Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, United Kingdom.
North of England Commissioning Support, Newcastle upon Tyne, United Kingdom.
PLoS One. 2022 Oct 11;17(10):e0275974. doi: 10.1371/journal.pone.0275974. eCollection 2022.
Frailty is a key issue in current healthcare delivery and falls is an important component. Care and support planning (CSP) is an established approach to managing long term conditions (LTCs) and has potential to provide more person-centred care for those at risk of falling. This qualitative evaluation aimed to understand the barriers and success criteria involved in incorporating falls assessment and management into the CSP process.
CSP for falls prevention was implemented in eight general practices in the North of England. Six of the eight practices participated in the qualitative evaluation. Seven group interviews were undertaken with staff (n = 31) that included practice nurses, health care assistants, nurses, and administrative staff (n = 2-8 per group). Observations of the falls and CSP training provided additional data. Interviews covered experiences and potential impacts of training, and processes of implementation of the programme, and were informed by normalisation process theory. Thematic analysis was undertaken using a team-based approach.
Although successfully implemented across the practices, how established CSP was and therefore 'organisational readiness' was an overarching theme that illustrated differences in how easily sites were able to implement the additional elements for frailty. The challenges, successes and impacts of implementation are demonstrated through this theme and four further themes: training resources and learning; positive impacts of the programme (including enabling easier conversations around 'frailty'); integrating work processes/work with patients; and dealing with uncertainty and complexity.
Care and Support Planning services designed to target frailty and falls is feasible and can successfully be delivered in the primary care setting, if key enablers are promoted and challenges to implementation addressed from planning through to integration in practice.
衰弱是当前医疗保健服务中的一个关键问题，而跌倒则是一个重要组成部分。护理和支持计划（CSP）是管理长期疾病（LTCs）的既定方法，并且有可能为那些有跌倒风险的人提供更以患者为中心的护理。本定性评估旨在了解将跌倒评估和管理纳入 CSP 流程中所涉及的障碍和成功标准。
在英格兰北部的八家全科诊所中实施了预防跌倒的 CSP。其中六家诊所参与了定性评估。对工作人员（n=31）进行了七次小组访谈，包括执业护士、医疗保健助理、护士和行政人员（每组 2-8 人）。对跌倒和 CSP 培训的观察提供了额外的数据。访谈涵盖了培训的经验和潜在影响，以及该计划的实施过程，并以规范化进程理论为依据。采用团队合作的方法进行主题分析。
尽管该计划在所有诊所中都成功实施，但 CSP 的成熟程度，即“组织准备情况”是一个贯穿始终的主题，说明了各诊所实施脆弱性额外元素的难易程度的差异。通过这一主题和另外四个主题展示了实施的挑战、成功和影响：培训资源和学习；该计划的积极影响（包括使有关“虚弱”的对话更容易进行）；整合工作流程/与患者的工作；以及应对不确定性和复杂性。
如果促进关键促进因素并解决从规划到实践整合过程中的实施挑战，那么针对虚弱和跌倒设计的护理和支持计划服务是可行的，可以在初级保健环境中成功实施。
