当问到“什么对你重要？”时，重要的是什么？——关于让老年人参与过渡性护理，卫生保健提供者的看法和经验。
What matters when asking, "what matters to you?" - perceptions and experiences of health care providers on involving older people in transitional care.
机构信息
Department of Physiotherapy, OsloMet - Oslo Metropolitan University, Oslo, Norway.
Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway.
出版信息
BMC Health Serv Res. 2020 Apr 16;20(1):317. doi: 10.1186/s12913-020-05150-4.
BACKGROUND
Transitional care for older chronically ill people is an important area for healthcare quality improvement. A central goal is to involve older people more in transitional care and make care more patient-centered. Recently, asking, "What matters to you?" (WMTY) has become a popular way of approaching the implementation of patient-centered care. The aim of this study was to explore health care providers' perceptions and experiences regarding the question of WMTY in the context of improving transitional care for older, chronically ill persons.
METHODS
The data comprise semi-structured individual interviews with 20 health care providers (HCPs) who took part in a Norwegian quality improvement collaborative, three key informant interviews, and observations of meetings in the quality improvement collaborative. We used a thematic analysis approach.
RESULTS
Three interrelated themes emerged from the analysis: WMTY is a complex process that needs to be framed competently; framing WMTY as a functional approach; and framing WMTY as a relational approach. There was a tension between the functional and the relational approach. This tension seemed to be based in different understandings of the purpose of asking the WMTY question and the responsibility that comes with asking it.
CONCLUSIONS
WMTY may appear as a simple question, but using it in everyday practice is a complex process, which requires professional competence. When seen in terms of a patient-centered goal process, the challenge of competently eliciting older people's personal goals and transferring these goals into professional action becomes evident. An important factor seems to be how HCPs regard the limits of their responsibility in relation to giving care within the larger frame of the patient's life project. Factors in the organizational and political context also seem to influence substantially how HCPs approach older patients with the WMTY question.
背景
为老年慢性病患者提供过渡性护理是改善医疗质量的一个重要领域。一个核心目标是让老年人更多地参与过渡性护理，并使护理更加以患者为中心。最近，“什么对您最重要？”（WMTY）已成为一种流行的方法，可以用来实施以患者为中心的护理。本研究的目的是探讨卫生保健提供者在改善老年慢性病患者过渡性护理的背景下，对 WMTY 问题的看法和经验。
方法
数据包括 20 名参与挪威质量改进合作的卫生保健提供者（HCPs）的半结构化个人访谈、3 次关键知情人访谈以及质量改进合作会议的观察。我们使用了主题分析方法。
结果
分析产生了三个相互关联的主题：WMTY 是一个需要有能力构建的复杂过程；将 WMTY 构建为一种功能方法；将 WMTY 构建为一种关系方法。功能方法和关系方法之间存在紧张关系。这种紧张关系似乎基于对提出 WMTY 问题的目的和提出问题所带来的责任的不同理解。
结论
WMTY 可能看起来是一个简单的问题，但在日常实践中使用它是一个复杂的过程，需要专业能力。从以患者为中心的目标过程来看，如何从老年人那里引出个人目标，并将这些目标转化为专业行动，这一挑战变得明显起来。一个重要因素似乎是 HCPs 如何看待他们在患者生活项目的更大框架内提供护理的责任界限。组织和政治背景中的因素似乎也在很大程度上影响 HCPs 如何用 WMTY 问题来对待老年患者。
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