英格兰社会处方联系工作者角色的微观自由裁量权和界限的后果:现实主义评估。

Stephanie Tierney, Debra Westlake, Geoffrey Wong, Amadea Turk, Steven Markham, Jordan Gorenberg, Joanne Reeve, Caroline Mitchell, Kerryn Husk, Sabi Redwood, Anthony Meacock, Catherine Pope, Kamal R Mahtani
{"title":"英格兰社会处方联系工作者角色的微观自由裁量权和界限的后果:现实主义评估。","authors":"Stephanie Tierney, Debra Westlake, Geoffrey Wong, Amadea Turk, Steven Markham, Jordan Gorenberg, Joanne Reeve, Caroline Mitchell, Kerryn Husk, Sabi Redwood, Anthony Meacock, Catherine Pope, Kamal R Mahtani","doi":"10.3310/JSQY9840","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Social prescribing addresses non-medical factors affecting health and well-being. Link workers are key to its delivery by connecting people to relevant support, often in the voluntary, community and social enterprise sector. Funding from the National Health Service means that link workers are becoming a common part of primary care in England.</p><p><strong>Objective: </strong>To explore and understand the implementation of link workers in primary care in England.</p><p><strong>Design: </strong>A realist evaluation addressed the question - <i>When implementing link workers in primary care to sustain outcomes - what works, for whom, why and in what circumstances?</i></p><p><strong>Setting: </strong>Link workers and staff associated with seven primary care sites across England.</p><p><strong>Methods: </strong>Researchers spent 3 weeks with each link worker, going to meetings with them, watching them interact with patients, with healthcare staff and with voluntary, community and social enterprise organisations. In addition, interviews were conducted with 61 patients and 93 professionals (voluntary, community and social enterprise representatives and healthcare staff, including link workers). Follow-up interviews were conducted with 41 patients and with link workers 9-12 months later. Data were coded and developed into statements to identify how context around the link worker triggers mechanisms that lead to intended and unintended outcomes.</p><p><strong>Results: </strong>We found that link workers exercise micro-discretions in their role - actions and advice-giving based on personal judgement of a situation, which may not always reflect explicit guidance or protocols. Our analysis highlighted that micro-discretions engender positive connections (with patients, healthcare staff, the voluntary, community and social enterprise sector) and promote buy-in to the link worker role in primary care. Micro-discretions supported delivery of person-centred care and enhanced job satisfaction. Data also highlighted that lack of boundaries could place link workers at risk of overstepping their remit.</p><p><strong>Limitations: </strong>Our research focused on link workers attached to primary care; findings may not be applicable to those working in other settings. Data were collected around seven link worker cases, who were selected purposively for variation in terms of geographical spread and how/by whom link workers were employed. However, these link workers were predominately white females.</p><p><strong>Conclusions: </strong>Enabling link workers to exercise micro-discretions allows for responsiveness to individual patient needs but can result in uncertainty and to link workers feeling overstretched.</p><p><strong>Future work: </strong>Poor link worker retention may, in part, be associated with a lack of clarity around their role. Research to explore how this shapes intention to leave their job is being conducted by authors of this paper.</p><p><strong>Funding: </strong>This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130247.</p>","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-17"},"PeriodicalIF":0.0000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The consequences of micro-discretions and boundaries in the social prescribing link worker role in England: a realist evaluation.\",\"authors\":\"Stephanie Tierney, Debra Westlake, Geoffrey Wong, Amadea Turk, Steven Markham, Jordan Gorenberg, Joanne Reeve, Caroline Mitchell, Kerryn Husk, Sabi Redwood, Anthony Meacock, Catherine Pope, Kamal R Mahtani\",\"doi\":\"10.3310/JSQY9840\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Social prescribing addresses non-medical factors affecting health and well-being. Link workers are key to its delivery by connecting people to relevant support, often in the voluntary, community and social enterprise sector. Funding from the National Health Service means that link workers are becoming a common part of primary care in England.</p><p><strong>Objective: </strong>To explore and understand the implementation of link workers in primary care in England.</p><p><strong>Design: </strong>A realist evaluation addressed the question - <i>When implementing link workers in primary care to sustain outcomes - what works, for whom, why and in what circumstances?</i></p><p><strong>Setting: </strong>Link workers and staff associated with seven primary care sites across England.</p><p><strong>Methods: </strong>Researchers spent 3 weeks with each link worker, going to meetings with them, watching them interact with patients, with healthcare staff and with voluntary, community and social enterprise organisations. In addition, interviews were conducted with 61 patients and 93 professionals (voluntary, community and social enterprise representatives and healthcare staff, including link workers). Follow-up interviews were conducted with 41 patients and with link workers 9-12 months later. Data were coded and developed into statements to identify how context around the link worker triggers mechanisms that lead to intended and unintended outcomes.</p><p><strong>Results: </strong>We found that link workers exercise micro-discretions in their role - actions and advice-giving based on personal judgement of a situation, which may not always reflect explicit guidance or protocols. Our analysis highlighted that micro-discretions engender positive connections (with patients, healthcare staff, the voluntary, community and social enterprise sector) and promote buy-in to the link worker role in primary care. Micro-discretions supported delivery of person-centred care and enhanced job satisfaction. Data also highlighted that lack of boundaries could place link workers at risk of overstepping their remit.</p><p><strong>Limitations: </strong>Our research focused on link workers attached to primary care; findings may not be applicable to those working in other settings. Data were collected around seven link worker cases, who were selected purposively for variation in terms of geographical spread and how/by whom link workers were employed. However, these link workers were predominately white females.</p><p><strong>Conclusions: </strong>Enabling link workers to exercise micro-discretions allows for responsiveness to individual patient needs but can result in uncertainty and to link workers feeling overstretched.</p><p><strong>Future work: </strong>Poor link worker retention may, in part, be associated with a lack of clarity around their role. Research to explore how this shapes intention to leave their job is being conducted by authors of this paper.</p><p><strong>Funding: </strong>This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130247.</p>\",\"PeriodicalId\":519880,\"journal\":{\"name\":\"Health and social care delivery research\",\"volume\":\" \",\"pages\":\"1-17\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Health and social care delivery research\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3310/JSQY9840\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health and social care delivery research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3310/JSQY9840","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

