Discipline of Public Health, Flinders University, Adelaide, SA, Australia.
Nurs Inq. 2011 Mar;18(1):55-65. doi: 10.1111/j.1440-1800.2011.00521.x.
Mental health care in Australia in the last 20 years has moved from stand-alone psychiatric hospitals to general hospitals and the community. This paper reports an action research project exploring the experiences of nurses on an acute mental health unit for older adults staffed with a skillmix of mental health and general nurses, which recently transitioned from a psychiatric to a general hospital. The new service provides comprehensive health care, including the management of physical co-morbidity and a recovery orientation. Recovery acknowledges the role and rights of consumers and carers in planning and management of care, choice and individual strengths (Shepherd). The new ward received additional resources to establish the model of care, including a broader skillmix. The paper explores the dynamics of development of a new model of care and of bringing together staff with different professional orientations, cultures and priorities. Focus groups and interviews were conducted with 18 staff. Analysis resulted in three themes relating to the impact of competing goals and foci of care upon professional boundaries; competing organisational cultures and the impact of service change upon work practices. The findings are explored in relation to ideas about health care delivery associated with neoliberalism.
在过去的 20 年中，澳大利亚的精神卫生保健已经从独立的精神病院转移到了综合医院和社区。本文报告了一个行动研究项目，该项目探讨了在一个为老年人提供精神卫生和普通护士混合技能的急性精神卫生病房工作的护士的经验，该病房最近从精神病院过渡到了综合医院。新服务提供全面的医疗保健，包括管理身体合并症和康复方向。康复承认消费者和照顾者在护理规划和管理、选择和个人优势方面的作用和权利（Shepherd）。新病房获得了额外的资源来建立护理模式，包括更广泛的技能组合。本文探讨了新护理模式的发展动态以及将具有不同专业方向、文化和优先事项的员工聚集在一起的动态。对 18 名员工进行了焦点小组和访谈。分析产生了三个主题，涉及竞争目标和护理重点对专业边界的影响；竞争的组织文化以及服务变更对工作实践的影响。研究结果与与新自由主义相关的医疗保健提供理念有关。
