Mockford Carole
Division of Health Sciences, Royal College of Nursing Research Institute, University of Warwick, Coventry, UK.
J Healthc Leadersh. 2015 Jun 22;7:21-28. doi: 10.2147/JHL.S70020. eCollection 2015.
In the UK, service user involvement is an important factor in health policy, and obtaining research funding. It may be helpful in expanding our knowledge in areas where research evidence is poor such as experiences of hospital discharge planning for the family carers of people with dementia.
A rapid review. All study designs published in the English language were eligible for inclusion. Databases included: Medline, Embase, CINAHL, PsycInfo, Cochrane library and Web of Knowledge. A qualitative analysis was undertaken.
Four themes were identified: preparation for hospital discharge - dissatisfaction with being kept informed, discharge arrangements and management of conditions; little time to prepare. Communication between staff and families at discharge - insufficient communication regarding services, not being listened to and being undervalued as a resource could compromise post-discharge care. Support services post discharge - carers need help negotiating, and working with, services with regard to timing, and meeting requirements. Coping post hospital discharge - inadequate understanding about ability to cope, and patient's impairment, and family conflict over care may lead to unnecessary re-admission to hospital, or long term care. Evidence of specialist dementia models at discharge is described.
Carers are not always involved in hospital discharge planning as well as they might be. Issues are complex and depend on a number of factors. Poor communication can be overcome and carers can be better supported to cope post discharge as illustrated in the dementia models. The evidence base is weak but the absence of evidence does not indicate an absence of good practice.
Carers who may feel their world is far removed from the academic world may not ordinarily participate in research studies. Service users, as co-researchers, may be able to improve trust and rapport between research and communities, collect fresh insights and gain deeper and more insightful data from participants.
在英国，服务使用者的参与是卫生政策及获取研究资金的一个重要因素。在研究证据匮乏的领域，如痴呆症患者家庭护理者的出院计划经验方面，它可能有助于拓展我们的知识。
快速综述。所有以英文发表的研究设计均符合纳入标准。数据库包括：医学期刊数据库（Medline）、荷兰医学文摘数据库（Embase）、护理学与健康领域数据库（CINAHL）、心理学文摘数据库（PsycInfo）、考克兰图书馆及科学网（Web of Knowledge）。进行了定性分析。
确定了四个主题：出院准备——对信息告知不满、出院安排及病情管理；准备时间不足。出院时工作人员与家属之间的沟通——关于服务的沟通不足、未被倾听以及作为资源未得到重视，可能会影响出院后的护理。出院后支持服务——护理者在服务的时间安排及满足需求方面需要协助进行协商及合作。出院后应对——对应对能力及患者损伤的理解不足，以及家庭护理冲突可能导致不必要的再次入院或长期护理。描述了出院时痴呆症专科模式的证据。
护理者在出院计划中的参与情况并非总是尽如人意。问题复杂且取决于多种因素。如痴呆症模式所示，沟通不畅可以克服，护理者在出院后应对方面可以得到更好的支持。证据基础薄弱，但缺乏证据并不意味着没有良好做法。
那些可能觉得自己与学术界相距甚远的护理者通常可能不会参与研究。服务使用者作为共同研究者，或许能够增进研究与社区之间的信任及融洽关系，收集新的见解，并从参与者那里获得更深入、更有洞察力的数据。
