University of Otago, Wellington, New Zealand.
Child Care Health Dev. 2020 Sep;46(5):552-562. doi: 10.1111/cch.12789. Epub 2020 Jun 23.
Participation outcomes and family-centred services are now widely agreed standards of care in paediatric rehabilitation. Evidence suggests that adoption of these practices into usual care has been slow internationally, and no studies of participation-focused or family-centred practices in New Zealand have been undertaken to date. The aims of this study were to identify the extent that goal setting in paediatric rehabilitation services is participation focused and family centred and to profile clinicians' beliefs about these foci.
Observational study including a retrospective case note audit and questionnaire. Case notes ('charts') were audited for participation-focused goal-related practice. Subgroup analysis of audit data by service, profession and child ethnicity were completed using weighted mean differences. Clinicians whose case notes were audited completed a 42-item questionnaire on factors related to practice behaviour including text responses with each item. Numerical and text data were analysed descriptively.
Five services were recruited (N = 46 clinicians) with case notes for 220 children audited. Auditors extracted 368 potentially participation-related goals (Mdn = 2 goals per child) with no goals extracted for 43 (20%) of case notes. Subsequent coding of extracted goals identified 61% reflected participation (225/368). Subgroup analysis revealed significant differences between services (p = 0.006) and professions (p < 0.001). Clinicians' reported valuing participation outcomes and family involvement and largely felt they did target participation. Skill gaps, absence of self-monitoring strategies and unsupportive professional and work cultures were cited as key challenges.
Although valued by clinicians, participation-focused practice is unusual care in paediatric rehabilitation in New Zealand. Substantial gains in the quality of care for children with disabilities could be afforded through training in collaborative goal setting to target participation outcomes.
参与结果和以家庭为中心的服务现在是儿科康复护理中广泛认可的标准。有证据表明，这些实践在国际上被常规护理采用的速度较慢，迄今为止，新西兰还没有针对以参与为重点或以家庭为中心的实践进行的研究。本研究的目的是确定儿科康复服务中目标设定在多大程度上以参与为重点和以家庭为中心，并描述临床医生对这些重点的看法。
观察性研究包括回顾性病历审核和问卷调查。对病历（“图表”）进行了参与为重点的目标相关实践的审核。通过服务、专业和儿童种族的加权平均差异，对审核数据进行了亚组分析。对病历进行审核的临床医生完成了一份 42 项与实践行为相关因素的问卷，包括对每个项目的文字回复。对数值和文字数据进行了描述性分析。
共招募了 5 个服务（N=46 名临床医生），对 220 名儿童的病历进行了审核。审核员提取了 368 个潜在的与参与相关的目标（每个孩子中位数为 2 个目标），其中 43 个（20%）病历中没有提取到目标。对提取目标的后续编码确定，61%反映了参与（368/61）。亚组分析显示服务之间（p=0.006）和专业之间（p<0.001）存在显著差异。临床医生报告重视参与结果和家庭参与，并普遍认为他们确实以参与为目标。技能差距、缺乏自我监测策略以及不支持的专业和工作文化被认为是关键挑战。
尽管临床医生重视以参与为重点的实践，但在新西兰的儿科康复护理中，这种实践并不常见。通过培训以协作方式设定目标，以实现参与结果，可以为残疾儿童的护理质量带来实质性的提高。
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