增加急性精神科病房心理治疗的可及性：阶梯式心理干预的医护人员及患者体验
Increasing access to psychological therapy on acute mental health wards: staff and patient experiences of a stepped psychological intervention.
作者信息
Johnston Isobel, Edge Dawn, Wilson Paul, Beinaraviciute Adele, Bucci Sandra, Drake Richard, Gilworth Gill, Haddock Gillian, Handerer Fritz, Kaur Sonalia, Lovell Karina, Morley Helen, Price Owen, Samji Mica, Berry Katherine
机构信息
Complex Trauma and Resilience Research Unit, Manchester Royal Infirmary, Manchester Greater Manchester Mental Health NHS Foundation Trust, Rawnsley Building, Manchester, M13 9WL, UK.
Division of Psychology and Mental Health, University of Manchester, Coupland 1 Building, Manchester, M13 9PL, UK.
出版信息
BMC Psychiatry. 2025 Mar 28;25(1):300. doi: 10.1186/s12888-025-06721-7.
BACKGROUND
Psychological therapies are recommended for people with serious mental health problems. However, access is limited, particularly in inpatient mental health settings. The Talk, Understand and Listen in InPatient Settings (TULIPS) study is a large multi-centre cluster-randomised controlled trial which aimed to evaluate a stepped psychological intervention model to increase access to therapies for inpatients. This paper presents findings from the embedded process evaluation focusing on the contextual factors influencing intervention delivery.
METHODS
Thirty-two staff and 31 patients from wards receiving the intervention participated in semi-structured interviews. Data was analysed using reflexive thematic analysis. Staff and patient data were analysed separately but perspectives were compared and interwoven resulting in five themes.
RESULTS
Patients reported sessions with psychologists facilitated greater self-understanding and coping. Staff and patients reflected that formulations improved staff understanding of patient presentations. This understanding was associated with improved staff-patient relationships, more person focused practice and reduced conflict and burnout. Psychologists' frequent physical presence on the wards and support of nursing teams enabled staff buy-in. However, significant barriers in resource, skill and confidence inhibited the delivery of nurse-led interventions within the stepped care model, as did perceptions that intervention delivery was outside the remit of nursing staff's role.
CONCLUSIONS
This study provides evidence that a stepped psychological intervention on acute mental health wards could improve patient coping and ward experience for patients and staff. Future studies should target nursing staff confidence and skill in the delivery of psychological interventions.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03950388. Registered 15th May 2019. https://clinicaltrials.gov/ct2/show/NCT03950388 .
背景
对于有严重心理健康问题的人，推荐采用心理治疗。然而，获得心理治疗的机会有限，尤其是在住院心理健康环境中。住院环境中的谈话、理解与倾听（TULIPS）研究是一项大型多中心整群随机对照试验，旨在评估一种逐步推进的心理干预模式，以增加住院患者获得治疗的机会。本文介绍了嵌入式过程评估的结果，重点关注影响干预实施的背景因素。
方法
来自接受干预病房的32名工作人员和31名患者参与了半结构化访谈。采用反思性主题分析法对数据进行分析。工作人员和患者的数据分别进行分析，但对观点进行了比较和交织，得出了五个主题。
结果
患者报告称与心理学家的会面有助于增强自我理解和应对能力。工作人员和患者反映，病情诊断改善了工作人员对患者情况的理解。这种理解与改善医患关系、更多以患者为中心的实践以及减少冲突和倦怠相关。心理学家经常在病房现身并给予护理团队支持，使工作人员能够接受。然而，资源、技能和信心方面的重大障碍阻碍了在逐步护理模式中由护士主导的干预措施的实施，认为干预实施超出护理人员职责范围的观念也是如此。
结论
本研究提供了证据，表明在急性心理健康病房进行逐步推进的心理干预可以改善患者的应对能力以及患者和工作人员的病房体验。未来的研究应针对护理人员在实施心理干预方面的信心和技能。
试验注册
ClinicalTrials.gov标识符：NCT03950388。于2019年5月15日注册。https://clinicaltrials.gov/ct2/show/NCT03950388 。
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