心理健康危机期间强化家庭治疗中的社会心理护理服务:定性主题分析。

Nicola Clibbens, Adrianne Close, Julie Poxton, Carly Davies, Lesley Geary, Geoffrey Dickens
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引用次数: 0

摘要

以社区为基础的家庭强化治疗(IHT)是作为危机解决服务的一部分,作为精神病院住院治疗的替代方案。接受居家强化治疗的人都有复杂的精神健康问题,并且处于极度痛苦之中。居家治疗通常是首选方案,而且有证据表明这种服务是可靠的,但人们对这种环境下的社会心理护理却知之甚少。本研究以批判现实主义认识论为基础,旨在从工作人员、服务使用者和家庭照护者的角度探讨家庭治疗背景下的社会心理护理。在英格兰的两家国家医疗服务体系机构中,通过个人访谈和焦点小组收集了数据。通过归纳式定性主题分析,得出了五个主题,分别集中在:(1)人员配置模式和有效的护理服务;(2)工作组织和有效的护理服务;(3)技能和培训与服务使用者的需求;(4)参与机会和个人选择;以及(5)有效的沟通。研究结果表明,共同生产可以改善综合医院服务设计、服务使用者和护理人员的需求以及工作人员对最佳护理的理想之间的一致性。我们提倡能优化护理连续性和有效沟通的服务设计。由于没有针对家庭治疗的具体情况对员工进行治疗干预方面的培训,因此培训效果有限。关于最有效的社会心理护理以及所需的相关培训和监督,仍存在证据差距。鉴于护理人员和家庭成员在工作人员探视间隙为患者提供支持的关键作用,他们应如何获得支持也不明确。
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Psychosocial Care Delivery in Intensive Home Treatment During a Mental Health Crisis: A Qualitative Thematic Analysis.

Community-based intensive home treatment (IHT) is delivered as an alternative to psychiatric hospital admission as part of crisis resolution services. People receiving IHT present with complex mental health issues and are acutely distressed. Home treatment options are often preferred and there is evidence of service fidelity, although less is known about psychosocial care in this setting. Underpinned by a critical realist epistemology, this study aimed to explore psychosocial care in the context of home treatment from the perspectives of staff, service users and family carers. Data were collected using individual interviews and focus groups in two NHS organisations in England. An inductive qualitative thematic analysis resulted in five themes focused on (1) the staffing model and effective care provision, (2) the organisation of work and effective care provision, (3) skills and training and service user need, (4) opportunities for involvement and personal choice, and (5) effective communication. Findings suggest that co-production may improve congruence between IHT service design, what service users and carers want and staff ideals about optimal care. Service designs that optimise continuity of care and effective communication were advocated. Staff training in therapeutic interventions was limited by not being tailored to the home treatment context. Evidence gaps remain regarding the most effective psychosocial care and related training and supervision required. There is also a lack of clarity about how carers and family members ought to be supported given their often-crucial role in supporting the person between staff visits.

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