背景:在英国,与痴呆症一起使用的术语“复杂”和“复杂性”反映在许多政策和实践文件中。然而,缺乏证据来探索复杂性是如何被感知的,由痴呆症患者建造和经历,在NHS痴呆症住院评估病房[痴呆症评估病房]工作的家庭护理人员和从业人员。
目的:从痴呆症评估病房的环境中探索痴呆症复杂性的含义和概念,并建立实践模型。
方法:该研究分为三个阶段:1)对英国国家痴呆症领导者的在线电子调查;2)在两个痴呆症评估病房中对痴呆症从业人员进行个人访谈和焦点小组;3)在痴呆症评估病房中居住的四名痴呆症患者的案例研究,其中包括他们确定的家庭照顾者/咨询者,病房的指定临床医生参与该人的护理和护理记录审查。
结果:研究结果强调,复杂性是通过许多相互连接和相互关联的领域来构建的,这些领域的敏锐度各不相同。这些发现已发展为“3Fs复杂性模型”和“3Fs固定模型”,灵活和波动。固定域由六个组件组成,这些组件始终以复杂性存在。灵活域由14个组件组成,痴呆症患者在任何时候都可能经历任何数量的灵活域组件。波动域强调所有组分具有改变其敏锐度的能力。
结论:与孤立地看待“症状”相比,“3Fs复杂性模型”可以更全面地看待痴呆症患者。展望未来,并有待进一步完善和测试,“3Fs复杂性模型”可以帮助指导定制的选择,针对痴呆症患者的个性化干预措施,包括制定方法。
BACKGROUND: In the United Kingdom, the use of the terms \'complex\' and \'complexity\' alongside dementia is reflected in a number of policy and practice documents. However, there is a lack of evidence that explores how complexity is perceived, constructed and experienced by people with dementia, family carers and practitioners working in the NHS dementia inpatient assessment wards [dementia assessment wards].
OBJECTIVE: To explore the meaning and concept of complexity in dementia from within the setting of a dementia assessment ward and develop a practice model.
METHODS: The study was conducted over three phases: 1) an online electronic survey of UK national dementia leaders; 2) individual interviews and a focus group with dementia practitioners in two dementia assessment wards; 3) case studies of four patients with dementia resident on a dementia assessment ward which included their identified family carer/consultee, the named clinician on the ward involved in that person\'s care and a care records review.
RESULTS: The findings highlighted that complexity is constructed through a number of interconnected and interrelated domains that vary in acuity. These findings have been developed into the \'3 Fs Model of Complexity\' and the 3\'Fs\' stand for Fixed, Flexible and Fluctuating. The Fixed domain consists of six components which are always present in complexity. The Flexible domain consists of 14 components and a person with dementia may experience any number of Flexible domain components at any one time. The Fluctuating domain highlights that all components have the ability to vary in their acuity.
CONCLUSIONS: The \'3 Fs Model of Complexity\' may facilitate a more holistic view of a person with dementia than when \'symptoms\' are viewed in isolation. Going forward, and subject to further refinement and testing, the \'3 Fs Model of Complexity\' could help guide the selection of tailored, personalised interventions for people with dementia, including formulation approaches.