The current situation of comprehensive quality of elderly rehabilitation nursing staff in medical and health care institutions
The results of this study showed that the overall score of the comprehensive quality of elderly rehabilitation nursing staff in medical and health care institutions is at a medium level. In each dimension, the highest score was professional attitude, followed by professional skills, and the lowest score was professional knowledge. These results are attributed to many reasons. Firstly, although in recent years, China has gradually attached importance to the training of elderly nursing professionals, but due to the late start, there is no specific theoretical knowledge system . Secondly, the elderly nursing courses in China are mostly aimed at the teaching and training of professional knowledge of students at higher vocational and undergraduate levels, while there is a lack of standardized training and guidance for elderly nursing staff . Through the questionnaire survey, it is known that most elderly rehabilitation nursing staff hope to learn systematic theoretical knowledge and skill operation through a variety of training methods. It was believed that the training courses for the elderly such as humanistic care and communication skills should be added, which could improve their comprehensive quality in all aspects in order to provide better humanistic care services for the elderly.
The comprehensive quality in different types of elderly rehabilitation nursing staff in medical and health care institutions
Wang Xichen et al.  pointed out that nursing skills of elderly nursing staff in China are not equal with a big gap. Our results showed that female elderly rehabilitation nurses had better mastery of professional knowledge and professional skills compared to male (P < 0.01). It may be related to more women in this survey. Furthermore, most men are managers who are less familiar with professional knowledge and skills in comparison with clinical nurses. In addition, the mastery of professional knowledge of elderly rehabilitation nursing staff in the age group of 56 and above was the best, while the mastery of professional skills in the age group of 35 and below was higher than that in other age groups (P < 0.05). And in terms of technical title, the scores of professional knowledge of the co-chief superintendent nurses and above groups were the highest, while the scores of professional skills of the supervisor nurses group were higher than those of other technical title groups (P < 0.01). With the accumulation of working time, the elderly rehabilitation nursing staff in the senior age group were promoted to co-chief superintendent nurses and above professional titles. Through years of learning, they gradually mastered more professional knowledge of elderly nursing, which are generally deeply rooted. Elderly rehabilitation nursing staff aged 35 and below were the main force of clinical work because they were mainly in clinical work, and their technical titles were mostly supervisor nurses. Therefore, their mastery of clinical professional nursing skills would be more profound.
Factors affecting comprehensive quality of elderly rehabilitation nursing staff in medical and health care institutions
The results of this study showed that the comprehensive quality of elderly rehabilitation nursing staff in medical and health care institutions was positively correlated with educational level (P < 0.01). The comprehensive quality of elderly rehabilitation nursing staff with bachelor degree or above was significantly higher than that of other educational groups, indicating that the higher the educational level, the higher the comprehensive quality. In terms of dimensions, the scores of professional knowledge and professional skills in the bachelor degree or above education groups were significantly higher than those in other education groups (P < 0.01). It indicated that with the improvement of educational level, the cognitive level of professional knowledge was bound to improve, and more effective access to richer and more cutting-edge knowledge of elderly care. Moreover, with a stronger learning enthusiasm, they would be more familiar with the mastery of professional skills.
Years of elderly rehabilitation nursing
Our results suggested that the comprehensive quality of elderly rehabilitation nursing staff in medical and health care institutions was positively correlated with the number of years engaged in elderly rehabilitation nursing (P < 0.05). According to the group of years of elderly rehabilitation nursing, the scores of professional knowledge and professional skills of elderly rehabilitation nursing staff engaged in more than 10 years were significantly higher than those engaged in less than 1 year (P < 0.05). It indicated that with the increase of working years, the comprehensive quality would be improved accordingly. Meanwhile, the familiarity with professional knowledge and professional skills would be better with the increase of time.
Countermeasures for improving comprehensive quality of elderly rehabilitation nursing staff in medical and health care institutions
Strengthen the training of elderly rehabilitation nursing professionals
At present, the training of elderly nursing professionals in China is still in its infancy. The elderly nursing professionals are far from enough to meet the needs of today' s society. The construction of nursing talent team is one of the bottlenecks for the long-term development of elderly nursing . Therefore, it is urgent to cultivate high-quality elderly rehabilitation nursing professionals. However, the lack of health human resources has led to the lack of specialized medical, rehabilitation and health services in many medical and health care institutions . Also, only《geriatric nursing》course is set up in clinical nursing specialty in colleges and universities in China, with fewer hours. So, students can only simply learn the basic knowledge of elderly care, and the training mode is relatively simple. Moreover, there is a lack of targeted practical skills of elderly care and opportunities for internships [22, 23].
