Participation-focused practices in paediatric rehabilitation for children with neurodisability in New Zealand: An observational study using MAPi audit tool
Participation-focused practices in paediatric rehabilitation for children with neurodisability in New Zealand: An observational study using MAPi audit tool
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DOI：
10.1111/cch.12789
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发表时间：
2020-06-23
影响因子：
1.9
通讯作者：
Levack, William
中科院分区：
文献类型：
--
作者：
Graham, Fiona;Timothy, Emily;Levack, William
背景 参与结果和以家庭为中心的服务现已成为儿科康复护理中广泛认可的标准。有证据表明，国际上将这些做法纳入常规护理的进程进展缓慢，迄今为止，新西兰尚未对以参与或以家庭为中心的做法进行研究。本研究的目的是确定儿科康复服务目标设定以参与为中心和以家庭为中心的程度，并分析临床医生对这些焦点的信念。方法 观察性研究，包括回顾性病例记录审核和问卷调查。案例说明（“图表”）经过审核，以了解以参与为中心的目标相关实践。使用加权平均差完成按服务、职业和儿童种族对审计数据进行亚组分析。接受审核病例记录的临床医生完成了一份包含 42 项的调查问卷，涉及与实践行为相关的因素，包括每个项目的文字回复。对数字和文本数据进行了描述性分析。结果 招募了 5 个服务机构（N = 46 名临床医生），并审核了 220 名儿童的病例记录。审核员提取了 368 个潜在的参与相关目标（Mdn = 每个孩子 2 个目标），其中 43 个（20%）案例说明没有提取目标。随后对提取的目标进行编码，确定 61% 反映了参与度 (225/368)。亚组分析显示服务 (p= 0.006) 和职业 (p< 0.001) 之间存在显着差异。临床医生报告重视参与结果和家庭参与，并在很大程度上认为他们确实以参与为目标。技能差距、缺乏自我监控策略以及不支持的专业和工作文化被认为是主要挑战。结论 尽管受到临床医生的重视，但以参与为中心的做法在新西兰儿科康复护理中并不常见。通过协作目标设定培训以实现参与成果，可以显着提高残疾儿童的护理质量。
Background Participation outcomes and family-centred services are now widely agreed standards of care in paediatric rehabilitation. Evidence suggests that adoption of these practices into usual care has been slow internationally, and no studies of participation-focused or family-centred practices in New Zealand have been undertaken to date. The aims of this study were to identify the extent that goal setting in paediatric rehabilitation services is participation focused and family centred and to profile clinicians' beliefs about these foci. Methods Observational study including a retrospective case note audit and questionnaire. Case notes ('charts') were audited for participation-focused goal-related practice. Subgroup analysis of audit data by service, profession and child ethnicity were completed using weighted mean differences. Clinicians whose case notes were audited completed a 42-item questionnaire on factors related to practice behaviour including text responses with each item. Numerical and text data were analysed descriptively. Results Five services were recruited (N =46 clinicians) with case notes for 220 children audited. Auditors extracted 368 potentially participation-related goals (Mdn= 2 goals per child) with no goals extracted for 43 (20%) of case notes. Subsequent coding of extracted goals identified 61% reflected participation (225/368). Subgroup analysis revealed significant differences between services (p= 0.006) and professions (p< 0.001). Clinicians' reported valuing participation outcomes and family involvement and largely felt they did target participation. Skill gaps, absence of self-monitoring strategies and unsupportive professional and work cultures were cited as key challenges. Conclusions Although valued by clinicians, participation-focused practice is unusual care in paediatric rehabilitation in New Zealand. Substantial gains in the quality of care for children with disabilities could be afforded through training in collaborative goal setting to target participation outcomes.