■NHS产妇服务中有一项政策驱动,以改善对受害家庭的公开披露,以及有关如何实现更好做法的信息有限。
■为了从家庭的角度确定改善公开披露的关键因素,医生,助产士和服务,并为改善服务提供可操作的证据。
■三阶段,采用现实主义方法论进行定性研究。第一阶段:两篇文献综述:对2013年后NHS政策进行范围审查,并对改进的初始计划理论进行现实主义综合;对NHS产妇安全和家庭的国家利益相关者进行访谈研究。第2阶段:在英格兰的三个NHS产妇服务中进行深入的人种学案例研究。阶段3:与研究参与者的解释性论坛。患者和公众参与策略是所有研究阶段的基础。
■全国招聘(研究阶段1和3);三个英语孕产服务(研究阶段2)。
■我们完成了n=142次面试,包括27个家庭;93小时的人种学观察,包括9个月内的52次服务和家庭会议;以及约69人的解释性论坛,包括11个家庭。
■政策审查确定了从将受伤家庭视为被动接受者到事件后学习的主动贡献者的转变,但缺乏改善家庭参与的可行指导。现实主义者的综合发现,国际孕产文献中公开披露干预措施有效性的证据薄弱,但通过组织范围的干预进行了一些改进。最近的证据主要来自英国。该研究确定并探索了公开披露的五个关键机制:对伤害的有意义的承认;受影响的人参与审查/调查;支持家庭自己的理智;熟练的临床医生(医生和助产士)的心理安全性;并知道护理已经有所改善。注意到每个家庭都需要以自己的方式理解这一事件。确定了一些临床医生对一些家庭更加开放的选择性举措。证明了对抗性法医学景观的挑战以及对实现激励目标的有限支持。
■大流行后进行了研究,对服务的特殊压力。案例研究人种学是三种表现更高的服务:案例研究结果的概括是有限的。在没有研究人员访问的情况下,无法观察到健康安全调查部门的调查。家庭招募没有反映人口多样性,非白人家庭的代表性有限,残疾家庭和其他社会边缘化群体和弱势群体。
■我们确定需要服务范围的系统,以确保受伤的家庭处于事件后的中心,确保对临床医生进行适当的培训和事件后护理,并促进与家庭的持续接触,超越一些临床医生为一些家庭所做的个人努力。需要进行立法修订,以促进NHS组织与家庭的开放性,以及组织家庭参与实践的更广泛变化,表示。检查研究结果在多大程度上适用于不同的英语孕产服务,以及对如何在产妇服务研究中鼓励家庭多样性的更广泛的重新思考。
■本研究注册为PROSPEROCRD42020164061。该研究已根据RAMESES现实主义指南进行了评估。
■该奖项由美国国家卫生与护理研究所(NIHR)卫生与社会护理提供研究计划(NIHR奖参考:17/99/85)资助,并在《健康与社会护理提供研究》中全文发表。12号22.有关更多奖项信息,请参阅NIHR资助和奖励网站。
这项研究描述了参与NHS产妇护理事件的家庭和医疗保健专业人员的经验。这些事件对婴儿或妇女造成了类似伤害或死亡。我们想知道服务是否涉及家庭进行调查和审查,以及这是如何做到的,什么工作得很好,什么工作不好,为什么。要做到这一点,我们首先看了已经写了关于“公开披露”或OD的内容。公开披露是NHS向家庭承认他们提供的护理直接造成了伤害。公开披露发生后,家庭应该参与确保NHS学习,以便将来能够为家庭提供更好的护理。在我们的阅读中,我们发现家人想要一个有意义的道歉,参与审查或调查,知道他们所爱的人发生了什么,由知识渊博的医生和助产士照顾,他们支持提供公开披露,并知道事情因为发生了什么而改变。让家庭参与公开披露的建议有所改善,但仍有工作要做,以确保家庭参与。接下来,我们与参与政府政策的100多名医疗保健专业人员进行了交谈,以公开披露产妇服务和27个遭受伤害的家庭。我们花了9个月的时间观察三个产妇服务机构的临床医生的工作,以观察公开披露情况。我们与家人分享了早期发现,医生,助产士和管理人员,包括他们的观点。我们发现服务需要提供专门的时间,为提供公开披露的员工提供教育和情感支持。服务需要确保家庭对事件有持续的支持和更好的沟通。最后,家庭必须参与审查过程,如果他们想在报告中反映他们的经验,并随时了解正在进行的改进。
UNASSIGNED: There is a policy drive in NHS maternity services to improve open disclosure with harmed families and limited information on how better practice can be achieved.
