从造口适应到生活参与的护理治理

Nursing Governance: From Ostomy Adjustment to Life Participation

摘要: 造口患者术后康复不仅涉及造口自我护理，还涉及身体形象、日常活动、家庭关系、工作及社会交往等生活领域。既往护理多聚焦技能训练和并发症预防，而患者出院后的专业照护可及性、身体尊严、自主选择及社会参与仍值得关注。本文在界定生物公民权与护理治理核心概念的基础上，基于生物公民权视角，结合“十五五”时期健康优先发展和基本公共服务均等化导向，梳理造口患者从术后适应走向生活参与过程中面临的专业照护、身份适应和社会支持困境，提出全周期护理、资源下沉、多主体支持及护理结局重构4项治理路径；进而分析路径实施在政策制度、资金、人力、技术信息及认知文化方面的现实障碍，提出初步应对策略，并结合英国、澳大利亚及我国本土实践案例说明框架关键元素的现实可行性。以生活参与作为护理服务的重要结果，有助于推动造口护理由技术照护向生活支持延伸，为完善连续性、可及性和以患者为中心的造口护理服务提供参考。

Abstract: Postoperative recovery among patients with ostomies involves not only ostomy self-care but also multiple domains of everyday life, including body image, daily activities, family relationships, employment, and social interactions. Previous nursing care has largely focused on skill training and complication prevention, whereas issues concerning access to professional care after hospital discharge, bodily dignity, autonomous decision-making, and social participation remain worthy of attention. After defining the core concepts of biocitizenship and nursing governance, and drawing on the perspective of biocitizenship in alignment with the health-priority development and equalization of basic public services advocated during China’s 15th Five-Year Plan period, this paper examines the challenges faced by patients with ostomies as they transition from postoperative adaptation to active participation in daily life, including difficulties related to professional care, identity adaptation, and social support. Four governance pathways are proposed: whole-course nursing care, decentralization of healthcare resources, multi-stakeholder support, and the reconstruction of nursing outcomes. The paper further analyzes the policy, financial, workforce, technical-informational, and sociocultural obstacles to implementation, proposes preliminary countermeasures, and draws on practical cases from the United Kingdom, Australia, and China to illustrate the feasibility of key elements of the framework. Positioning life participation as an important outcome of nursing services may help extend ostomy care from technical management toward broader life support and provide a reference for improving continuous, accessible, and patient-centered ostomy nursing services.