Psychiatric Research Unit, Slagelse, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
J Clin Nurs. 2023 Sep;32(17-18):6622-6633. doi: 10.1111/jocn.16703. Epub 2023 May 11.
To explore and describe the enactment of user involvement and combined care in a Danish clinic that aimed at providing integrated diabetes and mental health care.
An ethnographic study.
Data consisted of field notes from 96 hours of participant observations and field notes from 32 informal conversations with healthcare providers, users and relatives as well as 12 semistructured interviews with users. Data were analysed using a thematic analysis. This study reports to the SRQR guidelines.
Treatment was not combined as intended if only one healthcare provider handled the consultations. Here, the healthcare providers' focus was often on their own area of expertise-either mental health or diabetes. If more than one healthcare provider handled consultations, the consultations were often divided between them, focussing on one condition at the time. Healthcare providers noted, that learning from peer colleagues was a way to increase the possibility for combined care. Furthermore, combined care was highly dependent on the healthcare providers' ability to involve users' illness experiences in their own care planning. Here, a high level of user involvement increased the levels of combined care during consultations.
This study set out to explore and describe user involvement and combined care in a specialised diabetes and mental health outpatient clinic. Combined care is complexed and requires that healthcare providers are well-equipped to manage the complexity of delivering care for people with both conditions. The degree of combined care was linked with the healthcare providers' ability to involve users and their knowledge on the condition outside there are of expertise.
A peer-learning environment in combination with clinical guidelines and joint display could support healthcare providers in involving users in own care and when delivering care outside their area of expertise.
No patient or public contribution. Due to the COVID-19 pandemic, the original user council withdraw their consent to participate due to health-related worries and anxiety concerning the pandemic. The user council consisted of three members diagnosed with diabetes and severe mental illness. They were invited to participate in physical meetings, phone or online meetings. Presenting findings from the study to the study participants were also hindered by the second lockdown. This influenced the possibility for data triangulation.
探索和描述丹麦一家诊所实施患者参与和联合护理的情况，该诊所以提供综合糖尿病和精神健康护理为目标。
民族志研究。
数据包括 96 小时参与观察的现场记录和 32 次与医疗保健提供者、患者和家属的非正式对话的现场记录，以及 12 次与患者的半结构化访谈。使用主题分析进行数据分析。本研究符合 SRQR 指南。
如果只有一名医疗保健提供者处理咨询，治疗就不会如预期的那样综合进行。在这里，医疗保健提供者的重点往往是他们自己的专业领域——要么是精神健康，要么是糖尿病。如果有多名医疗保健提供者处理咨询，咨询通常会由他们分别进行，一次专注于一种疾病。医疗保健提供者指出，向同行同事学习是增加联合护理可能性的一种方式。此外，联合护理高度依赖于医疗保健提供者将患者的疾病经历纳入其自身护理计划的能力。在这里，高水平的患者参与度提高了咨询过程中的联合护理水平。
本研究旨在探索和描述专门的糖尿病和精神健康门诊诊所中的患者参与和联合护理。联合护理很复杂，需要医疗保健提供者具备良好的能力来管理为同时患有两种疾病的患者提供护理的复杂性。联合护理的程度与医疗保健提供者能够让患者参与到自己的护理中以及在其专业领域之外提供护理的能力有关。
在同行学习环境中结合临床指南和联合展示可以支持医疗保健提供者让患者参与自己的护理，并在其专业领域之外提供护理。
没有患者或公众的贡献。由于 COVID-19 大流行，最初的患者委员会出于与大流行相关的健康担忧和焦虑，撤回了参与的同意。该患者委员会由三名被诊断患有糖尿病和严重精神疾病的成员组成。他们被邀请参加实地会议、电话或在线会议。由于第二次封锁，向研究参与者介绍研究结果也受到了阻碍。这影响了数据三角测量的可能性。
