Evaluation of an Organisational Intervention to Promote Integrated Working between Health Services and Care Homes in the Delivery of End-of-Life Care for People with Dementia: Understanding the Change Process Using a Social Identity Approach.
Evaluation of an Organisational Intervention to Promote Integrated Working between Health Services and Care Homes in the Delivery of End-of-Life Care for People with Dementia: Understanding the Change Process Using a Social Identity Approach.
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DOI：
10.5334/ijic.2426
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发表时间：
2016-06-03
影响因子：
2.4
通讯作者：
Nicholson C
中科院分区：
文献类型：
--
作者：
Amador S;Goodman C;Mathie E;Nicholson C
在英国，大约三分之一的痴呆症患者生活在成人长期护理机构，其中大多数人处于生命的最后几年。英格兰卫生服务和护理院之间的工作安排在很大程度上是临时性的，而且往往是不公平的，但在这些环境中为痴呆症患者提供高质量的临终护理需要建立在现有实践基础上的合作伙伴关系。本文报告的定性组成部分的混合方法的研究，旨在评估的组织干预形成的赞赏性调查，以促进访问医疗保健从业人员（即全科医生和地区护士）和护理人员之间的综合工作。评估使用社会认同的方法来阐明干预的行动机制，并了解如何实现组织变革。我们发现了（i）身份动员和（ii）背景变化的证据，理论上定义为克服医疗保健部门的机制。具体而言，干预措施支持在卫生和社会护理环境中开展综合工作，方法是：（一）在共同观点和目标的基础上建立一个共同的群体身份，但也要认识到每个服务群体特有的知识和专长，这些知识和专长在提供临终护理方面为共同目标服务，以及（ii）开发特定背景的实践创新，并引入现有的临终关怀工具和框架，因此，这可以作为一个有意义的自下而上而不是自上而下的进程的一部分来实施。围绕社会认同方法构建的干预措施可以用来衡量服务群体之间的价值观和目标的一致性，没有这些措施，实现不同保健服务之间更大程度的整合的努力可能是无效的。这一办法的优点是，它能够容纳参与某一特定护理领域的服务群体的多样性，办法是重视他们各自的贡献，并利用现有的工作方式，在这种工作方式中，可以有意义地纳入做法的变化。
In the United Kingdom, approximately a third of people with dementia live in long-term care facilities for adults, the majority of whom are in the last years of life. Working arrangements between health services and care homes in England are largely ad hoc and often inequitable, yet quality end-of-life care for people with dementia in these settings requires a partnership approach to care that builds on existing practice. This paper reports on the qualitative component of a mixed method study aimed at evaluating an organisational intervention shaped by Appreciative Inquiry to promote integrated working between visiting health care practitioners (i.e. General Practitioners and District Nurses) and care home staff. The evaluation uses a social identity approach to elucidate the mechanisms of action that underlie the intervention, and understand how organisational change can be achieved. We uncovered evidence of both (i) identity mobilisation and (ii) context change, defined in theory as mechanisms to overcome divisions in healthcare. Specifically, the intervention supported integrated working across health and social care settings by (i) the development of a common group identity built on shared views and goals, but also recognition of knowledge and expertise specific to each service group which served common goals in the delivery of end-of-life care, and (ii) development of context specific practice innovations and the introduction of existing end-of-life care tools and frameworks, which could consequently be implemented as part of a meaningful bottom-up rather than top-down process. Interventions structured around a Social Identity Approach can be used to gauge the congruence of values and goals between service groups without which efforts to achieve greater integration between different health services may prove ineffectual. The strength of the approach is its ability to accommodate the diversity of service groups involved in a given area of care, by valuing their respective contributions and building on existing ways of working within which practice changes can be meaningfully integrated.
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影响因子：
2.8
作者：
Davies SL;Goodman C;Bunn F;Victor C;Dickinson A;Iliffe S;Gage H;Martin W;Froggatt K
通讯作者：
Froggatt K
影响因子：
4.1
作者：
Hall S;Goddard C;Stewart F;Higginson IJ
通讯作者：
Higginson IJ
影响因子：
4.4
作者：
Finucane, Anne M.;Stevenson, Barbara;Murray, Scott A.
通讯作者：
Murray, Scott A.
影响因子：
4.1
作者：
Gage H;Dickinson A;Victor C;Williams P;Cheynel J;Davies SL;Iliffe S;Froggatt K;Martin W;Goodman C
通讯作者：
Goodman C
制定和评估复杂的干预措施：新的医学研究委员会指南。
DOI：
10.1136/bmj.a1655
发表时间：
2008-09-29
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Craig P;Dieppe P;Macintyre S;Michie S;Nazareth I;Petticrew M;Medical Research Council Guidance
通讯作者：
Medical Research Council Guidance