Small Neil, Green John, Spink Joanna, Forster Anne, Lowson Karin, Young John
School of Health Studies, University of Bradford, and Department of Health Care for the Elderly, St Luke's Hospital, Bradford, UK.
J Eval Clin Pract. 2007 Feb;13(1):95-101. doi: 10.1111/j.1365-2753.2006.00653.x.
We report findings from a qualitative study to identify patient views of community hospital care. We consider how far these were in accord with the hospital staffs' views. This constituted part of a wider randomized controlled trial (RCT). The methodological challenges in seeking to identify patient satisfaction and in linking qualitative findings with trial results are explored.
A sample of 13 patients randomized to the community hospital arm of the RCT joined the qualitative study. Official documentation from the hospital were accessed and six staff interviewed to identify assumptions underlying practice.
Analysis of interviews identified a complex picture concerning expectations These could be classified as ideal, realistic, normative and unformed. The hospital philosophy and staff views about service delivery were closely in harmony, they delivered rehabilitation in a home-based atmosphere. The formal, or 'hard', process of rehabilitation was not well understood by patients. They were primarily concerned with 'soft' or process issues--where and how care was delivered.
We identify a model of community hospital care that incorporates technical aspects of rehabilitation within a human approach that is welcomed by patients. If patients are to be able to participate in making informed decisions about care, the rationale for the activities of staff need to be more clearly explained. Recommendations are made about the appropriate scope of qualitative findings in the context of trials and about techniques to access patient views in areas where they have difficulty in expressing critical impressions.
我们报告一项定性研究的结果，以确定患者对社区医院护理的看法。我们考量这些看法与医院工作人员看法的契合程度。这是一项更广泛的随机对照试验（RCT）的一部分。探讨了在确定患者满意度以及将定性研究结果与试验结果相联系方面所面临的方法学挑战。
随机分配至RCT社区医院组的13名患者参与了定性研究。查阅了医院的官方文件，并对6名工作人员进行了访谈，以确定实践背后的假设。
对访谈的分析揭示了有关期望的复杂情况。这些期望可分为理想型、现实型、规范型和未成型。医院理念和工作人员对服务提供的看法高度一致，他们在居家氛围中提供康复服务。患者对正式的或“硬性”的康复过程理解不足。他们主要关注“软性”或过程性问题——护理的地点和方式。
我们确定了一种社区医院护理模式，该模式在一种受患者欢迎的人性化方法中纳入了康复的技术层面。如果患者要能够参与对护理做出明智决策，就需要更清楚地解释工作人员活动的基本原理。针对试验背景下定性质性研究结果的适当范围以及在患者难以表达关键印象的领域获取患者看法的技术提出了建议。
