Factors affecting implementation of a National Clinical Programme for self-harm in hospital emergency departments: a qualitative study.

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Selena O'Connell, Grace Cully, Sheena McHugh, Margaret Maxwell, Anne Jeffers, Katerina Kavalidou, Sally Lovejoy, Rhona Jennings, Vincent Russell, Ella Arensman, Eve Griffin
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引用次数: 0

Abstract

Background: A substantial number of people experiencing self-harm or suicidal ideation present to hospital emergency departments (EDs). In 2014, a National Clinical Programme was introduced in EDs in Ireland to standardise care provision. Internationally, there has been limited research on the factors affecting the implementation of care for people who present with mental health crises in EDs.

Methods: This qualitative study examined factors influencing the implementation of the National Clinical Programme for Self-harm and Suicide-related Ideation in 15 hospitals in Ireland from early (2015-2017) through to later implementation (2019-2022). Semi-structured interviews were conducted with staff involved in programme delivery, with the topic guide and thematic analysis informed by the Consolidated Framework for Implementation Research.

Results: A total of 30 participants completed interviews: nurse specialists (n=16), consultant psychiatrists (n=6), nursing managers (n=2), emergency medicine staff (n=2) and members of the national programme team (n=4). Enablers of implementation included the introduction of national, standardised guidance for EDs; implementation strategies led by the national programme team; and training and support for nurse specialists. The following inner-setting factors were perceived as barriers to implementation in some hospitals: limited access to a designated assessment room, delayed access to clinical input and poor collaboration with ED staff. Overall, these barriers dissipated over time, owing to implementation strategies at national and local levels. The varied availability of aftercare impacted providers' ability to deliver the programme and the adaptability of programme delivery had a mixed impact across hospitals.

Conclusions: The perceived value of the programme and national leadership helped to advance implementation. Strategies related to ongoing training and education, developing stakeholder interrelationships and evaluation and monitoring have helped address implementation barriers and promote continued sustainment of the programme. Continued efforts are needed to support nurse specialists delivering the programme and foster partnerships with community providers to improve the transition to aftercare.

影响在医院急诊科实施自我伤害国家临床方案的因素:一项定性研究。
背景:大量有自我伤害或自杀意念的人到医院急诊科(ED)就诊。2014 年,爱尔兰在急诊科引入了一项国家临床计划,以规范护理服务的提供。在国际上,针对影响急诊室对出现心理健康危机的患者实施护理的因素的研究十分有限:本定性研究探讨了影响爱尔兰 15 家医院实施自残和自杀相关意念国家临床计划的因素,包括早期实施(2015-2017 年)和后期实施(2019-2022 年)。我们对参与计划实施的工作人员进行了半结构式访谈,并根据实施研究综合框架制定了主题指南和主题分析:共有 30 名参与者完成了访谈:专科护士(16 人)、精神科顾问医生(6 人)、护理经理(2 人)、急诊医学人员(2 人)和国家项目团队成员(4 人)。实施的有利因素包括:为急诊室引入国家标准化指南;由国家项目组领导的实施战略;以及对专科护士的培训和支持。在一些医院,以下内部因素被认为是实施的障碍:使用指定评估室的机会有限、迟迟无法获得临床投入以及与急诊室员工合作不力。总体而言,由于国家和地方层面的实施策略,这些障碍随着时间的推移逐渐消失。由于提供的术后护理服务不同,影响了医疗服务提供者实施计划的能力,而计划实施的适应性对各家医院的影响也不尽相同:结论:对计划价值的认知和国家领导力有助于推动计划的实施。与持续培训和教育、发展利益相关者之间的相互关系以及评估和监测有关的策略有助于解决实施障碍,并促进该计划的持续开展。还需要继续努力,为实施该计划的专科护士提供支持,并促进与社区医疗服务提供者的合作,以改善向术后护理的过渡。
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来源期刊
BMJ Quality & Safety
BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-
CiteScore
9.80
自引率
7.40%
发文量
104
审稿时长
4-8 weeks
期刊介绍: BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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