目的 探究长期护理保险(long-term care insurance,LTCI)制度背景下,老年人居家护理服务感知现状及分化成因,并提出优化路径。方法 采用解释性时序式混合研究设计,2025年1-4月,采用便利抽样法选择269名老年人为研究对象,对其开展居家护理服务感知问卷调查;采用目的抽样对25名典型个案进行半结构访谈,采用Braun主题分析法提炼主题。结果 老年人对护理人员准时上门和仪表整洁正面评价占比分别为70.63%和69.14%,操作熟练度、沟通有效性、健康教育专业性及工作尽责度等方面的负面评价相对突出;质性访谈提炼出2个主题:居家护理服务感知和感知差异化归因。结论 LTCI背景下老年人居家护理服务感知呈现基础规范整体达标、内涵质量分化明显的特征,建议构建分层、分类服务体系,优化护理人力资源配置,完善政策主动回应机制,提升老年人居家护理服务获得感。

Objective To explore the current status and divergent causes of perception in home care service among older adults in the context of promoting the long-term care insurance (LTCI) system, and to propose optimization strategies.Methods An explanatory sequential mixed-methods design was adopted.From January to April 2025, a convenience sample of 269 older adults was surveyed using a home care service perception questionnaire.Purposive sampling was used to conduct semi-structured interviews with 25 typical cases, and Braun thematic analysis was employed to extract themes.Results Positive evaluations of caregivers' punctuality and neat appearance accounted for 70.63% and 69.14%, respectively.Negative evaluations were relatively prominent in areas such as procedural proficiency, communication effectiveness, professionalism in health education, and work dedication.The qualitative analysis identified 2 themes: perception of home care services and attribution of perceptual differences.Conclusions In the context of LTCI, older adults' perception of home care services is characterized by overall compliance with basic standards but notable variation in service quality.It is recommended to establish tiered and categorized service systems, optimize nursing workforce allocation, and improve proactive policy response mechanisms to enhance older adults' sense of gain from home care services.

R473.2;R823

上海市卫生系统青年人才奖励基金会首届护理专项技术扶植项目