Investigation On Occupational Attraction Of Community Nursing Services And Community Nursing Demands Of Residents In Guangzhou

1.BackgroundThe community nursing services should provide the community inhabitants with effective,economical,convenient,comprehensive and continuous grassroots nursing services,including the six functions which are prevention,health care,medical care, recovery,health education and birth control technical services.Their work of thinking and form are different from clinical nursing,and the work scope is much larger than clinical nursing,which means the community nursing work must be done by the high quality nursing talents who grasp the various knowledge skills,including sanitary science and nursing theory and technology.But now a serious shortage of the community nursing human resources in our country are of an unreasonable structure.The quantity of community nurses is small,and the nurses are with low records of formal schooling,lack of training,the community nursing service philosophy and the related knowledge and skills.The low overall quality of the nursing group causes the inhabitants' disatisfaction with community nursing services.Nursing students and clinical nurses how to treat the community nursing service now? what are the factors affecting community nursing service occupational attraction? what are the community resident's community nursing demands?,these problems have not been very good answer at present.Therefore,studied on the junior college nursing students,undergraduate nursing students and clinical nurses of the affiliated hospitals in the Southern Medical University,with a breakthrough point of occupational attraction of community nursing work,realizes the intentions of the investigators' participations in community nursing work,and find out the factors of influence on the intention through the non-parametric test method.It combines with the investigation on the community nursing needs of inhabitants in Guangzhou,and obtains the principal aspect and project of the community nursing which the inhabitants' demand.2.Purposes2.1 To do some exploratory surveys on the influence factors of the occupational attraction of community nursing work,providing the reference for future community nursing service education.2.2 To investigate and analyse the community nursing demands of inhabitants in Guangzhou,and to know the content of the inhabitant's demands and the related factors of influence on the demands.To give the realistic guide meanings for providing more personalized community nursing services and satisfying the nursing needs of different groups of people,and to provide the theory basis for working out some correlative policy.2.3 Our country's new medical system reform is going to start.The community medical service will play a important role on the inhabitants' first hospital examination and two-way referral.So it needs increasingly high quality nursing talents,but now our country has not yet formed a set of complete community nurse training system.The conclusion of this research would provide the basis and reference to the level,content and syllabus of community nurse professional education.3.SubjectsThe first part of this research adopts the purposive sampling method,choosing 260 junior college nursing students,among which 190 of Grade two and 70 of Grade Three,190 undergraduate nursing students,among which 120 junior students and 70 senior students,and 160 clinical nurses in the affiliated hospitals of South Medical University.The second part adopts the two-stage cluster sampling method.In Guangzhou's three Old Cities,Haizhu District,Baiyun District,and Yuexiu District,6 community health service center are chosen at random by draw cuts,each center chooses 36 people by convenience sampling,including the patients in the center and the inhabitants in the community.It is expected to investigate 216 people with 236 real investigated objects.4.Methods4.1 The design of questionnairesBased on the correlative theories and methods of occupational attraction and health promotion,and the review of literature,around the purpose of the research and referred to the experts' advices,we design respectively the questionnaire of occupational attraction of community nursing work and the questionnaire of community nursing needs.After pre-investigation,the reliability and validity of two kinds of the questionnaires would be checked to improve and ensure the content and the form.The questionnaires of community nursing work's occupational attraction contain 9 parts,including one question of identification,six questions of using for knowing the investigated objects' subjective awareness of community nursing services,and two questions referring to the factors of community nursing work's occupational attraction.The objects should fill the questionnaire with anonymity in order to ensure the truth of the answers.The questionnaire of community nursing needs includes 3 dimensionalities.The first part is basic information of the objects,including 9 questions,the second part is the inhabitant's subjective understanding about the community nursing,including 6 questions,and the third part is the investigated community nursing needs of inhabitants,which is divided into three parts,10 items of disease nursing,9 items of health care and 9 items of health education,with totally 28 items.In addition,there are also open questions.We investigate the need by the questionnaire according to 5 degrees which are no need at all,no need,not clearly,need and need very much.4.2 The method of investigationTo do the one-person-one-questionnatre site investigation by the designed questionnaire.Considering the differences of the inhabitant cultural level and the age,we adopt interview mathod to collect the data from the inhabitants who have difficulties in reading and writing,and other inhabitants are sent the questionnaires to fill in which are taken back on the spot.the first part of the investigation period:April 2008～June 2008the second part of the investigation period:July 2008～September 20084.3 Data entry