A number of studies have pointed out that major colleges and universities can establish a cooperative relationship with medical and health care institutions, adopt a multi-teaching method, and formulate corresponding teaching objectives based on the different conditions of the elderly [23,24,25]. It is not only necessary for students to learn the theoretical knowledge of elderly care, but also create more practical opportunities for them to gradually adapt to the working environment of medical and health care institutions. Colleges and universities should also adopt interesting teaching methods to attract more students to fill in geriatric nursing-related majors and improve students ' interest in the actual teaching process .
Standardized training of elderly rehabilitation nursing professionals
The survey found that 52.90% of the elderly rehabilitation nursing staff spent most of their time working for disease professional care, followed by daily care, and only a small number of nursing staff spent most of their time working for psychological care and medication guidance for the elderly, which was similar to the findings of Liu Hui et al. . When asked what aspects of their abilities should be improved, the research objects of this study indicated that their comprehensive quality should be comprehensively improved. They should not only learn advanced theories and skills, but also cultivate the communication ability with the elderly. They should also provide psychological guidance and give humanistic care to the elderly in life, help them improve their quality of life and reduce the existing physical and mental pain. Faria et al.  also emphasized that elderly rehabilitation nursing staff can better accompany the elderly by designing and implementing active aging programs for the elderly by focusing on lifestyle, balanced training and promoting social participation.
Yang Li et al.  found that 70.00% of managers in medical and health care institutions have received relevant training in their work units, 56.60% of managers have received provincial or municipal training, but few have received professional training at the international level. This is different from the results of this study, which may be related to the fact that the respondents in this study are mostly nursing staff rather than managers. Although the State Council has proposed to promote the development of the combination of medical and health care since 2013, the government has less opportunities to provide training for nursing staff. The vast majority of personnel said that their training knowledge is mainly the experience accumulated gradually in their work. A number of survey results show that many elderly care workers in medical and health care institutions have not participated in pre-job training courses [24, 30, 31], which will bring unknowable safety hazards to the elderly. This requires us to explore a set of training system suitable for elderly nursing staff in China and carry out various forms of training courses. Medical and health care institutions should also provide more training opportunities for elderly rehabilitation nursing staff to learn advanced concepts of elderly rehabilitation nursing. Gilissen el al  suggested on-the-job training for health care staff in nursing homes, standardized documentation, structured dialogue, and promotion of multidisciplinary awareness. Managers in the institutions should also actively participate in international and national training courses, absorb excellent management experience at home and abroad for the management of the institution.
Strengthen propaganda to eliminate inherent prejudice and improve the remuneration of elderly rehabilitation nursing staff
The results of this study showed that the actual monthly income of elderly rehabilitation nursing staff in medical and health care institutions is different from their expected monthly income, which is similar to the results of Lin and Zhang [17, 33]. For multiple reasons, such as low wages, low development space, and low social status of elderly care, it is difficult for professional medical staff or managers to work in the medical and health care institutions for a long time. It will seriously affect the service quality of medical and health care institutions and the development of the combination of medical and health care mode.
A number of studies have shown that, the elderly are more accustomed to family care, rather than institutional care, some elderly even feel sent to pension institutions is a ' shame ' [14, 34, 35]. The government should increase publicity through social, media and other channels to change the occupational prejudice of society and students regarding elderly care. Encourage more medical graduates to work in medical and health care institutions, and establish relevant incentive and subsidy policies to link salary treatment with vocational skill levels, so as to attract more outstanding elderly rehabilitation nursing professionals [23, 36]. Managers in the institutions should standardize the talent recruitment system, job title evaluation and continuing education work mechanism, and effectively protect the self-interest of elderly rehabilitation nursing staff. Corresponding welfare subsidies should also be given to mobilize their enthusiasm for employment. At the same time, the nursing staff in the institutions should be regularly provided with professional prospects and ability training to clarify their job orientation and expectations for the future. This will gradually improve their work enthusiasm and professional identity , and create a good and positive working environment for elderly rehabilitation nursing staff.
This study has several limitations. First, this study only investigated the comprehensive quality status of elderly rehabilitation nursing staff in Liaoning Province's medical and health care institutions at a certain point in time, and did not conduct a comparative study on them after participating in the training. Second, due to lack of human, financial and material resources, only 189 elderly rehabilitation nursing staff in Liaoning Province’s medical and health care institutions were surveyed, with a small sample size. Follow-up research can increase the sample size and expand the scope of the research, not limited to Liaoning Province, but extended to the medical and health care institutions across the country.