Bigler B R
Crit Care Nurs Clin North Am. 1990 Sep;2(3):493-502.
The health care system in the United States is undergoing many changes, including the return of chronically dependent individuals who are medically fragile to the community's homes and schools. Community-based health care, when compared with hospital care, is more cost effective and is the consumer's preference. The supportive technology to perform skilled therapies is available and recent legislation, although not adequate, provides support. Not only is the community becoming an arena for the provision of more complex care, it is also becoming an arena for addressing ethical issues. The nursing profession is challenged to prepare skilled nurses for the greater independence that is required in community-based practice. Nurses need to become more aware of the authority inherent in their professional role in order to most effectively address and resolve the more complex and often intensive care needs of their clients who are medically fragile and being cared for in the community and to guide their families in the resolution of related ethical dilemmas.
美国的医疗保健系统正在经历诸多变革，包括让那些医疗状况脆弱、长期依赖他人照料的人回到社区的家庭和学校。与医院护理相比，基于社区的医疗保健更具成本效益，也是消费者的首选。用于开展专业治疗的支持技术已经具备，而且近期的立法虽然不够完善，但也提供了支持。社区不仅正成为提供更复杂护理的场所，也正成为解决伦理问题的场所。护理行业面临挑战，需要培养出能在基于社区的实践中具备更强独立性的专业护士。护士需要更加意识到其专业角色所固有的权威性，以便最有效地满足并解决那些在社区接受护理的医疗状况脆弱的客户更复杂且往往是高强度的护理需求，并指导他们的家人解决相关的伦理困境。