背景:社会处方处理影响健康和福祉的非医疗因素。联系工作者通常在志愿服务、社区和社会企业部门将人们与相关支持联系起来,是实施社会处方的关键。国民健康服务的资助意味着联系工作者正在成为英格兰初级保健的常见组成部分:目的:探索并了解联系工作者在英格兰初级医疗中的实施情况:设计:一项现实主义评估探讨了以下问题:在初级医疗中实施联系工作者以保持成果时,什么方法有效、对谁有效、为什么有效以及在什么情况下有效?方法:研究人员与每位联系工作者共同工作 3 周:研究人员与每位联系工作者相处了 3 周,与他们一起参加会议,观察他们与患者、医护人员以及志愿组织、社区和社会企业组织的互动。此外,还对 61 名患者和 93 名专业人员(志愿组织、社区和社会企业代表以及医疗保健人员,包括链接工作者)进行了访谈。9-12 个月后,对 41 名患者和联系工作者进行了后续访谈。我们对数据进行了编码,并将其编制成陈述,以确定链接工作者周围的环境如何触发机制,从而导致预期和非预期的结果:我们发现,链接工作者在履行职责时存在微观谨慎--根据个人对情况的判断采取行动和提供建议,而这可能并不总是反映明确的指导或协议。我们的分析强调,微观酌处权(与患者、医护人员、志愿服务、社区和社会企业部门)能产生积极的联系,并促进对初级保健中联系工作者角色的认同。微观谨慎有助于提供以人为本的护理,提高工作满意度。数据还显示,缺乏界限可能会使联系工作者面临越权的风险:我们的研究主要针对初级医疗机构的链接工作者,研究结果可能不适用于在其他机构工作的链接工作者。我们围绕七个联系工作者案例收集了数据,这些案例是有目的性地选择的,因为它们在地理分布和联系工作者的聘用方式/对象方面存在差异。不过,这些联系工作者主要是白人女性:结论:让联系工作者行使微观决定权可以满足个别病人的需求,但也可能导致不确定性,使联系工作者感到力不从心:未来工作:联系工作者的留任率低,部分原因可能与他们的角色不明确有关。本文作者正在开展研究,探讨这种情况如何影响离职意向:本文是由美国国家健康与护理研究所(NIHR)健康与社会护理服务研究项目资助的独立研究,奖励编号为 NIHR130247。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
The consequences of micro-discretions and boundaries in the social prescribing link worker role in England: a realist evaluation.

Background: Social prescribing addresses non-medical factors affecting health and well-being. Link workers are key to its delivery by connecting people to relevant support, often in the voluntary, community and social enterprise sector. Funding from the National Health Service means that link workers are becoming a common part of primary care in England.

Objective: To explore and understand the implementation of link workers in primary care in England.

Design: A realist evaluation addressed the question - When implementing link workers in primary care to sustain outcomes - what works, for whom, why and in what circumstances?

Setting: Link workers and staff associated with seven primary care sites across England.

Methods: Researchers spent 3 weeks with each link worker, going to meetings with them, watching them interact with patients, with healthcare staff and with voluntary, community and social enterprise organisations. In addition, interviews were conducted with 61 patients and 93 professionals (voluntary, community and social enterprise representatives and healthcare staff, including link workers). Follow-up interviews were conducted with 41 patients and with link workers 9-12 months later. Data were coded and developed into statements to identify how context around the link worker triggers mechanisms that lead to intended and unintended outcomes.

Results: We found that link workers exercise micro-discretions in their role - actions and advice-giving based on personal judgement of a situation, which may not always reflect explicit guidance or protocols. Our analysis highlighted that micro-discretions engender positive connections (with patients, healthcare staff, the voluntary, community and social enterprise sector) and promote buy-in to the link worker role in primary care. Micro-discretions supported delivery of person-centred care and enhanced job satisfaction. Data also highlighted that lack of boundaries could place link workers at risk of overstepping their remit.

Limitations: Our research focused on link workers attached to primary care; findings may not be applicable to those working in other settings. Data were collected around seven link worker cases, who were selected purposively for variation in terms of geographical spread and how/by whom link workers were employed. However, these link workers were predominately white females.

Conclusions: Enabling link workers to exercise micro-discretions allows for responsiveness to individual patient needs but can result in uncertainty and to link workers feeling overstretched.

Future work: Poor link worker retention may, in part, be associated with a lack of clarity around their role. Research to explore how this shapes intention to leave their job is being conducted by authors of this paper.

Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130247.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
A model of occupational stress to assess impact of COVID-19 on critical care and redeployed nurses: a mixed-methods study. Exploratory study from an end-of-life research partnership network to improve access for ethnically diverse communities in one region. Early mental health intervention and supported self-care for LGBTQ+ young people in the UK: a mixed-methods study. Interpersonal counselling for adolescent depression delivered by youth mental health workers without core professional training: the ICALM feasibility RCT. Clinical and cost-effectiveness of first contact physiotherapy for musculoskeletal disorders in primary care: the FRONTIER, mixed method realist evaluation.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1