背景:在英国,对安全性和分散的社区精神卫生保健的担忧导致了英格兰护理计划方法的发展以及威尔士的护理和治疗计划。这些系统要求服务用户有一个护理协调员,书面护理计划和定期审查他们的护理。过程需要协作,注重恢复和个性化,但很少被研究。我们旨在获取参与社区精神卫生保健的利益相关者的意见和经验,并确定促进或作为障碍的因素,协作,以恢复为重点的护理。
方法:我们在英格兰和威尔士的六个服务提供商站点进行了一项跨国比较研究,采用了并发变革性混合方法方法和嵌入式案例研究。这项研究包括对复苏观点的调查,服务使用者的授权和治疗关系(n=448)和护理协调员的康复(n=201);涉及与服务提供商访谈的嵌入式案例研究,服务用户和护理人员(n=117)和护理计划审查(n=33)。使用推断统计数据对站点内部和站点之间的定量和定性数据进行了分析,相关性和框架方法。
结果:在治疗关系的评分方面,各站点之间存在显著差异。在护理计划的经验以及对康复和个性化的理解方面,报告了站点和参与者组内的差异。护理计划被描述为行政负担,很少被咨询。护理人员报告了不同程度的参与。风险评估是临床关注的核心问题,但很少与服务用户讨论。服务使用者重视与护理协调员和其他人的治疗关系,并认为这些是复苏的核心。
结论:护理协调的管理要素减少了以恢复为重点和个性化工作的机会。对复苏的共识很少,这可能会限制共同的目标。关于风险的对话似乎被忽视了,服务用户没有进行评估。不愿参与有关风险管理的对话可能会不利于作为以恢复为重点的工作的一部分的积极冒险的机会。研究调查创新方法,以最大限度地提高员工与服务用户和护理人员的联系时间,风险评估中的共同决策,以及旨在实现个性化的培训,指出了以恢复为重点的护理协调。
BACKGROUND: In the UK, concerns about safety and fragmented community mental health care led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require service users to have a care coordinator, written care plan and regular reviews of their care. Processes are required to be collaborative, recovery-focused and personalised but have rarely been researched. We aimed to obtain the views and experiences of stakeholders involved in community mental health care and identify factors that facilitate or act as barriers to personalised, collaborative, recovery-focused care.
METHODS: We conducted a cross-national comparative study employing a concurrent transformative mixed-methods approach with embedded
case studies across six service provider sites in England and Wales. The study included a survey of views on recovery, empowerment and therapeutic relationships in service users (n = 448) and recovery in care coordinators (n = 201); embedded
case studies involving interviews with service providers, service users and carers (n = 117) and a review of care plans (n = 33). Quantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and framework method.
RESULTS: Significant differences were found across sites for scores on therapeutic relationships. Variation within sites and participant groups was reported in experiences of care planning and understandings of recovery and personalisation. Care plans were described as administratively burdensome and were rarely consulted. Carers reported varying levels of involvement. Risk assessments were central to clinical concerns but were rarely discussed with service users. Service users valued therapeutic relationships with care coordinators and others, and saw these as central to recovery.
CONCLUSIONS: Administrative elements of care coordination reduce opportunities for recovery-focused and personalised work. There were few common understandings of recovery which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work. Research to investigate innovative approaches to maximise staff contact time with service users and carers, shared decision-making in risk assessments, and training designed to enable personalised, recovery-focused care coordination is indicated.