利用移动设备支持社区临床护理的提供：参与式评估。
Harnessing mobile devices to support the delivery of community-based clinical care: a participatory evaluation.
机构信息
Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, England.
Division of Primary Care, School of Medicine, University of Nottingham, Tower Building, NG7 2RD, Nottingham, England.
出版信息
BMC Med Inform Decis Mak. 2019 Jul 16;19(1):134. doi: 10.1186/s12911-019-0869-x.
BACKGROUND
A large provider of community health services (an NHS Trust in England) deployed Apple iPads to its front-line community-based healthcare clinicians (predominantly nurses) to enable them to increase responsiveness to patients' and their families' needs. We conducted a participatory formative evaluation of this iPad initiative among different users and the informatics teams implementing it, to establish how such initiatives can sustain adoption and achieve their stated benefits.
METHODS
We used a participatory approach involving a partnership between study investigators and key decision-makers of the initiative to engage stakeholders in the study. Methods included focus groups and group discussion, meetings with key personnel and analysis of documents related to the initiative. Using a participatory technique, members of the organisation identified practical challenges to inform the on-going process of implementation and adoption in the Trust.
RESULTS
Healthcare professionals identified many benefits associated with having iPads to support care delivery, including streamlined workflows and accessible information at the point-of-care in the community. However, challenges that interfered with implementation were also reported by both the team implementing the initiative (IT team) and early users. Challenges reported by IT team are: adopter clinicians' scepticism and suspicion; clinician non-compliance with training and operational guidance procedures; and managing adopter expectations. Challenges reported by users are: setting-up and maintaining the devices on a long-term basis; blurring of personal and professional boundaries; and disconnection from the IT team. Results show that these challenges could be overcome if there were more informal 'socialised' interactions between adopters and between adopters and the IT team.
CONCLUSIONS
We suggest that similar initiatives require increased ongoing dialogue between different levels of stakeholder groups, in the form of socialised engagements, to avoid common misunderstandings and to promote the processes involved in co-constructing the initiative on a generally-agreed and sustainable basis.
背景
一家大型社区卫生服务提供商（英格兰的一家国民保健制度信托基金）将苹果 iPad 部署到其一线社区医疗保健临床医生（主要是护士）手中，以使他们能够更及时地满足患者及其家属的需求。我们在不同用户和实施其的信息学团队中对这项 iPad 计划进行了参与式形成性评估，以确定如何使此类计划能够持续采用并实现其既定利益。
方法
我们采用了一种参与式方法，由研究调查人员和计划的主要决策者之间的合作伙伴关系，让利益相关者参与到研究中来。方法包括焦点小组和小组讨论、与关键人员的会议以及与该计划相关的文件分析。利用组织成员的参与性技术，确定了实际挑战，以告知信托基金中计划的持续实施和采用过程。
结果
医疗保健专业人员确定了拥有 iPad 支持护理提供的许多好处，包括简化的工作流程和在社区护理点可获得的信息。然而，实施过程中也报告了团队和早期用户遇到的挑战。团队报告的挑战包括：采用者临床医生的怀疑和怀疑；临床医生不遵守培训和操作指南程序；以及管理采用者的期望。用户报告的挑战包括：长期设置和维护设备；个人和专业边界模糊；以及与 IT 团队断开连接。结果表明，如果采用者之间以及采用者与 IT 团队之间有更多非正式的“社会化”互动，这些挑战是可以克服的。
结论
我们建议，类似的计划需要不同层次的利益相关者群体之间增加持续的对话，以避免常见的误解，并促进共同构建计划的过程，在普遍认同和可持续的基础上进行。
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