以护士为主导的安宁疗护多学科协作服务模式的探索与思考：以华西医院老年医学中心为研究个案
Exploration and Thinking on the Nurse-led Multidisciplinary Collaborative Service Model of Hospice Care : Taking the Geriatrics Center of West China Hospital as an Example
纪铮 1谢灵灵 1吴驭 1高玥珊 1蒋艳 2陈茜3
作者信息
- 1. 610041 四川省成都市，四川大学华西医院老年医学中心/四川大学华西护理学院
- 2. 610041 四川省成都市，四川大学华西医院护理部
- 3. 610041 四川省成都市，四川大学华西国家老年疾病临床研究中心;610041 四川省成都市，四川大学华西医院老年医学中心/四川大学华西护理学院
- 折叠
摘要
背景 安宁疗护是健康老龄化在终末期患者医疗保健服务的重要实践。随着对安宁疗护的研究不断发展和试点政策的不断推进，三级公立医院安宁疗护全人照护服务模式成为改善患者生命质量、减轻治疗负担并优化资源配置服务体系的重要组成部分。目的 基于华西医院老年医学中心的实践，建立并评估一套以护士为主导的多学科协作安宁疗护服务模式，以提升终末期患者的全人照护质量和生命末期尊严。方法 采用个案研究设计，通过系统文献分析（检索中英文数据库，最终纳入56篇核心文献）和专家论证法（邀请13名资深专家进行结构化研讨），构建以“4S”（身体、心理、社会、精神）全人照护理念为核心的服务模式，并明确多学科团队架构、分级培训体系与实践路径。研究于2017—2023年对227例终末期老年患者实施干预，并通过电子病历数据、满意度调查及多学科协作效率等指标综合评价模式效果。结果 构建的以护士为主导的华西安宁疗护多学科协作服务模式主要为：以护士为核心协调者，以“核心层-执行层-辅助层”三级多学科团队为协作模式，并形成了系统化的评估工具、培训机制与标准化服务路径。实施以护士为主导的华西安宁疗护多学科协作服务模式后，患者疼痛等症状控制有效提升，家属满意度达98.5~99.7分；2017—2023年华西医院老年医学中心安宁疗护病房与老年医学中心的另一普通病房相比，转ICU率一定程度上降低［0.44%（1/227）与 2.93%（6/205），P=0.066］，但无统计学差异；团队响应速度和协作效率明显改善。结论 华西安宁疗护多学科协作模式通过突出护士主导与全人照护理念，有效整合医疗与人文服务资源，显著提升终末期患者的照护质量与尊严生命质量。该模式为我国医院系统发展安宁疗护服务提供了实践范式和科学依据，未来需进一步扩大资源覆盖并完善社区联动机制。
Abstract
Background Hospice care plays a vital role in the healthcare of terminally ill patients and supports the objectives of healthy aging. In China, with the continuous development of research and pilot policies, holistic hospice care models in tertiary public hospitals are increasingly recognized as essential for improving patients' quality of life, reducing treatment burden, and optimizing healthcare resource allocation. Objective Based on the clinical practice in the Geriatric Medicine Center of West China Hospital, this study aimed to develop and evaluate a nurse-led, multidisciplinary hospice care service model designed to improve holistic care quality and preserve dignity in patients with terminal illness. Methods We conducted a case study using systematic literature review (56 core publications from Chinese and English databases) and structured expert consultations (13 senior specialists). A service model centered on the "4S" (Somatic, Sentiment, Social, and Spirit) holistic care framework was developed. The model defined a multidisciplinary team structure, a tiered training system, and standardized care pathways. Between 2017 and 2023, the model was implemented for 227 elderly patients with terminal illness. Effectiveness was evaluated using electronic health records, satisfaction surveys, and multidisciplinary collaboration indicators. Results The nurse-led Huaxi Multidisciplinary Hospice Care Model features nurses as care coordinators within a three-tier team structure (core, implementation, and support layers). The model incorporates systematic assessment tools, training protocols, and standardized workflows. Following implementation, symptom control (e.g., pain management) improved, and family satisfaction scores reached 98.5-99.7 points. From 2017 to 2023, the hospice care ward demonstrated a lower ICU transfer rate compared to a general ward in the same center [0.44% (1/227) vs. 2.93% (6/205), P=0.066], but there was no statistically significant difference. Team response time and collaboration efficiency also improved. Conclusion The multidisciplinary hospice care model at West China Hospital, with its emphasis on nurse leadership and holistic care, successfully integrates clinical and humanistic resources. It enhances care quality and end-of life dignity for terminally ill patients. This model offers a practical and evidence-based framework for implementing hospice care in Chinese hospital settings. Future efforts should expand resource accessibility and strengthen community-based linkages.关键词
安宁疗护/多学科协作/全人照护/服务模式引用本文复制引用
纪铮,谢灵灵,吴驭,高玥珊,蒋艳,陈茜.以护士为主导的安宁疗护多学科协作服务模式的探索与思考：以华西医院老年医学中心为研究个案[EB/OL].(2026-02-13)[2026-02-15].https://chinaxiv.org/abs/202602.00161.学科分类
临床医学
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