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早产儿家庭过渡性护理新模式中的跨专业协作——医护人员视角

Interprofessional Collaboration in a New Model of Transitional Care for Families with Preterm Infants - The Health Care Professional's Perspective.

作者信息

Schuetz Haemmerli Natascha, von Gunten Geraldine, Khan Jeannine, Stoffel Liliane, Humpl Tilman, Cignacco Eva

机构信息

Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.

Inselspital, University Children's Hospital, Neonatology, Bern, Switzerland.

出版信息

J Multidiscip Healthc. 2021 Apr 23;14:897-908. doi: 10.2147/JMDH.S303988. eCollection 2021.

Abstract

BACKGROUND

Families with preterm infants find life after hospital discharge challenging and need tailored support to thrive. The "Transition to Home (TtH)"-model offers structured, individual support for families with preterm infants before and after hospital discharge. TtH improves parental mental health and competence, promotes child development and fosters interprofessional collaboration (IPC).

AIM

Evaluate the TtH-models' structure and implementation process and its associated interprofessional collaboration from the healthcare professional's (HCP) perspective.

METHODS

This qualitative explorative study thematically analyzed four focus group interviews (n=28 HCP) and an open-ended questionnaire with general pediatricians (n=8).

RESULTS

The main themes of the thematic analysis were the benefits of the TtH-model, tailored parental support, the challenges of changing interprofessional collaboration, facilitators and barriers to successfully implementing the model, and feasibility and health economic limits. HCP acknowledge that continuous family-centered care led by an advanced practice nurse (APN) supports, strengthens, and relieves families with preterm infants in the transition from hospital to home. Families in complex situations benefit most. The TtH-model incorporates key aspects of integrated care like shared decision-making, considering family preferences, and defining the APN as the family's main contact. HCP want network collaboration but found communication, cooperation, and reorganization challenging in the new IPC process. IPC challenges and involving many HCP in family care can create parental oversupply, negatively affect treatment outcomes, and raise health care costs.

CONCLUSION

These challenges need to be addressed to ensure sustainable implementation of the model. The roles and tasks of HCP should be clearly distinguished from each other, and HCP must have time to learn this new form of IPC. Learning requires time, effective communication strategies, and leadership support. Political action is also required to implement new models of care, including regulating advanced practice roles and developing new financing models.

摘要

背景

早产婴儿家庭在出院后的生活面临挑战,需要量身定制的支持才能茁壮成长。“过渡到家庭(TtH)”模式为早产婴儿家庭在出院前后提供结构化的个性化支持。TtH可改善父母的心理健康和能力,促进儿童发育,并促进跨专业协作(IPC)。

目的

从医疗保健专业人员(HCP)的角度评估TtH模式的结构和实施过程及其相关的跨专业协作。

方法

这项定性探索性研究对四个焦点小组访谈(n = 28名HCP)和一份面向普通儿科医生的开放式问卷(n = 8)进行了主题分析。

结果

主题分析的主要主题包括TtH模式的益处、量身定制的父母支持、跨专业协作变革的挑战、成功实施该模式的促进因素和障碍,以及可行性和卫生经济限制。HCP认识到由高级实践护士(APN)主导的持续以家庭为中心的护理能够支持、加强并减轻早产婴儿家庭从医院过渡到家庭的负担。处于复杂情况的家庭受益最大。TtH模式纳入了综合护理的关键方面,如共同决策、考虑家庭偏好以及将APN定义为家庭的主要联系人。HCP希望进行网络协作,但发现在新的IPC过程中沟通、合作和重组具有挑战性。IPC挑战以及让许多HCP参与家庭护理可能会导致向父母提供的服务过多,对治疗结果产生负面影响,并增加医疗成本。

结论

需要应对这些挑战,以确保该模式的可持续实施。HCP的角色和任务应明确区分,并且HCP必须有时间学习这种新的IPC形式。学习需要时间、有效的沟通策略和领导支持。还需要采取政治行动来实施新的护理模式,包括规范高级实践角色和开发新的融资模式。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d953/8079346/c77c08ed0f38/JMDH-14-897-g0001.jpg

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