Dziruni Tendayi Bruce, Hutchinson Alison M, Keppich-Arnold Sandra, Bucknall Tracey
School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.
Alfred Health, Melbourne, VIC, Australia.
Front Health Serv. 2024 Jul 15;4:1400060. doi: 10.3389/frhs.2024.1400060. eCollection 2024.
Mental state deterioration poses significant challenges in healthcare, impacting patients and providers. Symptoms like confusion and agitation can lead to prolonged hospital stays, increased costs, and the use of restrictive interventions. Despite its prevalence, there's a lack of consensus on effective practices for managing mental state deterioration in acute hospital settings. To address this gap, a rapid response team model has been proposed as a potential intervention, aiming to provide early identification and targeted interventions.
Based on realist evaluation steps, first, initial program theories are formulated to understand the logic behind the intervention. Second, literature synthesis identifies empirical evidence on contexts, mechanisms, and outcomes elements, refining initial theories. During the third step, data will be collected using qualitative methods such as field observations and interviews, as well as quantitative methods such as surveys of the staff, audits of electronic medical records, and analysis of incident records of mental state deterioration. Analysing this data informs configurations of contexts, mechanisms, and outcomes. In the fifth step, the configurations are synthesised, presenting refined, evidence-informed program theories.
This study addresses the knowledge gap by evaluating the rapid response model's effectiveness in managing mental state deterioration in acute hospital settings. Realist principles guide the exploration of causal mechanisms and their interaction with specific implementation contexts. The objective is to identify what works, for whom, and under what circumstances, aiming to manage deterioration, reduce restrictive interventions, and enhance the experience for patients and staff by implementing a proactive model of care. The findings contribute to evidence-based approaches for managing mental state deterioration in hospital settings, informing policy and practice in this crucial area of healthcare.
精神状态恶化给医疗保健带来了重大挑战，对患者和医护人员都会产生影响。诸如意识模糊和躁动等症状可能导致住院时间延长、成本增加以及采取限制性干预措施。尽管精神状态恶化很常见，但在急性医院环境中，对于管理精神状态恶化的有效做法仍缺乏共识。为了填补这一空白，有人提出了快速反应团队模式作为一种潜在干预措施，旨在实现早期识别和针对性干预。
基于现实主义评价步骤，首先，制定初始项目理论以理解干预背后的逻辑。其次，文献综合确定关于背景、机制和结果要素的实证证据，对初始理论进行完善。在第三步中，将使用定性方法（如实地观察和访谈）以及定量方法（如对工作人员的调查、电子病历审核和精神状态恶化事件记录分析）收集数据。对这些数据进行分析可了解背景、机制和结果的配置情况。在第五步中，对配置情况进行综合，呈现经过完善的、基于证据的项目理论。
本研究通过评估快速反应模式在急性医院环境中管理精神状态恶化方面的有效性来填补知识空白。现实主义原则指导对因果机制及其与特定实施背景的相互作用的探索。目的是确定什么有效、对谁有效以及在什么情况下有效，旨在通过实施积极主动的护理模式来管理病情恶化、减少限制性干预措施，并改善患者和工作人员的体验。研究结果有助于为医院环境中管理精神状态恶化提供循证方法，为医疗保健这一关键领域的政策和实践提供参考。
