Elderly health and integrated medical care service capability improvement training

The core goal of the training to improve the service capabilities of elderly health and medical care has never been to give caregivers a bunch of test points and get a certificate and then be done with it, but to actually break through the choke points of elderly care that "cannot be treated in hospitals, cannot be cared for at home, and cannot be taken care of by institutions" - this is the most direct conclusion I came to after visiting 27 public and private elderly care institutions and spending three months doing research.

What I encountered at a private nursing home in Jianggan District, Hangzhou last month still leaves a deep impression on me. The 72-year-old Aunt Zhang suffered from a cerebral infarction and was paralyzed. The caregiver her daughter hired could only feed her and wipe her body. She couldn't even turn her body at a 30-degree angle to prevent pressure sores. Last winter, she almost choked and developed pneumonia due to aspiration due to too fast feeding. Later, the institution sent this caregiver to participate in three special training sessions. Now she can not only cooperate with the rehabilitation therapist at the community hospital to do passive physical training, but also provide early warning of health risks through the elderly's tongue coating and bowel movements. Aunt Zhang has not even caught a cold in the past six months. Her daughter specially sent a banner to the institution last week, saying, "Before, I was always afraid that my mother would suffer here, but now I am much more at ease at work."

Don’t think this is an exception. Last year, 40% of the complaints against nursing homes across the country came from unprofessional care and poor communication. It was not a hardware problem at all. There is actually quite a lot of controversy in the industry over this type of training. Academic experts insist that they must learn 120 hours of systematic knowledge such as geriatric medicine, rehabilitation nursing, and nutrition before they can start working. They feel that if the foundation is not solid, safety accidents will occur sooner or later. ； Most directors of front-line nursing homes think they are too dogmatic, saying that many elderly people's problems are not written in textbooks at all. For example, an elderly person with Alzheimer's disease suddenly becomes emotional. No matter how much knowledge you memorize about dementia care, it is not as effective as taking out his favorite mung bean cake.

What both sides say actually makes sense. There was a pilot project in Jiangsu last year. At the beginning, it all followed the academic content and took a lot of theoretical tests. As a result, 80% of the caregivers were at a loss when encountering elderly people who refused to take a bath. Some even resigned after less than half a month. Later, the proportion of courses was adjusted, and 70% of the class hours were real-life simulations: simulating how to handle a lost elderly person, simulating first aid for choking, and simulating how to soothe an elderly person with dementia who has an emotional breakdown. There was no need to take a test paper for the assessment. He went directly to a real nursing home for 3 days. If he could independently handle more than 3 common care problems, he passed. The final training satisfaction rate increased directly from 42% to 89%.

To be honest, the biggest problem with training conducted in many places now is that it is just a formality. Find a hotel to rent a conference room, find a teacher to read PPT for two days, and finally take a group photo and issue a training certificate. It doesn't matter whether the people who learn it can use it. I have met Sister Li, a nurse in Shandong, who participated in three trainings organized by different departments. She learned the Heimlich maneuver all three times, but never touched the simulator. Last year, I met an old man who choked on glutinous rice balls at the institution. Her hands were shaking as she stood nearby and she dared not move. It was the dean who rushed over to save her. Later, she participated in a practical training session and pressed the simulator with her own hands. Only then did she realize that the place where the force was exerted was not on the chest, but on the two fingers above the navel. The force had to be strong enough to flush out the foreign object. "It was better to remember it after listening to the class three times than to do it once with my own hands."

Of course, I'm not saying that theoretical knowledge is not important. If you don't even know the contraindications for the elderly with high blood pressure and just give them folk prescriptions, something big will happen. But there is no need to make the knowledge points so obscure. I have seen some organizations compile the key points of care for common diseases of the elderly into a jingle, "antihypertensive drugs, take them after meals, and change posture slowly." The nursing sisters can remember it much faster than memorizing textbooks. There is also the "empathy ability" training that few people have mentioned before. I think it is the most important content - it is not that the caregivers are required to be saints, but that they need to know how to communicate with the elderly. For example, if the elderly say "I don't want to live anymore," you don't come up and just say "stop talking nonsense." Sit down and ask him if the child didn't come to see him yesterday and if he hurts somewhere. Many conflicts will not happen at all.

At present, this type of training is still trying to cross the river by feeling for stones. Some places have done a good job and directly linked the training subsidies to the salary of caregivers, so that those who learn are motivated.； Some places are still scraping together people to complete tasks, spending a lot of money without seeing any results. But no matter how it changes, there is actually only one final criterion: whether the elderly are really comfortable, whether their families are really relieved, and whether the caregivers really feel that what they have learned is useful. Everything else is empty.