；2）保持对现有理论和资料的敏感，继续寻找新的理论线索；3）采用持续比较的方法，在不同资料和理论之间不断进行对比[9]。本研究采用扎根理论研究方法对病历进行精炼，探讨护理院开展安宁疗护服务中存在的问题。
2.3　研究过程
运用扎根理论的编码技术，选取82个护理院安宁疗护病历，利用Nvivo 12.0对相关文本进行编码分析。将扎根理论的3种编码过程划分为自由节点和树状节点，自由节点中的案例来源数及参考点数越多可能对树状节点内容的影响力越大。参考点数主要指与自由节点相关的内容在案例文本中出现的次数，每次出现记为1个参考点。
将82份护理院病历相关文本导入Nvivo 12.0，以病人患病表现、护理方式、查体情况为主题，辅以其他相关信息进行节点编码；在软件中仔细阅读病历文本，寻求与核心主题相关的信息，对其进行编码；在比较和分析的基础上对核心节点进行分类、归纳，形成具有相同概念范畴的树状节点。所有病历文本编码结束后，反复阅读相应节点内容，并根据内容对节点名称进行规范。
3　结果
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护理院服务对象以高龄老年人为主，服务内容主要包括支持性的护理和关怀。但在安宁疗护服务合作生产体系中，护理院作为弥补医院急诊治疗和养老院长期照护之间断裂的枢纽，未起到良好的衔接和链接作用。护理院在安宁疗护服务体系中应与医院、养老院和社工机构形成功能互补、资源高效置换的整体化安宁疗护服务网络。本研究基于护理院82个具体病历文本分析发现，在护理院服务过程中，各主体孤立运作，各自的资源和优势无法得到最大限度的发挥。
3.1　护理院职能缺位
护理院是一种具有家庭式环境设施的医养机构，因长期住院导致日常生活能力不足的病人往往健康需求较为复杂，脆弱性明显，护理院通常会为这类人群提供24 h功能性支持和护理[10]。护理院的服务对象大部分患有不可治愈的慢性疾病，其中以老年多重慢性病病人居多，见表1。护理院的服务目标是为症状严重以至于影响日常生活甚至难以自理的病人提供疗护，帮助病人最大限度地提升生活质量，维持身心的舒适安宁。但在安宁疗护服务合作生产实践过程中，承担执行者角色的护理院难以良好地履行自身职责，出现标准化不高、定位不明、监管缺失、专业服务不足等问题，直接影响服务品质、病人满意度和护理院安宁疗护的发展。1）护理院内部标准化、统一化制度缺失，导致护理院服务定位不精确，使病人与护理院面临供需不匹配的困境，如部分轻症病人降低了院内医疗资源使用效率，使得护理院难以负荷重症病人的急救医疗，进而使安宁疗护工作开展受到影响。2）安宁疗护服务模式系统性、全面性、科学性不足，难以全面反映病人的真实状况，在实际过程中偏重考察生理症状，未能充分满足病人的心理需求和社会支持需求，服务质量和效果难以得到保障。3）护理院接收的病人病症种类复杂、治疗难度较高、病情变化较大，对护理人员的专业水平和技能素质要求较高。但部分护理人员缺乏系统化的安宁疗护学习培训，面对病人复杂多变的情况无法及时、高效应对。
3.2　转介机制不完善
公众对护理院安宁疗护服务的认知度不足，对安宁疗护服务的内容、价值以及重要性了解较少，病人和家属对护理院的收治条件和服务内容了解不清晰。在既有认知观念影响下，人们对安宁疗护的接受程度不高，关注点聚焦于医院治疗效果，忽略了减轻病人生命末期病痛折磨、获得人性关怀与精神慰藉的需求。且医院的医疗和财政资源有限，使其难以满足多重慢性病病人长效护理和心理关怀需求，可能严重影响病人就医的主观感受。基层医疗卫生服务体系不健全，致使多重慢性病病人就医困难现象普遍存在[11]。护理院的功能实践与多重慢性病病人的需求较贴合，能为病人提供适配的分级护理服务，同时能满足其身、心、社、灵多维度的安宁疗护需求，见表2。然而，医院与护理院之间缺乏合理、有效的转介机制，成为病人转入护理院的路径阻碍。本研究中，护理院部分病人无法承担医院长期的治疗、照护费用，考虑到护理院可以使用医疗保险报销护理费用，故选择从医院出院后联系护理院。此类病人转治过程中，医院未充分发挥对病人生命关照的作用，护理院与医院之间的信息无法顺畅交流，护理院处于被动等待选择的地位，病人医护情况出现空窗期。
