CAJ | 학술논문

为探索一套有效的延续性护理工作方法，我院于2012年9月成立了延续性护理服务中心，制定了一系列的工作制度和管理方法，设立专、兼职护理岗位，通过患者档案电子化管理、电话随访和温馨短信提示、上门专科服务、健康知识讲座、网络平台管理等方法实施延续性护理服务。延续性护理服务中心成立一年以来，建立延续性护理健康档案1200余份，电话随访3000余人次，开展健康知识讲座32次，上门专科护理服务120余人次。延续性护理中心的工作保证了患者康复的连续性，提高了患者的满意度和自我管理能力。
위탐색일투유효적연속성호리공작방법，아원우2012년9월성립료연속성호리복무중심，제정료일계렬적공작제도화관리방법，설립전、겸직호리강위，통과환자당안전자화관리、전화수방화온형단신제시、상문전과복무、건강지식강좌、망락평태관리등방법실시연속성호리복무。연속성호리복무중심성립일년이래，건립연속성호리건강당안1200여빈，전화수방3000여인차，개전건강지식강좌32차，상문전과호리복무120여인차。연속성호리중심적공작보증료환자강복적련속성，제고료환자적만의도화자아관리능력。
In order to establish an effective transitional care mode, the transitional care center was established in September 2012. Accordingly, a series of working systems and management practice were developed, full-time and part-time nursing positions were established, and electronic patient ifle management, telephone follow-up and warm SMS tips, home of specialist services, health lectures, and other methods were carried out to run extended care. Within one year, more than 1200 electronic patient ifles were built, over 3000 telephone cares follow-up for discharged patients and 32 times health lectures were carried out, and more than 120 cases received home visit services. The work of transitional care center ensured the continuity of patient rehabilitation , and improved patients' satisfaction and self-management skills.