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运用卫生系统理论重新认识儿童复杂出院问题:结合专家咨询与理论发展的新型综合综述

Reconceptualizing children's complex discharge with health systems theory: novel integrative review with embedded expert consultation and theory development.

作者信息

Noyes Jane, Brenner Maria, Fox Patricia, Guerin Ashleigh

机构信息

Centre for Health-Related Research, School of Healthcare Sciences, Bangor University, UK.

出版信息

J Adv Nurs. 2014 May;70(5):975-96. doi: 10.1111/jan.12278. Epub 2013 Oct 25.

Abstract

AIM

To report a novel review to develop a health systems model of successful transition of children with complex healthcare needs from hospital to home.

BACKGROUND

Children with complex healthcare needs commonly experience an expensive, ineffectual and prolonged nurse-led discharge process. Children gain no benefit from prolonged hospitalization and are exposed to significant harm. Research to enable intervention development and process evaluation across the entire health system is lacking.

DESIGN

Novel mixed-method integrative review informed by health systems theory. DATA

SOURCES

CINAHL, PsychInfo, EMBASE, PubMed, citation searching, personal contact. REVIEW

METHODS

Informed by consultation with experts. English language studies, opinion/discussion papers reporting research, best practice and experiences of children, parents and healthcare professionals and purposively selected policies/guidelines from 2002-December 2012 were abstracted using Framework synthesis, followed by iterative theory development.

RESULTS

Seven critical factors derived from thirty-four sources across five health system levels explained successful discharge (new programme theory). All seven factors are required in an integrated care pathway, with a dynamic communication loop to facilitate effective discharge (new programme logic). Current health system responses were frequently static and critical success factors were commonly absent, thereby explaining ineffectual discharge.

CONCLUSION

The novel evidence-based model, which reconceptualizes 'discharge' as a highly complex longitudinal health system intervention, makes a significant contribution to global knowledge to drive practice development. Research is required to develop process and outcome measures at different time points in the discharge process and future trials are needed to determine the effectiveness of integrated health system discharge models.

摘要

目的

报告一项新颖的综述,以构建一个针对有复杂医疗需求儿童从医院成功过渡到家庭的卫生系统模型。

背景

有复杂医疗需求的儿童通常经历昂贵、无效且漫长的由护士主导的出院过程。儿童无法从长期住院中获益,反而会遭受重大伤害。目前缺乏能够在整个卫生系统中推动干预措施发展和进行过程评估的研究。

设计

基于卫生系统理论的新颖混合方法综合综述。

数据来源

护理学与健康领域数据库(CINAHL)、心理学文摘数据库(PsychInfo)、荷兰医学文摘数据库(EMBASE)、医学期刊数据库(PubMed)、引文检索、个人联系。

综述方法

在与专家协商的基础上进行。对2002年至2012年12月期间的英文研究、报告研究、最佳实践以及儿童、家长和医疗专业人员的意见/讨论论文,并从目的选取的政策/指南中,采用框架综合法进行摘要提取,随后进行迭代理论发展。

结果

从五个卫生系统层面的34个来源中得出的七个关键因素解释了成功出院的原因(新的项目理论)。在综合护理路径中需要所有这七个因素,并通过动态沟通循环来促进有效出院(新的项目逻辑)。当前的卫生系统应对措施往往是静态的,关键成功因素普遍缺失,从而解释了出院无效的原因。

结论

这个新颖的循证模型将“出院”重新概念化为一项高度复杂的纵向卫生系统干预措施,为推动实践发展的全球知识做出了重大贡献。需要开展研究以制定出院过程中不同时间点的过程和结果衡量指标,并且需要未来的试验来确定综合卫生系统出院模型的有效性。

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