3.3　服务呈现趋同化
我国提倡通过整合养老资源与医疗资源打造具备连续性、专业性、一体式的医养结合服务体系。该体系中护理院可充当衔接医院急性期治疗和养老院长期照护之间的中央枢纽，弥补医疗和养老服务之间的断裂，为多重慢性病病人提供以提高生活质量为目标的护理服务[12]。但从实践来看，护理院和养老院因服务对象存在相似性导致服务内容逐渐趋同，可能与医保政策引导有关，城乡居民基本医疗保险政策将符合条件的医养结合机构中的医疗机构纳入定点范围，促使养老院越来越注重医疗护理，淡化了对老年人生活照护方面的关注。
本研究中，病人多为自理能力完全丧失或半丧失的老年人（见表3），大部分老年人患有多重慢性病，其对生理方面的医疗护理服务有刚性需求，但护理院因自身医疗资质有限、专业的医护人员短缺等现实情况，无法充分满足老年人需求，使得需慢性病健康管理和康复治疗的老年人仍要花费大量时间和精力往返于养老院与医疗机构之间[13]。同时，护理院老年人多受我国传统文化观念影响，避讳谈及死亡，不接受开展安宁疗护服务，若开展安宁疗护工作往往需要向其他医疗机构寻求帮助[14]。
3.4　社会资源未能充分利用
在安宁疗护服务合作生产关系中，护理院、医院和养老院间尚未建立良好的交流合作桥梁，且三者与民间资源也未形成合理的互补机制。现阶段，安宁疗护体系的实施动力有所不足，宣传工作不到位，民众对安宁疗护了解匮乏，部分病人和家属对安宁疗护服务存在实际需求，但无法及时得到满足。社会资源的加入可为多重慢性病病人带来更加有力的支持，如医务社会工作者对精神、照料、就医等方面的介入在相对被忽略的病人家属哀伤抚慰领域发挥了不可忽视的作用[15-16]。借助社会团体、志愿者、社会工作者、慈善机构等力量可以让更多人认可安宁疗护，为病人提供基础的生活照料与心灵关怀，是对安宁疗护中人文关怀的补充，还能够在政策资源对接到个人的过程中起到协助传达的作用。
4　对策建议
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随着多重慢性病患病率的逐渐增高，养老和医疗服务机构将面临巨大压力。为了有效应对我国医养供需不平衡问题，确保安宁疗护服务体系建设稳步发展，提供专业照护服务的护理院是体系建设的关键。但整体而言，我国护理院发展水平较低，针对护理院安宁疗护的相关政策较少，诸多问题亟待解决。针对护理院的发展困境，提出以下对策建议。
4.1　准确定位护理院职能，强化人员技能水平
随着社会老龄化的加剧和医疗技术的不断发展，安宁疗护服务作为一项重要的医疗服务越来越受到人们重视。为促进护理院的发展，首先应准确定位护理院在整个安宁疗护服务中的枢纽功能，健全科学合理的服务机制和护理人员培训机制是病人得到优质化、个性化服务的重要保障。其次，护理人员是安宁疗护服务的中坚力量，其专业水平提升对安宁疗护服务质量提升具有重要意义，应加强对护理人员的安宁疗护服务业务培训，保证护理人员的知识和技能与时俱进，以全面提升专业素养。此外，护理院还应建立定期评估和改进机制，在规范服务评估和人员培训的过程中，通过及时调整和优化不断提升服务质量，并结合本院实际情况进行适当修改和补充，从病人身体状况、心理状态、家庭支持情况等多个维度制定个性化的服务方案。
4.2　健全转介机制，贯通合作生产体系
在我国大力推进医养融合的背景下，护理院成为安宁疗护服务体系中链接养老院和医院的重要环节，其优势在于能够承担平衡养老资源和医疗资源的中间转介责任。一方面应健全转介机制，明确安宁疗护合作生产体系中3个主体之间的转介标准和流程，制定可供参考的转介指南。例如在医院设立专门的转介协助员，负责向病人和家属介绍护理院的安宁疗护服务，协助完成转介流程；另一方面应加强卫生健康委员会、民政、社会保障等相关部门的跨部门合作，形成合力以推动安宁疗护服务发展。应加强基层医疗卫生服务体系建设，提高医疗服务的可及性和便利性，实现医疗资源配置优化，确保多重慢性病病人能够得到持续和全面的护理。
4.3　实施服务差异化策略，挖掘护理院服务优势
