Psychiatric Emergency Room Care: Staff Perspectives

描述（由申请人提供）：该提案是一系列研究的第一步，旨在更好地了解繁忙的城市精神病急诊室（PERs）发生了什么。很少注意到工作人员、消费者和其他利益相关者参与PER护理的观点、态度和信念，以及这些观点对提供护理的影响。该建议侧重于PER工作人员。我们将通过询问PER员工在PER中做什么来描述PER员工的工作以及他们与患者的互动。我们将描述员工对影响的理解，特别是那些与他们工作的社会背景和偶然事件有关的影响，以及他们与患者的互动——PER员工对他们所做的事情是如何思考和感受的？我们将评估工作人员对使用PER的患者的态度和信念，以及工作人员识别或标记使用PER的患者的过程。最后，我们将以初步的方式探讨被工作人员标记（积极或消极）的患者与其他患者之间是否存在差异，并探讨基于工作人员标识或标记的消费者/患者收到的PER中护理的内容和性质是否存在差异。我们将利用定性和定量研究方法。该建议以指导理论为依据，这些理论涉及工作场所特征与员工需求之间的关系，以及员工对他们的工作和他们所服务的患者的看法。标签理论将有助于指导我们分析和解释与员工标签对PER护理过程的潜在影响相关的结果。数据收集方法将包括结构化观察、深度访谈、焦点小组和带有定量分析的结构化医疗图表审查。这些数据关注的是PER的工作人员，对于在PER中设计适当的干预措施和服务，并最终与对消费者和其他利益相关者的研究相结合，以改善使用PER的人的临床结果，将产生巨大的影响。如果我们要以适合消费者/患者和PER员工的方式提供精神病学紧急护理，我们必须提高我们对PER员工工作的理解，员工对他们工作的理解，他们对他们工作的患者的态度，以及使用PER的患者群体的方式，以及员工标签对PER护理过程的潜在影响。

DESCRIPTION (provided by applicant): This proposal is a first step in a line of research designed to better understand what occurs in busy, urban psychiatric emergency rooms (PERs). Little attention has been paid to the perspectives, attitudes and beliefs of the staff, consumers and other stakeholders involved in PER care, and the influence of these perspectives on the provision of care. This proposal focuses on PER staff. We will describe the work of PER staff and their interactions with patients by asking what PER staff do in the PER. We will describe staff understandings of the influences, particularly those related to the social context and contingencies of their work, on their interactions with patients - How do PER staff think and feel about what they do? We will assess staff attitudes and beliefs about patients who use the PER and the processes by which staff identify or label patients who use the PER. And finally we will explore in a preliminary fashion whether there are differences between patients labeled (either positively or negatively) by staff and other patients and to explore if there are differences in the content and nature of care in the PER received by consumers/patients based on staff identification or labeling. We will draw upon both qualitative and quantitative research methodologies. The proposal is informed by guiding theories which relate to the relationship between workplace characteristics and demands on staff, and staff perspectives on their work and the patients they work with. Labeling theory will help guide our analyses and interpretation of the results related to the potential impact of staff labeling on the process of care in the PER. Data collection methods will include structured observations, in-depth interviews, focus groups and a structured medical chart review with quantitative analyses. These data, which focus on the staff of the PER, will have tremendous implications for the designing of appropriate interventions and services within the PER and ultimately when integrated with research on consumers and other stake holders, to improve the clinical outcomes of people who use the PER. We must increase our understanding of the work of the PER staff, the staffs understanding's of their work, their attitudes about the patients they work with and the way the group patients who use the PER, and the potential impact of the labeling of staff on the process of PER care, if we are to provide psychiatric emergency care in ways that are appropriate for consumers/patients and PER staff.