Brook Judy, Salmon Debra, Knight Rachael-Anne
1Lecturer in Health Visiting,School of Health Sciences,Division of Health Services Research and Management,City University London,Northampton Square,London,UK.
2Deputy Dean,School of Health Sciences,City University London,Northampton Square,London,UK.
Prim Health Care Res Dev. 2017 May;18(3):270-281. doi: 10.1017/S1463423617000123. Epub 2017 Mar 14.
Aim This study aimed to explore the ability of sexual health nurses working in the South West of England, to implement new learning within existing sexual health service delivery models. Drawing on Lipsky's account of street-level bureaucracy to conceptualise policy implementation, the impact of workforce learning on the development of integrated services across this region of the United Kingdom was assessed.
In order to achieve the United Nations' goal of universal access to sexual health, it is essential for reproductive and sexual health, including HIV provision, to integrate into a single service. This integration requires a commitment to collaboration by service commissioners and an alignment of principles and values across sexual health and contraceptive services. UK health policy has embraced this holistic agenda but moves towards integrating historically separate clinical services, has presented significant workforce development challenges and influenced policy success.
Employing a qualitative approach, the study included data from semi-structured telephone interviews and focus groups, and longitudinal data from pre- and post-intervention surveys, collected between September 2013 and September 2015. Data were collected from 88 nurses undertaking a workforce development programme and six of their service managers. Data were analysed using thematic analysis to identify consistent themes. Findings Nurses confirmed the role of new learning in enabling them to negotiate the political landscape but expressed frustration at their lack of agency in the integration agenda, exposing a clear dichotomy between the intentions of policy and the reality of practice. Nevertheless, using high levels of professional judgement and discretion practitioners managed the incongruence between policy and practice in order to deliver integrated services in the interests of patients. Workforce education, while essential for the transition to the delivery of integrated services, was insufficient to fulfil the sexual health agenda without a strengthening of public health.
目的 本研究旨在探讨在英格兰西南部工作的性健康护士在现有性健康服务提供模式中实施新学习内容的能力。借鉴利普斯基对街头官僚作风的描述来概念化政策实施，评估了劳动力学习对英国该地区综合服务发展的影响。
为了实现联合国普及性健康服务的目标，将生殖健康和性健康（包括艾滋病毒防治）整合为单一服务至关重要。这种整合需要服务专员致力于合作，并使性健康和避孕服务的原则与价值观保持一致。英国卫生政策已接受这一整体议程，但朝着整合历史上独立的临床服务迈进，带来了重大的劳动力发展挑战，并影响了政策的成功实施。
采用定性方法，该研究纳入了2013年9月至2015年9月期间收集的半结构化电话访谈和焦点小组数据，以及干预前后调查的纵向数据。数据收集自88名参加劳动力发展计划的护士及其6名服务经理。使用主题分析法对数据进行分析，以确定一致的主题。研究结果 护士们确认了新学习在使他们能够应对政治环境方面的作用，但对他们在整合议程中缺乏自主权表示沮丧，这暴露了政策意图与实践现实之间的明显二分法。尽管如此，从业者运用高水平的专业判断和自由裁量权来处理政策与实践之间的不一致，以便为了患者利益提供综合服务。劳动力教育虽然对于向提供综合服务的转变至关重要，但如果不加强公共卫生，就不足以实现性健康议程。
