What is a nurse?

China is stepping into an aging society. With the large increase of urban retirees, "getting old before getting rich" is bound to increase the financial burden of the country. The second generation family structure makes providing for the aged a social problem. It is predicted that the aging society will be a big problem in China in the next ten to twenty years. Nursing for the elderly will directly affect their quality of life.

The division of labor between "nurse" and "care worker" is not clear.

Shanghai is the first city in China to become an aging city. At present, the average life expectancy of women in Shanghai is 80 years and that of men is 70 years. According to the statistics of relevant departments, in 2002, the registered population of the city was 1334250, of which 2,494,900 were elderly people over 60 years old, accounting for 1.8.70% of the total population, and this number is still rising.

In recent years, there are more and more pension institutions in Shanghai. Nursing homes, nursing homes, nurseries and nursing homes are distributed in all districts and counties of the city, but the demand is still in short supply. In some well-equipped nursing homes with reasonable fees, there are even more than 100 empty beds waiting in line for registration, and many people still can't get the number with their eyes closed.

While the elderly lamented the difficulty in entering the nursing home, the old-age care institutions also lamented the hardships. Beds are tight, making ends meet, and more importantly, there are few nursing staff, which cannot meet the needs of more elderly people. Almost all old-age care institutions recruit a large number of nursing workers. After systematic training, most of these care workers from rural areas can only engage in simple manual labor such as feeding, bathing, turning over and emptying urinals for the elderly. Nurses still need to take the elderly's temperature, blood pressure, bedsore cleaning, oral cleaning, intubation nursing and sputum aspiration. Nursing care, "care" is almost zero, while nurses "work" is greater than "care". On the one hand, there is a shortage of nurses, and the workload is heavy. On the other hand, nursing workers cannot provide all-round services. Nursing care for the elderly has become a prominent problem in Shanghai's pension institutions. If this problem cannot be properly coordinated and solved, the quality of life of the elderly will be greatly reduced.

The two concepts of "treatment" and "pension"

As early as thirty years ago, Japan, which is adjacent to China, entered an aging society. According to some data, in 2000, the elderly over 65 years old in Japan accounted for 17.4% of the total population, and it is expected to reach 25% by 20 14. To some extent, China's aging is following in Japanese footsteps. As a relatively developed city in China, Shanghai has certain similarities and comparability with Japanese. Their experience and lessons in the laws and regulations of the pension system still have certain reference value for us in Shanghai. At least on the basis of others, combined with their own actual national conditions, learn from each other's strengths and make fewer detours.

A few days ago, the "Training Course for Elderly Nursing Teachers" jointly organized by Shanghai Red Cross Society and Asahikawa Village in Japan officially started in Ruijin Hospital affiliated to Shanghai Second Medical University. This is the first geriatric nursing training course in China, and it is also a friendly exchange between China and Japan in geriatric nursing. The trainees of this training course come from more than ten Red Cross geriatric hospitals in the city. They not only have intermediate titles or above, but also are the backbone nurses of geriatric nursing.

Hongliang is the head nurse of the Red Cross Tianlin Geriatric Nursing Hospital. She has many years of nursing experience for the elderly. On the first day of class, she was deeply moved by the advanced concept of Japanese pension. It turns out that in Japanese elderly care, treatment, rehabilitation and old-age care are completely separated. Unlike us, as long as the elderly live in the elderly hospital, everything will be fine, and there will be no treatment and rehabilitation. Anyway, when you get to the hospital, you will retire.

When the elderly in Japan are sick, they will first enter the elderly hospital for treatment. Wards, sickbeds, hospital gowns, oxygen cylinders ... There, doctors and nurses are the ones they come into contact with the most, and then nurses. After the illness is stable, the elderly will be sent to rehabilitation institutions for rehabilitation treatment, and then go to nursing homes or nursing homes and other old-age care institutions. In the pattern of six rooms or eight rooms and one hall, the living room, bathroom, kitchen and other home facilities are also very complete. Old people can chat in the living room, go to the kitchen to cook and go back to their rooms to rest. It is not so much a nursing home as a big family. There are no uniform beds in the hospital, and there are almost no doctors and nurses wearing white coats and nurses' uniforms. It is not nurses or nurses who are inseparable from the elderly, but "nurses", Japanese full-time staff who specialize in nursing the elderly.

Old people don't do everything

Ms. Okamoto Seijiang, who is over 60 years old, is currently the vice president of Japan's Asahi Kasawa Nursing Home. She has been a nurse for 35 years. She told reporters that about 15 years ago, Japan began to implement "referral nurses" who took full-time care of the elderly. At present, there are about 6,543.8+0.2 million nurses in Japan, and another 4,654.38+0.0 million people have obtained "nurse certificates", of which 6,543.8+0./kloc-0. 0 million people are in the front-line posts of geriatric nursing, and most of them are young women. Different from nursing workers, "referral nurses", like nurses, need to go through two years of formal study in health schools and pass exams before they can get a license.

