Jones Adrian
North East Wales NHS Trust, Wrexham, UK.
Int J Ment Health Nurs. 2006 Mar;15(1):19-28. doi: 10.1111/j.1447-0349.2006.00400.x.
The aim of this paper is to report on findings identifying some of the difficulties encountered by the multidisciplinary team in the development and implementation of a care pathway for patients diagnosed with schizophrenia. Policy direction has shifted towards greater team working and blurring of professional boundaries. Moreover, there is greater need to deliver care according to set standards and for patients to reach particular outcomes of care. Care pathways are relatively new for psychiatry and will potentially uncover tensions within the team. Data were collected by participant observation and semistructured interviews over a period of 12 months on an acute psychiatric unit. The care team developed the care pathway and the process of development and implementation was observed through action research. Cross-sectional indexing was used to analyse the data, and themes were developed using interview and observational data collection methods. Clinicians argued strongly for clear role boundaries but also defended their perceived control over health care from other professions. The findings indicate that designing a care pathway for people with schizophrenia may produce conflicting perceptions from the team. Conflict may arise through professions being unwilling to accept plurality over roles, which may hinder progress in meeting the needs of patients. The findings also counter the impression that care pathways can be implemented with little impact on the team.
本文旨在报告一些研究结果，这些结果揭示了多学科团队在为被诊断患有精神分裂症的患者制定和实施护理路径时遇到的一些困难。政策方向已转向更多的团队协作和专业界限的模糊化。此外，更有必要按照既定标准提供护理，并使患者达到特定的护理结果。护理路径在精神病学领域相对较新，可能会揭示团队内部的紧张关系。在12个月的时间里，通过参与观察和半结构化访谈在一个急性精神科病房收集了数据。护理团队制定了护理路径，并通过行动研究观察了制定和实施过程。采用横断面索引分析数据，并使用访谈和观察数据收集方法形成主题。临床医生强烈主张明确的角色界限，但也捍卫他们认为自己对来自其他专业的医疗保健的控制权。研究结果表明，为精神分裂症患者设计护理路径可能会在团队中产生相互矛盾的看法。冲突可能因各专业不愿接受角色的多元性而产生，这可能会阻碍满足患者需求方面的进展。研究结果也反驳了那种认为护理路径可以在对团队几乎没有影响的情况下实施的观点。
