Svanström Rune, Andersson Susanne, Rosén Helena, Berglund Mia
School of Health and Education, University of Skövde, 54128, Skövde, Sweden.
Health Sciences, University of Lund, Lund, Sweden.
BMC Res Notes. 2016 Jul 23;9:361. doi: 10.1186/s13104-016-2165-5.
In implementing new programs of care, such as person-centered care, there is a risk that the focus will be at an organizational level, instead of a level that describes what happens in the personal development among staff. The aim of this study was to describe experiences of the implementation process of a learning supporting model designed to increase patient involvement and autonomy in care. The project, which lasted 2 years, involved training sessions, supervision and reflective meetings. Over the period, the staff who participated focused on developing their dialogues with patients to make the patients aware of their own capabilities and to encourage them to be fully involved in the treatment. A reflective lifeworld approach was used. Data were collected through interviews, notes and written stories, and analyzed using hermeneutic analysis with a focus on meanings.
At the beginning of the project, the participants perceived the model as abstract and difficult to understand but supervision and reflection sessions enabled understanding and changed the participants' approach to caring. The participants described the model as an approach used in challenging patients to become involved in their care and to take charge of their lives when living with a chronic life-threatening disease. The participants' experience of implementing the model has not been easy but has led to increased self-confidence and feelings of improved competence in dialogue with patients.
Using the PARISH model when critically examining the results shows that in the implementation process there were some difficulties, e.g. the context was supportive and facilitating but there was no appointed facilitator. By making participation in improvement work voluntary, the impact of such work becomes less efficient, less cost-effective and probably less sustainable. Furthermore, implementation needs encouragement since changing approaches takes time and requires patience. Group supervision sessions seem an appropriate way to translate research into practice; systematic scheduled and mandatory group supervision sessions would, therefore, probably make implementation more robust and sustainable. In addition, a well-trained facilitator would be able to motivate staff to undertake daily reflection and participate in group supervision sessions. Reflection seems to be a key component in the personal learning necessary to change work routines and approaches.
在实施新的护理计划，如以患者为中心的护理时，存在一种风险，即关注点会停留在组织层面，而非描述员工个人发展中所发生事情的层面。本研究的目的是描述一种旨在提高患者在护理中的参与度和自主性的学习支持模式的实施过程体验。该项目持续了两年，包括培训课程、督导和反思会议。在此期间，参与的工作人员专注于发展与患者的对话，以使患者意识到自身能力，并鼓励他们充分参与治疗。采用了反思性生活世界方法。通过访谈、笔记和书面故事收集数据，并使用以意义为重点的诠释学分析进行分析。
在项目开始时，参与者认为该模式抽象且难以理解，但督导和反思会议促成了理解，并改变了参与者的护理方式。参与者将该模式描述为一种促使患者在患有慢性危及生命疾病时参与自身护理并掌控自己生活的方法。参与者实施该模式的体验并不轻松，但增强了自信心，并在与患者对话时提升了胜任感。
批判性审视结果时使用PARISH模式表明，在实施过程中存在一些困难，例如环境具有支持性和促进作用，但没有指定的促进者。由于让参与改进工作是自愿的，此类工作的影响效率更低、成本效益更低，且可能更难以持续。此外，实施需要鼓励，因为改变方法需要时间且需要耐心。小组督导会议似乎是将研究转化为实践的合适方式；因此，系统性的定期且强制性的小组督导会议可能会使实施更有力且可持续。此外，训练有素的促进者能够激励员工进行日常反思并参与小组督导会议。反思似乎是改变工作常规和方法所需的个人学习中的关键组成部分。
