Clibbens Nicola, Close Adrianne, Poxton Julie, Davies Carly, Geary Lesley, Dickens Geoffrey
Northumbria University, Coach Lane Campus, Newcastle-upon-Tyne, UK.
Rotherham, Doncaster and South Humber NHS Foundation Trust, Doncaster, UK.
Int J Ment Health Nurs. 2024 Dec;33(6):2257-2266. doi: 10.1111/inm.13394. Epub 2024 Jul 21.
Community-based intensive home treatment (IHT) is delivered as an alternative to psychiatric hospital admission as part of crisis resolution services. People receiving IHT present with complex mental health issues and are acutely distressed. Home treatment options are often preferred and there is evidence of service fidelity, although less is known about psychosocial care in this setting. Underpinned by a critical realist epistemology, this study aimed to explore psychosocial care in the context of home treatment from the perspectives of staff, service users and family carers. Data were collected using individual interviews and focus groups in two NHS organisations in England. An inductive qualitative thematic analysis resulted in five themes focused on (1) the staffing model and effective care provision, (2) the organisation of work and effective care provision, (3) skills and training and service user need, (4) opportunities for involvement and personal choice, and (5) effective communication. Findings suggest that co-production may improve congruence between IHT service design, what service users and carers want and staff ideals about optimal care. Service designs that optimise continuity of care and effective communication were advocated. Staff training in therapeutic interventions was limited by not being tailored to the home treatment context. Evidence gaps remain regarding the most effective psychosocial care and related training and supervision required. There is also a lack of clarity about how carers and family members ought to be supported given their often-crucial role in supporting the person between staff visits.
基于社区的强化居家治疗（IHT）作为危机解决服务的一部分，是作为精神病院住院治疗的替代方案提供的。接受IHT的人存在复杂的心理健康问题且极度痛苦。居家治疗方案通常更受青睐，并且有服务保真度的证据，尽管在这种情况下对心理社会护理的了解较少。本研究以批判实在论认识论为基础，旨在从工作人员、服务使用者和家庭照顾者的角度探索居家治疗背景下的心理社会护理。在英格兰的两个国民保健服务（NHS）组织中，通过个人访谈和焦点小组收集数据。归纳性定性主题分析得出了五个主题，重点关注（1）人员配置模式与有效护理提供，（2）工作组织与有效护理提供，（3）技能与培训以及服务使用者需求，（4）参与和个人选择的机会，以及（5）有效沟通。研究结果表明，共同生产可能会提高IHT服务设计、服务使用者和照顾者的需求以及工作人员对最佳护理的理想之间的一致性。提倡优化护理连续性和有效沟通的服务设计。治疗干预方面的工作人员培训因未针对居家治疗背景进行量身定制而受到限制。关于最有效的心理社会护理以及所需的相关培训和监督，仍然存在证据空白。对于照顾者和家庭成员在工作人员探访间隙如何支持患者发挥关键作用，也缺乏明确的支持方式。
