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以病例管理计划和积极外展团队为背景下与患者互动的理论方法:文献的系统综述。

Theoretical approaches to the engagement with patients in case-management programmes and assertive outreach teams: A systematic review of the literature.

机构信息

Instituto de Neuropsiquiatría y Adicciones (INAD), Consorci Mar Parc de Salut de Barcelona (PSMar), Barcelona, Spain.

Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic Barcelona, Spain.

出版信息

J Psychiatr Ment Health Nurs. 2022 Oct;29(5):647-658. doi: 10.1111/jpm.12831. Epub 2022 Apr 24.


DOI:10.1111/jpm.12831
PMID:35384145
Abstract

WHAT IS KNOWN ON THE SUBJECT?: It is generally accepted that all interventions carried out by mental health nurses involve engagement with the patient; this engagement is a process that is gradually constructed and is not immediate. In Spain during last decade, nurses working in assertive outreach teams have gradually replaced the traditional institutional setting in favour of environments that are more familiar to the patient. In contrast, when patients and nurses interact outside institutional settings, a new approach and skillset is required in order to adapt to the new environment. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We have systematically identified and assessed the available evidence on how nurses work in assertive outreach team programmes. The therapeutic link is not just assistance; it is actually a construct, which is established between nurse and patient, with the aim of favouring, fostering and strengthening the therapeutic relationship. Only a few studies have discussed the nurse-patient therapeutic link in assertive outreach services. However, it seems important that nurses use a standardized language, that is, a language promoted as a model of correct use and used for functions of greater prestige, especially in public administration and teaching, to integrate it into the theoretical framework. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: With the synthesis that we present, we hope that it promote a more consistent use of the engagement concept in research on this topic. In turn, this will enhance staff support and training and will foster evidence-based practice. The conceptualization of nursing language and its use by professionals helps to improve practice and the lack of a theoretical framework with a nurse perspective. It is necessary to establish a consensus between mental health nurses around the engagement' meaning in the programmes of assertive outreach teams. ABSTRACT: Introduction During last decade in Spain, nurses working in assertive outreach programmes have replaced the traditional institutional setting in favour of the patient's own environment. Engagement with patients requires a different skillset when the axis of the nurse-patient interaction is the patient's own environment. The engagement alone could be associated with the innate concept of patient's care and the helping relationship. However, in the individualized care models, the engagement seems to be an instrument with its own characteristics for the purpose of providing mental health care. Aim/Question To systematically identify and assess the empirical evidence on the relationships and engagement between patients with mental illness (schizophrenia, psychotic disorders, schizoaffective disorders, mood disorders and disorders of adult personality) and nursing mental health nurses. Method Systematic literature review based on PRISMA guidance. Results We identified and reviewed seven primary research studies. Following the analytic processes, three themes emerged: existence of different engagement levels, training needs and skills in the creation and consolidation of the engagement, and engagement as process. Discussion The engagement of nurse and patient is understood as a process that incorporates different stages. Whilst it is established, the engagement is subject to positive and negative influences. For the creation of the engagement and its maintenance specialized skills, knowledge and personal attributes (resilience, psychosocial skills, compressive knowledge of mental health illnesses, capacity to build effective relationships, adaptability and problem-solving) are necessary, but the main focus is on context where it develops, selected by the patient himself, for example, his home. Implications for Practice Administrators may have questions about appropriate hiring practices for assertive outreach teams since certain skills are necessary to obtain un engagement process, and staff training should be considered a key issue to provide specific skills for enhancing engagement and the therapeutic relationship. Conclusion The engagement must be understood as a long-term process. For the creation of the engagement and its maintenance, specialized skills, knowledge and personal attributes are necessary.

摘要

已知信息:
通常认为,精神科护士所进行的所有干预措施都涉及与患者的接触;这种接触是一个逐渐构建的过程,并非即时发生的。在过去十年的西班牙,从事坚定性外展团队工作的护士逐渐取代了传统的机构环境,转而倾向于更接近患者熟悉的环境。相比之下,当患者和护士在机构环境之外进行互动时,需要采用新的方法和技能来适应新的环境。

本文新增内容:
我们系统地确定并评估了现有关于护士在坚定性外展团队项目中工作的证据。治疗联系不仅仅是援助;它实际上是护士和患者之间建立的一种构建,旨在促进、培养和加强治疗关系。只有少数研究讨论了坚定性外展服务中的护士-患者治疗联系。然而,似乎重要的是,护士使用标准化语言,即作为正确使用模型并用于更有声望的功能的语言,特别是在公共行政和教学中,将其纳入理论框架。

对实践的影响:
通过我们提出的综合分析,我们希望它能促进在这个主题的研究中更一致地使用接触概念。反过来,这将增强对员工的支持和培训,并促进循证实践。护理语言的概念化及其专业人员的使用有助于改善实践和缺乏以护士视角为基础的理论框架。有必要在精神科护士之间就坚定性外展团队项目中的“接触”的含义达成共识。

摘要: 介绍:
在过去十年的西班牙,从事坚定性外展项目的护士已经取代了传统的机构环境,转而倾向于患者自己的环境。当护士-患者互动的轴心是患者自己的环境时,与患者接触需要不同的技能。接触本身可能与患者护理的固有概念和帮助关系有关。然而,在个性化护理模式中,接触似乎是提供精神卫生保健的一种具有自身特点的工具。

目的/问题:
系统地识别和评估与患有精神疾病(精神分裂症、精神病性障碍、分裂情感性障碍、心境障碍和成人人格障碍)的患者和精神科护士之间的关系和接触的实证证据。

方法:
基于 PRISMA 指南的系统文献综述。

结果:
我们确定并审查了七项原始研究。在分析过程之后,出现了三个主题:不同接触水平的存在、创造和巩固接触的培训需求和技能,以及作为过程的接触。

讨论:
护士和患者的接触被理解为一个包含不同阶段的过程。在建立接触的同时,它会受到积极和消极的影响。为了建立接触并保持接触,需要专门的技能、知识和个人属性(韧性、心理社会技能、对精神健康疾病的综合知识、建立有效关系的能力、适应性和解决问题的能力),但重点是患者自己选择的接触发展的背景,例如他的家。

对实践的影响:
管理人员可能会对坚定性外展团队的适当招聘实践提出问题,因为获得接触过程需要某些技能,员工培训应被视为提供特定技能以增强接触和治疗关系的关键问题。

结论:
接触必须被理解为一个长期的过程。为了建立接触和保持接触,需要专门的技能、知识和个人属性。

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