Department of Public Health, Policy and Social Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
School of Healthcare Sciences, Cardiff University, Cardiff, CF24 0AB, UK.
BMC Psychiatry. 2019 Apr 16;19(1):115. doi: 10.1186/s12888-019-2094-7.
Involving mental health service users in planning and reviewing their care can help personalised care focused on recovery, with the aim of developing goals specific to the individual and designed to maximise achievements and social integration. We aimed to ascertain the views of service users, carers and staff in acute inpatient wards on factors that facilitated or acted as barriers to collaborative, recovery-focused care.
A cross-national comparative mixed-methods study involving 19 mental health wards in six service provider sites in England and Wales. This included a survey using established standardised measures of service users (n = 301) and staff (n = 290) and embedded case studies involving interviews with staff, service users and carers (n = 76). Quantitative and qualitative data were analysed within and across sites using descriptive and inferential statistics, and framework method.
For service users, when recovery-oriented focus was high, the quality of care was rated highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Staff members rated the quality of therapeutic relationships higher than service users did. Staff accounts of routine collaboration contrasted with a more mixed picture in service user accounts. Definitions and understandings of recovery varied, as did views of hospital care in promoting recovery. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent.
There is positive practice within acute inpatient wards, with evidence of commitment to safe, respectful, compassionate care. Recovery ideas were evident but there remained ambivalence on their relevance to inpatient care. Service users were aware of efforts taken to keep them safe, but despite measures described by staff, they did not feel routinely involved in care planning or risk management decisions. Research on increasing therapeutic contact time, shared decision making in risk assessment and using recovery focused tools could further promote personalised and recovery-focused care planning. This paper arises from a larger study published by National Institute for Health Research (Simpson A, et al, Health Serv Deliv Res 5(26), 2017).
让精神卫生服务使用者参与规划和审查他们的护理可以帮助提供以康复为重点的个性化护理，目的是制定针对个人的具体目标，旨在最大限度地提高成就和社会融合。我们旨在确定急性住院病房的服务使用者、护理者和工作人员对促进或阻碍以合作、以康复为重点的护理的因素的看法。
这是一项涉及英格兰和威尔士六个服务提供者地点的 19 个精神科病房的跨国比较混合方法研究。这包括使用既定的服务使用者（n=301）和工作人员（n=290）标准化测量工具进行的调查，以及涉及工作人员、服务使用者和护理者的嵌入式案例研究（n=76）。使用描述性和推断性统计以及框架方法在各地点和跨地点分析定量和定性数据。
对于服务使用者而言，当以康复为重点的焦点较高时，护理质量的评价较高，治疗关系的质量也较高。对于工作人员而言，康复方向与治疗关系质量之间存在中度相关性，且具有相当大的可变性。工作人员对治疗关系的评价高于服务使用者。工作人员对常规合作的描述与服务使用者描述的更为复杂的情况形成对比。康复的定义和理解各不相同，对医院护理促进康复的看法也各不相同。管理风险是工作人员的一个核心问题，服务使用者意识到为了保证他们的安全而采取的措施，尽管他们参与讨论的情况不太明显。
急性住院病房存在积极的实践，有证据表明对安全、尊重、富有同情心的护理的承诺。康复理念显而易见，但对于它们与住院护理的相关性仍存在矛盾看法。服务使用者意识到为了保证他们的安全而采取的措施，但尽管工作人员描述了这些措施，他们并不觉得自己经常参与护理计划或风险管理决策。关于增加治疗性接触时间、在风险评估中共同决策以及使用以康复为重点的工具的研究可以进一步促进个性化和以康复为重点的护理计划。本文源于国家卫生研究院（Simpson A 等人，Health Serv Deliv Res 5(26), 2017）发表的一项更大的研究。
