在亚急性中期精神卫生病房（ISMHU）实施以康复为导向的模式。
Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU).
作者信息
Frost Barry G, Turrell Megan, Sly Ketrina A, Lewin Terry J, Conrad Agatha M, Johnston Suzanne, Tirupati Srinivasan, Petrovic Kerry, Rajkumar Sadanand
机构信息
School of Psychology, Faculty of Science and Technology, University of Newcastle, Callaghan, NSW, 2308, Australia.
Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia.
出版信息
BMC Health Serv Res. 2017 Jan 3;17(1):2. doi: 10.1186/s12913-016-1939-8.
BACKGROUND
An ongoing service evaluation project was initiated following the establishment of a new, purpose-built, 20-bed sub-acute Intermediate Stay Mental Health Unit (ISMHU). This paper: provides an overview of the targeted 6-week program, operating within an Integrated Recovery-oriented Model (IRM); characterises the clients admitted during the first 16 months; and documents their recovery needs and any changes.
METHODS
A brief description of the unit's establishment and programs is initially provided. Client needs and priorities were identified collaboratively using the Mental Health Recovery Star (MHRS) and addressed through a range of in-situ, individual and group interventions. Extracted client and service data were analysed using descriptive statistics, paired t-tests examining change from admission to discharge, and selected correlations.
RESULTS
The initial 154 clients (165 admissions, average stay = 47.86 days) were predominately male (72.1%), transferred from acute care (75.3%), with schizophrenia or related disorders (74.0%). Readmission rates within 6-months were 16.2% for acute and 3.2% for sub-acute care. Three MHRS subscales were derived, together with stage-of-change categories. Marked improvements in MHRS Symptom management and functioning were identified (z-change = -1.15), followed by Social-connection (z-change = -0.82) and Self-belief (z-change = -0.76). This was accompanied by a mean reduction of 2.59 in the number of pre-action MHRS items from admission to discharge (z-change = 0.98). Clinician-rated Health of the Nation Outcome Scales (HoNOS) improvements were smaller (z-change = 0.41), indicative of illness chronicity. Staff valued the elements of client choice, the holistic and team approach, program quality, review processes and opportunities for client change. Addressing high-levels of need in the 6-week timeframe was raised as a concern.
CONCLUSIONS
This paper demonstrates that a recovery-oriented model can be successfully implemented at the intermediate level of care. It is hoped that ongoing evaluations support the enthusiasm, commitment and feedback evident from staff, clients and carers.
背景
在新建了一个专门建造的、拥有20张床位的亚急性中期心理健康单元（ISMHU）之后，启动了一项正在进行的服务评估项目。本文：概述了在综合康复导向模型（IRM）内运行的为期6周的目标项目；描述了前16个月收治的患者情况；记录了他们的康复需求及任何变化。
方法
首先简要介绍了该单元的设立及项目情况。使用心理健康康复之星（MHRS）共同确定患者需求和优先事项，并通过一系列现场、个体和团体干预措施加以解决。对提取的患者和服务数据进行描述性统计分析、采用配对t检验检查从入院到出院的变化情况，并进行选定的相关性分析。
结果
最初的154名患者（165人次入院，平均住院时间 = 47.86天）主要为男性（72.1%），从急性护理机构转入（75.3%），患有精神分裂症或相关障碍（74.0%）。急性护理的6个月内再入院率为16.2%，亚急性护理为3.2%。得出了三个MHRS子量表以及改变阶段类别。发现MHRS症状管理和功能方面有显著改善（z变化 = -1.15），其次是社会联系（z变化 = -0.82）和自我信念（z变化 = -0.76）。与此同时，从入院到出院，预行动MHRS项目数量平均减少了2.59个（z变化 = 0.98）。临床医生评定的国民健康结果量表（HoNOS）改善较小（z变化 = 0.41），表明疾病的慢性特征。工作人员重视患者选择、整体和团队方法、项目质量、审查流程以及患者改变的机会等要素。在6周时间内满足高水平需求被视为一个问题。
结论
本文表明，康复导向模型可以在中级护理层面成功实施。希望持续的评估能够支持工作人员、患者和护理人员所表现出的热情、承诺和反馈。
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