一方面，可挖掘护理院拥有医养融合型安宁疗护服务的优势，实施服务差异化策略，促使护理院安宁疗护服务区别于养老院，从而赢得竞争优势。另一方面，可增强护理院安宁疗护服务的有效宣传，让更多的病人、家属和公众了解护理院安宁疗护服务的优势，积极满足终末期病人安宁疗护服务需求。为了加强安宁疗护宣传工作，可采取以下策略：1）建立宣传团队，团队可以由安宁疗护机构的宣传部门和社会组织团体共同组成，负责制订宣传计划和策略，确保宣传工作有效、持续开展。2）利用多种媒体渠道进行宣传，除传统的海报、宣传册和宣传栏外，还可通过网站、微信公众号、微博等互联网平台，让更多人了解到安宁疗护服务的内容和方式，减少公众对安宁疗护服务的误解。3）开展宣传活动，可以由社会机构组织安宁疗护知识讲座、义诊活动、健康讲座等，吸引更多人参与并了解安宁疗护，提高公众对护理院安宁疗护服务的认可度。
4.4　充分整合社会资源，推进医养融合服务发展
首先，护理院应当充分整合社会团体、志愿者、社会工作者、慈善机构等社会资源，动员他们积极参与护理院安宁疗护志愿服务，从而丰富安宁疗护服务的实现路径，同时增强自身提供安宁疗护服务的认知和知名度。其次，国家应明晰安宁疗护服务机构主体间差异化的角色定位、服务范围和收治标准（如护理院侧重于提供医疗护理服务，医院侧重于急性疾病治疗，养老院侧重于提供老年人的生活照护和日常活动支持），并制定相关政策引导和鼓励不同主体扩大其自身优势。此外，安宁疗护服务在我国仍处于初步发展阶段，政府可以通过出台相关政策，加大对安宁疗护服务体系建设的资金和保险报销支持，如通过完善医疗保险制度、增强资金支持等措施促进医疗、民政、社保等相关部门之间的合作，共同健全和实施医疗养老服务标准和规范，确保服务质量和效率。
5　小结
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随着人口老龄化加重和多重慢性病患病率不断升高，我国在健康卫生服务领域面临着严峻挑战。护理院安宁疗护是为多重慢性病病人提供照护的有效途径，目标是给予病人和家属全面的舒缓疗护，提升多重慢性病病人在生命末期的生活质量，帮助病人缓解痛苦的同时提供心理关怀，并重视家属的哀伤抚慰。本研究对82个安宁疗护病历进行文本分析，清晰呈现了护理院在安宁疗护服务实践的具体运作状况，进而讨论我国安宁疗护服务体系主体间合作生产关系存在的困境和不足。研究发现，护理院在合作生产关系中定位不明，没有充分发挥链接医院和养老院的功能，医养机构各自独立，缺少协同互补的高效合作机制。建议应尽快完善安宁疗护服务相关政策，重构安宁疗护合作生产中的主体关系，以点带面将安宁疗护服务体系中的各部分联合起来，构建多主体协作共赢的合作生产体系，以实现对多重慢性病病人的多维度健康服务，进一步推动医养融合型安宁疗护服务事业的发展。

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2026年第40卷第10期
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doi: 10.12102/j.issn.1009-6493.2026.10.023
  • 接收时间：2025-04-25
  • 首发时间：2026-10-30
  • 出版时间：2026-05-25
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  • 收稿日期：2025-04-25
  • 修回日期：2026-02-13
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    1广西科技大学人文艺术与设计学院，广西 545006
    2广西大学公共管理学院
    3山东大学公共卫生学院
    4厦门大学公共事务学院
    5新南威尔士大学乔治全球健康研究院
    6墨尔本大学人口与全球健康学院
    7钦州红枫叶护理院

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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