背景:世卫组织提倡患者和公众参与作为一种伦理要求,由于患者生活经验的价值。更深入地了解医疗保健专业人员和管理人员的共同含义和基本信念,支持和反对将患者纳入护理途径发展。
目的:探讨医疗保健专业人员和管理人员对患者和公众参与护理途径发展的考虑。
方法:在一个医疗康复中心,我们进行了一个案例研究,该研究是混合护理途径发展的2年行动研究计划的一部分。在对医疗保健专业人员和经理进行了14次半结构化采访之后,我们分析了他们关于患者参与的价值以及潜在的威胁和机会的论述。
结果:我们确定了四种话语。患者作为专家将参与视为相关,作为增加新的观点,并根据需要充分了解患者的需求。技能和代表性是基于这样的结构,即从患者那里获得有价值的见解需要一定的技能和能力。自我保护侧重于个人,对患者参与的跨行业反对意见。专业人士最清楚地揭示了避免或推迟参与的与专业知识相关的原因。
结论:这些论述解释了为什么患者和公众参与护理途径发展有时会被推迟,参与范围和水平有限,和/或避免。以下策略可以最大程度地减少这些话语的瘫痪效果:加强所有相关利益相关者的能力;使用混合的互补技术来参与护理途径发展的不同阶段;并创造/促进安全的环境。放在一起,这些策略将促进持续的,互惠学习,可以提高患者的参与度。
■这项研究属于混合护理途径开发的行动研究计划(开发综合,协调的患者护理计划,结合远程,数字远程医疗应用,自我管理工具和面对面护理)。多学科团队采用质量协作方法来改进质量(将患者视为利益相关者),以开发11条混合护理途径。尽管指示专业人员和管理人员邀请患者加入他们的团队并参加护理途径设计研讨会,很少有球队(3/11)真正做到了。解开为什么会发生这种情况将有助于改善患者和公众对护理途径发展的参与。
BACKGROUND: The WHO advocates patient and public involvement as an ethical imperative, due to the value of the lived experience of patients. A deeper understanding of the shared meanings and underlying beliefs of healthcare professionals and managers for and against including patients in care pathway development.
OBJECTIVE: To explore the considerations of healthcare professionals and managers on the involvement of patients and public in care pathway development.
METHODS: In a medical rehabilitation centre we conducted a single case study that was part of a 2-year action research programme on blended care pathway development. Following 14 semistructured interviews with healthcare professionals and managers, we analysed their discourses on the value of patient involvement as well as the potential threats and opportunities.
RESULTS: We identified four discourses. Patient as expert frames involvement as relevant, as adding new perspectives and as required to fully understand the patient\'s needs. Skills and representation is based on the construct that obtaining valuable insights from patients requires certain skills and competences. Self-protection focusses on personal, interprofessional objections to patient involvement. Professional knows best reveals expertise-related reasons for avoiding or postponing involvement.
CONCLUSIONS: These discourses explain why patient and public involvement in care pathway development is sometimes postponed, limited in scope and level of participation, and/or avoided. The following strategies might minimise the paralysing effect of these discourses: strengthen the capabilities of all stakeholders involved; use a mix of complementary techniques to gain involvement in distinct phases of care pathway development; and create/facilitate a safe environment. Put together, these strategies would foster ongoing, reciprocal learning that could enhance patient involvement.
UNASSIGNED: This study belonged to an action research programme on blended care pathway development (developing an integrated, coordinated patient care plan that combines remote, digital telehealth applications, self-management tools and face-to-face care). Multidisciplinary teams took a quality collaborative approach to quality improvement (considering patients as stakeholders) to develop 11 blended care pathways. Although professionals and managers were instructed to invite patients onto their teams and to attend care pathway design workshops, few teams (3/11) actually did. Unravelling why this happened will help improve patient and public involvement in care pathway development.