养老护理机构中衰弱护士和全科医生主导的护理模式：增强健康在养老护理机构框架实施中所面临的影响因素的作用。

Frailty nurse and GP-led models of care in care homes: the role of contextual factors impacting Enhanced health in care homes framework implementation.

机构信息

Department of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.

Chief Operating Officer, North Tyneside Clinical Commissioning Group, Newcastle upon Tyne, UK.

出版信息

BMC Geriatr. 2023 Feb 3;23(1):69. doi: 10.1186/s12877-023-03742-3.

DOI:10.1186/s12877-023-03742-3

PMID:36737688

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9898931/

Abstract

BACKGROUND

The Enhanced Health for Care homes (EHCH) framework is an innovative response to provide more proactive, preventative approaches to care for residents living in care homes. It involves co-producing a shared vision with primary care. As part of EHCH a UK clinical commissioning group supported GP's in two localities to implement their preferred delivery approach involving a new Frailty Nurse-led (FN-led) model in care homes alongside an existing General Practitioner-led (GP-led) model. This paper focuses on implementation of the new FN-led model.

METHODS

A qualitative study design was adopted. Forty-eight qualitative semi-structured interviews were undertaken across six care home sites in a Northern locality: three implementing the FN-led and three engaged in an existing GP-led model. Participants included residents, family members, care home managers, care staff, and health professionals working within the EHCH framework.

RESULTS

Two overarching themes were generated from data analysis: Unanticipated implementation issues and Unintended consequences. Unsuccessful attempts to recruit Frailty Nurses (FN) with enhanced clinical skills working at the desired level (UK NHS Band 7) led to an unanticipated evolution in the implementation process of the FN-led model towards 'training posts'. This prompted misaligned role expectations subsequently provoking unexpected temporary outcomes regarding role-based trust. The existing, well understood nature of the GP-led model may have further exacerbated these unintended consequences.

CONCLUSION

Within the broader remit of embedding EHCH frameworks, the implementation of new FN roles needed to evolve due to unforeseen recruitment issues. Wider contextual factors are not in the control of those developing new initiatives and cannot always be foreseen, highlighting how wider factors can force evolution of planned implementation processes with unintended consequences. However, the unintended consequences in this study highlight the need for careful consideration of information dissemination (content and timing) to key stakeholders, and the influence of existing ways of working.

摘要

背景

增强护理院健康（EHCH）框架是为了提供更积极、预防性的护理方法，以照顾居住在护理院的居民而采取的创新措施。它涉及与初级保健共同制定共同愿景。作为 EHCH 的一部分，英国临床委托组支持两位当地的全科医生实施他们首选的交付方法，包括在现有的全科医生主导（GP 主导）模式之外，在护理院引入新的衰弱护士主导（FN 主导）模式。本文重点介绍新的 FN 主导模式的实施。

方法

采用定性研究设计。在北部一个地区的六个护理院现场进行了 48 次半结构化访谈：三个实施 FN 主导模式，三个参与现有的 GP 主导模式。参与者包括居民、家属、护理院经理、护理人员以及在 EHCH 框架内工作的卫生专业人员。

结果

数据分析产生了两个总体主题：意外的实施问题和意外的后果。未能成功招聘具有增强的临床技能并按预期水平（英国国民保健制度 7 级）工作的衰弱护士（FN），导致 FN 主导模式的实施过程意外演变，成为“培训职位”。这引发了角色期望的错位，进而导致了基于角色的信任的临时意外结果。现有的、被充分理解的 GP 主导模式可能进一步加剧了这些意外后果。

结论

在更广泛的 EHCH 框架背景下，由于招聘问题的不可预见，新 FN 角色的实施需要演变。更广泛的背景因素不在开发新举措的人的控制范围内，也无法总是预见，这突出了更广泛的因素如何迫使计划的实施过程发生演变，并带来意外的后果。然而，本研究中的意外后果强调了需要仔细考虑向关键利益相关者传播信息（内容和时间），以及现有工作方式的影响。