Practice Development and Co Director ImpACT Research Group, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
England Centre for Practice Development, Faculty of Medicine, Health & Social Care, Canterbury Christ Church University, Canterbury, Kent, UK.
Health Expect. 2023 Apr;26(2):869-881. doi: 10.1111/hex.13712. Epub 2023 Jan 30.
There is a need for better integration of services across communities and sectors for people living with traumatic brain injury (TBI) to meet their complex needs. Building on insights gained from earlier pilot work, here we report the outcomes of a participatory workshop that sought to better understand the challenges, barriers and opportunities that currently exist within the care pathway for survivors of TBI.
A diverse range of stakeholders from the acute and rehabilitation care pathway and the health and social care system were invited to participate in a 3-h workshop. The participants worked in four mixed subgroups using practice development methodology, which promotes person-centred, inclusive and participatory action.
Thematic analysis identified shared purposes and values that were used to produce a detailed implementation and impact framework for application at both the level of the care interface and the overarching integrated care system. A variety of enablers were identified that related to collective values and behaviours, case management, team leadership and integrated team working, workforce capability, evidence-based practice and resourcing. The clinical, economic, cultural and social outcomes associated with these enablers were also identified, and included patient safety, independence and well-being, reduced waiting times, re-admission rates, staff retention and professional development.
The co-produced recommendations made within the implementation and impact framework described here provide a means by which the culture and delivery of health and social care services can be better tailored to meet the needs of people living with TBI. We believe that the recommendations will help shape the formation of new services as well as the development of existing ones.
Patient and public involvement have been established over a 10-year history of relationship building through a joint forum and events involving three charities representing people with TBI, carers, family members, clinicians, service users, researchers and commissioners, culminating in a politically supported event that identified concerns about the needs of people following TBI. These relationships formed the foundation for the interactive workshop, the focus of this publication.
需要更好地整合社区和部门之间的服务，以满足创伤性脑损伤（TBI）患者的复杂需求。在此基础上，我们借鉴早期试点工作的经验，报告了一项参与式研讨会的结果，该研讨会旨在更好地了解 TBI 幸存者护理途径中目前存在的挑战、障碍和机遇。
邀请来自急性和康复护理途径以及卫生和社会保健系统的各种利益相关者参加了 3 小时的研讨会。参与者使用实践发展方法分成四个混合小组工作，该方法促进了以患者为中心、包容和参与性的行动。
主题分析确定了共同的目的和价值观，这些目的和价值观被用来为护理界面和整体综合护理系统的应用制定一个详细的实施和影响框架。确定了各种促进因素，这些促进因素与集体价值观和行为、病例管理、团队领导和团队合作、劳动力能力、循证实践和资源有关。还确定了与这些促进因素相关的临床、经济、文化和社会效益，包括患者安全、独立性和幸福感、减少等待时间、再入院率、员工保留和职业发展。
这里描述的实施和影响框架中提出的共同建议为更好地调整卫生和社会保健服务的文化和提供方式以满足 TBI 患者的需求提供了一种手段。我们相信，这些建议将有助于塑造新服务的形成以及现有服务的发展。
通过一个联合论坛和涉及三个代表 TBI 患者、护理人员、家庭成员、临床医生、服务用户、研究人员和决策者的慈善机构的活动，建立了 10 年的关系建设患者和公众参与，最终举行了一次政治支持的活动，确定了人们对 TBI 后需求的关注。这些关系为互动研讨会奠定了基础，也是本出版物的重点。
