Bee Penny, Price Owen, Baker John, Lovell Karina
Penny Bee, PhD, Owen Price, MSc, John Baker, PhD, Karina Lovell, PhD, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
Penny Bee, PhD, Owen Price, MSc, John Baker, PhD, Karina Lovell, PhD, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
Br J Psychiatry. 2015 Aug;207(2):104-14. doi: 10.1192/bjp.bp.114.152447.
Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice.
To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur.
Systematic evidence synthesis.
Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes.
Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs.
服务使用者（患者）参与护理计划是心理健康政策所秉持的一项原则，但在实际操作中却常常遭到患者及其护理人员的批评。
探讨服务使用者参与的护理计划在心理健康服务中是如何实施的，并确定服务使用者参与面临挑战的地点、方式及原因。
系统证据综合分析。
对117项研究的数据进行综合分析表明，服务使用者参与度不高是因为患者的参照标准与提供者不同。服务使用者和护理人员认为护理计划中人际关系方面最为重要。卫生专业人员对护理计划过程的质量认识不一，反而倾向于根据可量化的服务导向结果来界定服务使用者的参与度。
服务使用者参与的护理计划通常作为一系列符合审核标准的实践活动来实施。有意义的参与需要以患者为中心的护理计划质量新定义。新的组织举措应认可与服务使用者相处的时间，并对满足他们的需求表现出更切实、灵活的承诺。
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