Department of Mental Health, St. George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom.
Psychiatr Serv. 2010 Mar;61(3):293-9. doi: 10.1176/ps.2010.61.3.293.
Service provision in psychiatric and social care is increasingly guided by recovery principles. However, little is known about the degree of consensus among stakeholders in diverse contexts on the components of care that most promote recovery. This study aimed to identify specific items of care that key stakeholders regard as most important in promoting recovery for people with longer-term mental health problems in institutional care, to measure consensus between and across stakeholder groups and countries, and to develop a conceptual framework of the most important domains of care.
Ten European countries in various stages of deinstitutionalization participated in a series of conventional three-round iterative Delphi exercises. In each country individuals in four separate expert groups (service users, mental health professionals, caregivers, and advocates) identified components of care that they considered important to recovery and then rated their group's suggestions in terms of importance. Median and consensus ratings were measured. High-ranking items were grouped into domains.
A total of 4,098 separate items of care were proposed by the 40 participating groups. Eleven broad domains of care important for recovery were identified: social policy and human rights, social inclusion, self-management and autonomy, therapeutic interventions, governance, staffing, staff attitudes, institutional environment, postdischarge care, caregivers, and physical health care. Consensus between groups and countries was generally high, but some modest differences in priorities were noted.
The most consistently highly rated consensus domain was therapeutic interventions. Domains and components of care related to recovery principles were also viewed as important across stakeholder groups.
精神科和社会护理服务的提供越来越多地遵循康复原则。然而，对于不同背景下的利益相关者在促进康复方面最重要的护理内容方面的共识程度知之甚少。本研究旨在确定关键利益相关者认为在机构护理中对长期精神健康问题患者的康复最重要的特定护理内容，衡量利益相关者群体和国家之间以及跨群体之间的共识，并制定最重要的护理领域的概念框架。
十个处于去机构化不同阶段的欧洲国家参与了一系列常规的三轮迭代德尔菲调查。在每个国家，四个不同专家群体（服务使用者、心理健康专业人员、护理人员和倡导者）的个人确定了他们认为对康复重要的护理内容，然后根据重要性对他们所在群体的建议进行评分。衡量中位数和共识评分。排名较高的项目被分为不同的领域。
40 个参与小组共提出了 4098 项单独的护理内容。确定了 11 个对康复很重要的广泛护理领域：社会政策和人权、社会包容、自我管理和自主权、治疗干预、治理、人员配备、员工态度、机构环境、出院后护理、护理人员和身体健康护理。群体和国家之间的共识通常很高，但也注意到一些优先事项存在适度差异。
一致性最高的共识领域是治疗干预。与康复原则相关的领域和护理内容也被各利益相关者群体视为重要内容。
