Weaver N, Coffey M, Hewitt J
Public Health, Policy and Social Sciences, College of Human and Health Sciences, Swansea University, Swansea, UK.
J Psychiatr Ment Health Nurs. 2017 Aug;24(6):431-450. doi: 10.1111/jpm.12387.
WHAT IS KNOWN ON THE SUBJECT?: Care continuity is considered to be a cornerstone of modern mental health care. As community mental health services have become increasingly fragmented and complex, the crucial criterion for best quality care has become the degree to which treatment delivered by separate services and professionals is continuous and well coordinated. However, clarification of the key elements of continuity has proved challenging and a consensus has not been reached. Recent research has shown significant levels of variation in the quality of care coordination across England and Wales, with potentially detrimental consequences for individuals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Studies on care continuity identified in this review are grouped into three categories: studies defining concepts of care continuity, studies providing models of continuity and studies describing development of questionnaires about care continuity. There are many similarities and parallels between concepts of continuity described in the studies under review. Therefore, there is potential for developing a consensus on the nature of care continuity as a multidimensional concept. The priority placed upon the patient's experience of care continuity is identified as a major focus in these studies. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A consensus on the nature of care continuity would benefit both theory and practice in mental health nursing. It would provide a firmer foundation for new research seeking to improve continuity for people using services, and enable mental health nurses working as care coordinators to have a better understanding of the elements of their role that are most effective.
Introduction The increased complexity of community mental health services, and associated fragmentation of traditional dividing lines between services, has underscored the centrality of care continuity and coordination in modern mental health care. However, clarification of the key features of the care continuity concept has proved difficult and a consensus has not been reached. Aim/Question This review draws together and critically examines latest evidence concerning concepts, models and scales based on a multidimensional understanding of care continuity. Method Databases ASSIA, PubMed, MEDLINE and Cochrane were searched for papers dating from January 2005 to July 2016, of which 21 articles met the inclusion criteria. These were subjected to quality appraisal based on CASP and COSMIN checklists. Studies were grouped into three thematic categories describing concepts, models and scales of care continuity. Results/Discussion Synthesis indicated correspondence between independent, multidimensional models of care continuity, providing greater clarity regarding the essential features of the concept. Association, although not causation, between care continuity factors and health outcomes is supported by current evidence. Implications for practice Clarification of care continuity in mental health services may enable nurses working as care coordinators to develop a better understanding of key elements of their role, and provide guidance for future service development.
关于该主题已知的信息有哪些？：护理连续性被视为现代精神卫生保健的基石。随着社区精神卫生服务日益碎片化和复杂化，优质护理的关键标准已成为不同服务和专业人员提供的治疗在多大程度上具有连续性且协调良好。然而，事实证明，明确连续性的关键要素具有挑战性，尚未达成共识。最近的研究表明，英格兰和威尔士各地的护理协调质量存在显著差异，可能对个人产生不利影响。本文对现有知识的补充是什么？：本综述中确定的关于护理连续性的研究分为三类：定义护理连续性概念的研究、提供连续性模型的研究以及描述护理连续性问卷发展的研究。在所审查的研究中描述的连续性概念之间存在许多相似之处。因此，有可能就护理连续性作为一个多维概念的本质达成共识。这些研究确定，将重点放在患者对护理连续性的体验上是一个主要关注点。对实践有哪些启示？：就护理连续性的本质达成共识将有益于精神卫生护理的理论和实践。它将为旨在改善服务使用者护理连续性的新研究提供更坚实的基础，并使担任护理协调员的精神卫生护士能够更好地理解其角色中最有效的要素。
引言 社区精神卫生服务的复杂性增加，以及传统服务分界线的相关碎片化，凸显了护理连续性和协调在现代精神卫生保健中的核心地位。然而，事实证明，明确护理连续性概念的关键特征很困难，尚未达成共识。目的/问题 本综述汇集并批判性地审视了基于对护理连续性的多维理解的有关概念、模型和量表的最新证据。方法 在ASSIA、PubMed、MEDLINE和Cochrane数据库中检索了2005年1月至2016年7月的论文，其中21篇文章符合纳入标准。根据CASP和COSMIN清单对这些文章进行质量评估。研究分为三类主题，分别描述护理连续性的概念、模型和量表。结果/讨论 综合表明，独立的多维护理连续性模型之间存在对应关系，这使得该概念的基本特征更加清晰。当前证据支持护理连续性因素与健康结果之间存在关联，尽管不是因果关系。对实践的启示 明确精神卫生服务中的护理连续性可能使担任护理协调员的护士更好地理解其角色的关键要素，并为未来的服务发展提供指导。
