Jones Rowena, McGovern Dermot, Reading Bethan
West Midlands Poisons Unit,City Hospital,Birmingham B18 7QH,UK.
Ladywood Assertive Outreach Team,Ladywood Middleway,Ladywood,Birmingham B1 2JT,UK.
Ir J Psychol Med. 2008 Dec;25(4):131-136. doi: 10.1017/S0790966700011241.
Over recent years in England there has been widespread development of assertive outreach teams supporting patients with severe mental illness living in the community. Assertive outreach staff members are exposed to a variety of new stressors and risks. This study investigated the emotional impact on keyworkers of working with assertive outreach patients. This was considered in terms of the attitudes keyworkers hold towards patients with particular types of difficulty. The study also measured individual keyworker stress.
Keyworkers from three teams in Birmingham were surveyed regarding their attitudes towards individual patients. Questionnaires measuring attitudes and patient difficulties were derived for the purpose of the study. Strengths of attitudes were correlated against different patient difficulties. Keyworker stress was measured using the General Health Questionnaire, GHQ12.
Certain patient difficulties, in particular poor engagement, psychotic symptoms and aggression were associated with feelings of failure in keyworkers whilst drug use, particularly crack cocaine use, was associated with fear of visiting patients at home. Some 41% of keyworkers met 'caseness' criteria on the GHQ12. Negative attitudes appeared to be independent of GHQ scores.
Keyworkers expressed a number of positive and negative attitudes in relation to patient difficulties. Negative attitudes did not appear to be simply a feature of keyworker stress, however it is acknowledged that the sample size was small. Keyworkers' responses suggested a sense of personal failure when their patients were unwell or poorly engaged, despite patients being selected for assertive outreach on the basis of such difficulties. Recognition of negative attitudes may help in the improvement of training and supervision of staff members.
近年来在英格兰，积极外展团队得到了广泛发展，这些团队为生活在社区中的严重精神疾病患者提供支持。积极外展工作人员面临各种新的压力源和风险。本研究调查了与积极外展患者合作对关键工作人员的情感影响。这是根据关键工作人员对有特定类型困难的患者所持的态度来考虑的。该研究还测量了关键工作人员个人的压力。
对伯明翰三个团队的关键工作人员进行了调查，询问他们对个别患者的态度。为该研究目的设计了测量态度和患者困难的问卷。态度强度与不同的患者困难进行了关联。使用一般健康问卷GHQ12来测量关键工作人员的压力。
某些患者困难，特别是参与度差、精神病症状和攻击性，与关键工作人员的失败感相关，而药物使用，尤其是快克可卡因的使用，与在家探访患者时的恐惧相关。约41%的关键工作人员在GHQ12上达到了“病例”标准。消极态度似乎与GHQ得分无关。
关键工作人员对患者困难表达了一些积极和消极的态度。消极态度似乎并非仅仅是关键工作人员压力的一个特征，然而需要承认样本量较小。关键工作人员的回答表明，当他们的患者病情不佳或参与度差时，他们会有个人失败感，尽管患者是基于这些困难而被选为积极外展对象的。认识到消极态度可能有助于改进工作人员的培训和监督。