"As soon as I walked into the Japanese nursing home, my first impression was clean and cordial. No matter where I look, it doesn't look like I'm in a ward, but like I'm at home. Referral nurses around the age of 20 are with the old people, wearing their own clothes, chatting with them and cooking with them. It feels like a grandson living together. " Yang li Ping, head nurse of Zunyi Senior Hospital of Shanghai Red Cross Society, still remembers visiting a nursing home in Japan.

The classrooms of "Jie Nurse" school are all decorated into nursing homes, blind roads extending in all directions, toilets for the disabled, and even a kitchen with complete condiments, chopping boards and kitchen knives, which are specially prepared for students to learn to cook. The school even requires students to carry sewing kits with them and practice at any time so as to serve the elderly in the future.

"To say the level of nursing, nurses graduated from Ala Shanghai Nursing School are absolutely not worse than Japanese' nurses', and we also have junior college graduates from the nursing department of medical college. To talk about the gap, the concept of "people-oriented" in Japanese elderly care is really worth learning. " Teacher Zhang Jingfen, a nursing major at the School of Health Technology, Second Medical University, said.

In China, people are usually used to judging the quality of nursing work by how much they do for the elderly. Most elderly people also think that bathing and washing clothes with their mouths open is the enjoyment of their later years. In Japan, on the other hand, "referral nurses" don't do everything, but try their best to help the elderly live a nearly normal life. Old people prefer cooking unless they are paralyzed in bed. What the "referral nurse" has to do is to prepare the raw materials and then cook a delicious meal with the elderly. Even the elderly in bed are unwilling to be fed. Nurses will prepare the most labor-saving tableware for the elderly: spoons are bent into various radians and angles, and chopsticks are designed as clips to meet the various needs of the elderly. Anyone who has been to Japan knows that the seats for the elderly in the Japanese subway are generally empty, because no one will admit that he is an old man. "I am not old, and I can take care of myself." This is a happy old age. Ms okamoto chengjiang is a typical example. At the age of 64, she refused to receive a pension, but she was proud of her determination to continue working to earn money to support herself.

Learn from each other's strengths and look forward to legislation

Most nursing homes in Japan are concentrated in various communities. The scale is not large and the facilities are relatively simple. Generally, a single room can only accommodate a single bed, a wardrobe and a bedside table, but it is five or six square meters. The newly-built old-age care institutions in Shanghai attract mostly extravagant people. Director Ye of the Shanghai Red Cross Office said that luxury is attractive, but for the vast majority of elderly people living on pensions, the threshold is still a bit high. The cost of one or two thousand yuan makes many elderly people who want to enter nursing homes daunting. Nursing homes should mainly consider humanization, practicality and rationality. Instead of spending too much money on hardware facilities, it is better to reduce the construction cost. After all, nursing homes are popular rather than aristocratic.

Is it suitable for Japanese "referral nurses" to move to Shanghai and China? Many people in the industry think that simple mechanical copying is not enough. After all, China and Japan have different national conditions and different levels of economic development. However, one thing is certain: Japan's aging situation today is a mirror of China in a few years. The most important thing for "referral nurses" to provide for the aged is the need for a complete old-age security system, including insurance and legislation.

Japanese geriatric nursing can be advanced in the world, thanks to the government's relevant laws and regulations and security system, which is also worth learning from Shanghai and even China. According to Chen Yijun, a teacher with a double bachelor's degree in medical law at the Second Medical University, as early as 1963, the Japanese government promulgated the Welfare Law for the Elderly to solve the basic living security of the local elderly, and in 1982, it also promulgated the Health Care Law for the Elderly in view of the increase of senile diseases. In the 1990' s, there were more and more bedridden and demented elderly people in Japanese society. Therefore, in 1997, the Japanese government promulgated the Nursing Insurance Law, stipulating that Japanese citizens must take out insurance from the age of 40, so that when they are old, they can enjoy nursing, buy insurance and have legal protection. This old age life is of course guaranteed.

It is reported that Germany also introduced "intermediary nurses" in China in the early years. The economic pressure on the state to bear the pension was so great that the government finally had to declare the plan a failure. Compared with Japan, an important reason for Germany's failure is that it neglected the investment in the early stage, and the nursing insurance implemented in Japan enabled everyone to invest in their later years as early as middle age.

At present, most of the fees charged by nursing homes in Shanghai are at their own expense. If an old man who needs life care is admitted to a nursing home, it is not enough to rely solely on his pension. With the rapid growth of the elderly population, this will evolve into a new social problem. Some experts suggest that in the face of the coming aging society, what the government urgently needs to solve is to protect the legitimate rights and interests of the elderly through legislation.