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在寻求专业整合的心理健康护理环境中不确定性的现实:一种混合方法研究

The Reality of Uncertainty in Mental Health Care Settings Seeking Professional Integration: A Mixed-Methods Approach.

作者信息

Pomare Chiara, Ellis Louise A, Churruca Kate, Long Janet C, Braithwaite Jeffrey

机构信息

Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, AU.

出版信息

Int J Integr Care. 2018 Dec 19;18(4):13. doi: 10.5334/ijic.4168.


DOI:10.5334/ijic.4168
PMID:30588218
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6300768/
Abstract

INTRODUCTION: Uncertainty is a common experience in the complex adaptive health system, particularly amongst mental health professionals structured for the delivery of integrated care. Increased understanding of uncertainty will not necessarily make things more certain, but can act to sensitize professionals to the challenges they face. The aim of this study is to examine the types and situations of uncertainty experienced by professionals working in a mental health setting based on an integrated care model. The research assesses the impact of experience and professional group on reported uncertainties. METHODS: First, semi-structured interviews were undertaken with clinical and non-clinical staff to examine uncertainties experienced by professionals working in headspace centres in Australia. Second, an online survey was conducted to quantify the experiences of uncertainty and explore associations. RESULTS: Findings revealed three overarching and largely interrelated aspects of uncertainty, namely: decision-making; professional role; and external factors. Most commonly, staff reported experiences of uncertainty pertaining to deciding to accept a client into the service and then deciding how to treat them. This is often due to arbitrary, or overly-restrictive criteria in integrated care. Findings also suggested that uncertainty does not necessarily decline with experience and there were no significant differences in levels of uncertainty between clinical and non-clinical staff. CONCLUSIONS: This study highlights the importance of acknowledging uncertainties and actively clarifying role ambiguities when working alongside diverse professionals in mental health care.

摘要

引言:在复杂的适应性健康系统中,不确定性是一种常见现象,尤其是在为提供综合护理而构建的心理健康专业人员中。对不确定性的更多理解不一定会使事情变得更确定,但可以让专业人员对他们面临的挑战更加敏感。本研究的目的是基于综合护理模式,考察心理健康环境中专业人员所经历的不确定性的类型和情况。该研究评估经验和专业群体对所报告的不确定性的影响。 方法:首先,对临床和非临床工作人员进行半结构化访谈,以考察澳大利亚headspace中心工作人员所经历的不确定性。其次,进行在线调查以量化不确定性经历并探索关联。 结果:研究结果揭示了不确定性的三个总体且在很大程度上相互关联的方面,即:决策;专业角色;以及外部因素。最常见的是,工作人员报告在决定接纳客户进入服务以及随后决定如何治疗他们方面存在不确定性经历。这通常是由于综合护理中标准的随意性或过于严格。研究结果还表明,不确定性不一定会随着经验而减少,临床和非临床工作人员在不确定性水平上没有显著差异。 结论:本研究强调了在心理健康护理中与不同专业人员合作时,承认不确定性并积极澄清角色模糊性的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6ba/6300768/ea14f96aa58c/ijic-18-4-4168-g1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6ba/6300768/ea14f96aa58c/ijic-18-4-4168-g1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6ba/6300768/ea14f96aa58c/ijic-18-4-4168-g1.jpg

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本文引用的文献

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Integrated (one-stop shop) youth health care: best available evidence and future directions.

Med J Aust. 2017-11-20

[2]
Handovers in primary healthcare in Norway: A qualitative study of general practitioners' collaborative experiences.

Health Soc Care Community. 2018-1

[3]
Mental health services conceptualised as complex adaptive systems: what can be learned?

Int J Ment Health Syst. 2017-6-29

[4]
Socializing Identity Through Practice: A Mixed Methods Approach to Family Medicine Resident Perspectives on Uncertainty.

Fam Med. 2015

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A typology of uncertainty derived from an analysis of critical incidents in medical residents: A mixed methods study.

BMC Med Educ. 2015-11-4

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JAMA Pediatr. 2015-10

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Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science.

Implement Sci. 2014-11-19

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The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: a systematic review of views from patients, carers and health-care professionals.

Palliat Med. 2014-10

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Int J Integr Care. 2013-3-22

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