UNASSIGNED: To identify critical factors for improving open disclosure from the perspectives of families, doctors, midwives and services and to produce actionable evidence for service improvement.
UNASSIGNED: A three-phased, qualitative study using realist methodology. Phase 1: two literature reviews: scoping review of post-2013 NHS policy and realist synthesis of initial programme theories for improvement; an interview study with national stakeholders in NHS maternity safety and families. Phase 2: in-depth ethnographic case studies within three NHS maternity services in England. Phase 3: interpretive forums with
study participants. A patient and public involvement strategy underpinned all
study phases.
UNASSIGNED: National recruitment (study phases 1 and 3); three English maternity services (
study phase 2).
UNASSIGNED: We completed n = 142 interviews, including 27 with families; 93 hours of ethnographic observations, including 52 service and family meetings over 9 months; and interpretive forums with approximately 69 people, including 11 families.
UNASSIGNED: The policy review identified a shift from viewing injured families as passive recipients to active contributors of post-incident learning, but a lack of actionable guidance for improving family involvement. The realist synthesis found weak evidence of the effectiveness of open disclosure interventions in the international maternity literature, but some improvements with organisation-wide interventions. Recent evidence was predominantly from the United Kingdom. The research identified and explored five key mechanisms for open disclosure: meaningful acknowledgement of harm; involvement of those affected in reviews/investigations; support for families\' own sense-making; psychological safely of skilled clinicians (doctors and midwives); and knowing that improvements to care have happened. The need for each family to make sense of the incident in their own terms is noted. The selective initiatives of some clinicians to be more open with some families is identified. The challenges of an adversarial medicolegal landscape and limited support for meeting incentivised targets is evidenced.
UNASSIGNED: Research was conducted after the pandemic, with exceptional pressure on services. Case-
study ethnography was of three higher performing services: generalisation from case-
study findings is limited. No observations of Health Safety Investigation Branch investigations were possible without researcher access. Family recruitment did not reflect population diversity with limited representation of non-white families, families with disabilities and other socially marginalised groups and disadvantaged groups.
UNASSIGNED: We identify the need for service-wide systems to ensure that injured families are positioned at the centre of post-incident events, ensure appropriate training and post-incident care of clinicians, and foster ongoing engagement with families beyond the individual efforts made by some clinicians for some families. The need for legislative revisions to promote openness with families across NHS organisations, and wider changes in organisational family engagement practices, is indicated. Examination of how far the study\'s findings apply to different English maternity services, and a wider rethinking of how family diversity can be encouraged in maternity services research.
UNASSIGNED: This study is registered as PROSPERO CRD42020164061. The
study has been assessed following RAMESES realist guidelines.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme (NIHR award ref: 17/99/85) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 22. See the NIHR Funding and Awards website for further award information.
This study describes the experiences of families and healthcare professionals involved in incidents in NHS maternity care. The incidents caused harm-like injury or death to the baby or woman. We wanted to know whether services involved families in investigations and reviews and how this was done, what worked well, what did not work well and why. To do this, we first looked at what had already been written about ‘open disclosure’ or OD. Open disclosure is when the NHS admits to families that the care they provided has directly caused harm. After open disclosure occurs, families should be involved in making sure that the NHS learns so it can deliver better care for families in the future. In our reading, we found that families want a meaningful apology, to be involved in reviews or investigations, to know what happened to their loved one, to be cared for by knowledgeable doctors and midwives who are supported in providing open disclosure and to know things have changed because of what happened. Recommendations for involving families in open disclosure have improved, but there is still work to be done to make sure families are involved. Next, we talked to over 100 healthcare professionals involved in government policy for open disclosure in maternity services and 27 families who experienced harm. We spent 9 months observing the work of clinicians at three maternity services to watch open disclosure. We shared early findings with families, doctors, midwives and managers, and included their views. We found that services need to provide dedicated time, education and emotional support for staff who provide open disclosure. Services need to ensure that families have ongoing support and better communication about incidents. Finally, families must be involved in the review process if they want to be with their experiences reflected in reports and kept informed of ongoing improvements.