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精神卫生保健环境中的出院计划:综述和概念分析。

Discharge planning in mental healthcare settings: A review and concept analysis.

机构信息

Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

出版信息

Int J Ment Health Nurs. 2019 Aug;28(4):816-832. doi: 10.1111/inm.12599. Epub 2019 Apr 30.

Abstract

To ensure a safe transition of mental health patients from hospital to community settings, greater attention is being given to discharge planning. However, assessing the quality of discharge planning has been challenging due to wide variations in its definition. To facilitate evaluation of discharge planning, its meaning in the mental health literature was systematically explored. This concept analysis is part of a larger study to develop an instrument to measure the quality of discharge planning processes in mental health care. Walker and Avant's (2011) concept analysis approach was adopted to provide a comprehensive definition of discharge planning. Electronic databases and grey literature were searched and analysed according to Grant and Booth's (2009) systematic search and review process. Literature published between 1900 and 2018 was reviewed. Forty-nine articles meeting the inclusion criteria were included in the analysis. Discharge planning is a complex, multifaceted concept with six defining attributes: comprehensive needs assessment; collaborative, patient-centered care; resource availability management; care and service coordination; discharge planner role; and a discharge plan. Discharge planning begins with the initial rapid assessment and symptom stabilization of a patient on admission, coincides with treatment planning, and is associated with hospital readmissions and continuity of care. The mental health literature was reviewed to analyse different interpretations of discharge planning. The conceptual definition provided can assist healthcare providers, organizational leaders, and policymakers to design and implement effective discharge planning policies and guidelines. Providing clarity regarding discharge planning also provides a critical foundation for developing an instrument.

摘要

为确保精神健康患者从医院顺利过渡到社区环境,人们越来越关注出院计划。然而,由于出院计划的定义存在广泛差异,对其质量进行评估一直具有挑战性。为了便于评估出院计划,本文对精神健康文献中的出院计划含义进行了系统探讨。这项概念分析是开发精神卫生保健中评估出院计划过程质量的工具的更大研究的一部分。本文采用 Walker 和 Avant(2011)的概念分析方法,对出院计划进行了全面定义。根据 Grant 和 Booth(2009)的系统搜索和审查流程,对电子数据库和灰色文献进行了搜索和分析。对 1900 年至 2018 年期间发表的文献进行了综述。符合纳入标准的 49 篇文章被纳入分析。出院计划是一个复杂的、多方面的概念,具有六个定义属性:全面的需求评估;协作、以患者为中心的护理;资源可用性管理;护理和服务协调;出院计划者角色;以及出院计划。出院计划始于患者入院时的快速初始评估和症状稳定,与治疗计划同时进行,并与医院再入院和护理连续性相关。本文对精神健康文献进行了回顾,以分析出院计划的不同解释。所提供的概念定义可以帮助医疗保健提供者、组织领导人和政策制定者设计和实施有效的出院计划政策和指南。明确出院计划还为开发工具提供了重要基础。

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