and collationThe researcher leading 2 data entry clerks consists of a data-entry group,which accomplishes data entry and collation in 5 days by using the SPSS13.0 software,and selects,classifies,labels and collates the data according to the needs of the research. Then,the data should be generally collated twice.4.4 Statistical methods All the data are logged by the SPSS13.0 software.The nursing students and clinical nurses' understanding about community nursing services,and inhabitants' basic information and nursing needs should be compiled and described.The influence factors of the professional attraction of community nursing work and the inhabitants' nursing needs would analyzed by the non-parametric test method.5.Results5.1 community nursing work's occupational attraction5.1.1 The intention of the investigated objects' engaged in the community nursing servicesAmong 410 investigated objects,71.2%are willing to be engaged in this work. According to percentage analysis,the wishes to be engaged in the community nursing work of the junior college nursing students are strongest ar all(82.8%),and following by the ones of clinical nurses(66.0%) and the undergraduate nursing students(58.3%)(χ~2=23.853,P=0.000).5.1.2 The factors influence the wills to work as a commnity nurse5.1.2.1 StatusJunior college students holds the highest approval attitude toward community nursing,clinical nurses lower and undergraduate students the lowest,this difference has statistical significance(u were 23.216,22.548,25.521,P were 0.000,0.000, 0.000).5.1.2.2 Educational ExperienceThe wishes of those investigators who has related coures to be engaged in the community nursing work are stronger.the average mean rank is 212.49 for those students who has certain coures,192.32 for those students who did not take the coures,this difference has statistical significance(Z=-2.091,P=0.037)5.1.2.3 The attractions of taking the job of community nursing Ranked by the quantity people who choosed,strong independency of the work come first(143 choices),follow by the significance of the job(136 choices),the stable and less pressure of the job counted third(133 choices).5.1.2.4 Reasons for not taking the job of community nursingRanked by the quantity of people who choosed,low welfare comes first(164 choices), heavy workload and tedious rank second(108 choices),low approval counted third (106 choices).5.2 Demands of community nursing in Guangzhou citizen5.2.1 The reliability and theValidity of questionnaireTotally 178 effective questionnaire in the 236 handed out counting 75.4%.the whole Cronbach's alpha data for the needs of community nursing is 0.933,0.820 for disease nursing,0.871 for prevention health care and 0.897 for health education showing highly inner consistency of the study.The Correlation Analysis indicate a good Construct Validity.5.2.2 The needs of community nursing in the study communitiesThe total average needs is 3.89,3.75 for disease nursing,4.05 for prevention health care,3.89 for health education.Rank by the average counting,the top 10s are first aid,planned immunization program,preventions of common disease for senior citizen,regular physical check,health instruction for senior citizen,prevention of common diseases for children,nursing for chronic diseases,prevention of common disease for women,establishing health file,health care for babies and infants.Rank by the choice of needed disease nursing,the top three are first aid,nursing for chronic diseases and nursing consulation for different kinds of diseases.Rank by the choices of prevention health care,top three are planned immunization program,preventions of common disease for senior citizen and regular physical check. Rank by the choice of health education,top three are opinions on bear and rear better children,health care during pregnancy and healthcare for senior citizen.5.2.3 The analysis of the influence factors of nursing demandsFirst is the differences of the general community nursing need and the need of prevention from disease and health care according to the objects' records of formal schooling.((χ~2 were 9.626,11.542,P were0.047,0.021 )graduate students' demands is the strongest.Second one is the differences of setting household sickbed,hospice care,regular medical check-ups,prevention of old persons' common diseases,the guide to the health care of old persons according to the ages of the objects.and old persons according to the ages of the objects(χ~2were 7.852,15.009,7.252,7.875,8.406,P were0.020,0.001,0.027,0.010,0.015).old persons' demands is the strongest.the last one is the differences of the accidental urgent nursing care according to the health conditions of the objects(χ~2=8.755,P=0.013).people in good health's demands is the strongest.6.Conclusions6.1 The community nursing services have a strongest attraction on the junior college students6.2 The understanding about community nursing work has the influence on the wish to be engaged in it.The college education can promote the professional attraction of community nursing work.The objects who have studied some related courses would be more willing to choose the community nursing work.6.3 The main reasons for the objects' unwilling to do the community nursing work are bad welfare benefits,heavy work load,tedious work and the low social approval. And the main factors of attracting nurses' participations in community work are the strong independency,significance and stability of the work. 6.4 The inhabitants have the strongest need of the prevention from diseases and health care.The order of the needs for the inhabitants' community nursing is prevention and health care,health education and disease nursing.The need of accidental first aid is listed as the first place.The low satisfaction about the community nursing,71.4%(127/178)of the citizens hope the nurses to hold Junior college degree or above.6.5 The educational degree of opening comminity nursing should firstly begin at junior college.The course should meet the need of community nursing,and emphasize knowledge and skills of healthcare and health education.