“She’s Been a Rock”: The Function and Importance of “Holding” by Social Prescribing Link Workers in Primary Care in England—Findings from a Realist Evaluation

IF 2 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Debra Westlake, Geoffrey Wong, Steven Markham, Amadea Turk, Jordan Gorenberg, Catherine Pope, Joanne Reeve, Caroline Mitchell, Kerryn Husk, Sabi Redwood, Anthony Meacock, Kamal R. Mahtani, Stephanie Tierney
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Abstract

Social prescribing link workers are recently introduced roles in English primary care. One of their intended functions is to support patients with conditions influenced by the wider, social determinants of health. Their main purpose is to connect people to community resources to meet their nonmedical needs. However, our research reveals that link workers provide not only connections but also what we have described as “holding” for individuals with complex needs, who lack informal networks of support or who are waiting to access services. We explore the concept of holding, its meaning and significance in this context, and consider its consequences. As part of a realist evaluation, we observed seven link workers in GP practices in England during focussed ethnographies over a 3-week period. We took field notes and interviewed 61 patients and 93 healthcare and voluntary sector professionals. Nine to twelve months later, we carried out follow-up interviews with forty-one patients, seven link workers, and a link worker manager. We identified four functions of holding: supporting patients waiting for services, sustaining patients as they prepare for change, reducing the emotional burden of primary healthcare professionals, and bearing witness to patients’ distress. Holding appears to be a vital but often overlooked aspect of social prescribing. Patients benefit from having a reliable and consistent person to support their emotional needs. However, similar to the impact of holding on other primary care professionals, there are unintended consequences: some link workers exceed their capacity, become overburdened, experience burnout, and leave their job. Recognizing the importance of holding and understanding its role in link workers’ primary care responsibilities are critical. If holding work is accepted as a role for link workers, providing training and support to them should be prioritised to ensure successful implementation and positive outcomes for patients, link workers, and primary healthcare staff.

Abstract Image

"她是一块磐石":英国初级保健中社会处方联系工作者 "坚持 "的功能和重要性--现实主义评估的结果
社会处方联系工作者是英国初级医疗最近引入的一种角色。他们的职能之一是为受到更广泛的健康社会决定因素影响的病人提供支持。他们的主要目的是将人们与社区资源联系起来,以满足他们的非医疗需求。然而,我们的研究表明,联系工作者不仅为有复杂需求、缺乏非正式支持网络或正在等待获得服务的个人提供联系,而且还提供我们所描述的 "支持"。我们探讨了 "持有 "的概念、其在这种情况下的含义和意义,并考虑了其后果。作为现实主义评估的一部分,我们在为期三周的重点人种学研究中观察了英格兰全科医生诊所的七名链接工作者。我们做了实地记录,并采访了 61 名病人和 93 名医疗保健及志愿服务部门的专业人士。九至十二个月后,我们对 41 名患者、七名链接工作者和一名链接工作者经理进行了后续访谈。我们确定了 "支持 "的四种功能:为等待服务的患者提供支持;在患者准备接受改变时为他们提供支持;减轻初级医疗保健专业人员的情感负担;见证患者的痛苦。陪伴似乎是社会处方的一个重要方面,但却经常被忽视。有一个可靠、始终如一的人支持患者的情感需求,患者会从中受益。然而,与 "陪伴 "对其他初级保健专业人员的影响类似,"陪伴 "也会带来意想不到的后果:一些联系工作者超出了自己的能力范围,负担过重,出现职业倦怠,甚至离职。认识到持有工作的重要性并理解其在链接工作者的初级保健职责中的作用至关重要。如果认为持有工作是链接工作者的一项职责,则应优先为他们提供培训和支持,以确保成功实施,并为患者、链接工作者和初级医疗保健人员带来积极成果。
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来源期刊
CiteScore
4.50
自引率
8.30%
发文量
423
期刊介绍: Health and Social Care in the community is an essential journal for anyone involved in nursing, social work, physiotherapy, occupational therapy, general practice, health psychology, health economy, primary health care and the promotion of health. It is an international peer-reviewed journal supporting interdisciplinary collaboration on policy and practice within health and social care in the community. The journal publishes: - Original research papers in all areas of health and social care - Topical health and social care review articles - Policy and practice evaluations - Book reviews - Special issues
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