School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, 4 Dublin, Ireland.
School of Social Policy, Social Work and Social Justice, University College Dublin, Belfield, 4 Dublin, Ireland.
Int J Environ Res Public Health. 2020 May 9;17(9):3294. doi: 10.3390/ijerph17093294.
The Assisted Decision-Making (ADM) (Capacity) Act was enacted in 2015 in Ireland and will be commenced in 2021. This paper is focused on this pre-implementation stage within the acute setting and uses a health systems responsiveness framework.
We conducted face-to-face interviews using a critical incident technique. We interviewed older people including those with a diagnosis of dementia ( = 8), family carers ( = 5) and health and social care professionals (HSCPs) working in the acute setting ( = 26).
The interviewees reflected upon a healthcare system that is currently under significant pressures. HSCPs are doing their best, but they are often halted from delivering on the will and preference of their patients. Many older people and family carers feel that they must be very assertive to have their preferences considered. All expressed concern about the strain on the healthcare system. There are significant environmental barriers that are hindering ADM practice.
The commencement of ADM provides an opportunity to redefine the provision, practices, and priorities of healthcare in Ireland to enable improved patient-centred care. To facilitate implementation of ADM, it is therefore critical to identify and provide adequate resources and work towards solutions to ensure a seamless commencement of the legislation.
《辅助决策（能力）法》（ADM（Capacity）Act）于 2015 年在爱尔兰颁布，并将于 2021 年开始实施。本文聚焦于该法在急性治疗环境中的实施前阶段，并使用了卫生系统响应性框架。
我们采用关键事件技术进行了面对面访谈。我们采访了老年人，包括被诊断患有痴呆症的老年人（=8）、家庭照顾者（=5）以及在急性治疗环境中工作的卫生和社会保健专业人员（HSCPs）（=26）。
受访者反思了当前面临巨大压力的医疗体系。HSCPs 正在尽最大努力，但他们经常无法按照患者的意愿和偏好行事。许多老年人和家庭照顾者认为，他们必须非常坚定地主张自己的偏好才能得到考虑。所有人都对医疗系统的压力表示担忧。存在许多环境障碍，阻碍了辅助决策的实践。
ADM 的启动为重新定义爱尔兰医疗保健的提供、实践和优先事项提供了机会，以实现以患者为中心的护理。为了促进 ADM 的实施，因此必须确定并提供足够的资源，并努力寻找解决方案，以确保该法规的顺利启动。
