以社区为基础的救护车模式:从南非的紧急医疗服务(EMS)和日常医疗系统复原力中汲取的经验教训。

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Leanne Brady, Lucy Gilson, Asha George, Shaheem De Vries, Shakira Hartley
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引用次数: 0

摘要

随着救护人员应对不断变化的疾病负担以及暴力和不平等等社会压力,全球紧急医疗服务(EMS)的角色正在发生变化。我们需要以新的思维方式来思考如何提供紧急医疗服务,从而将紧急医疗服务从主要侧重于临床护理和将病人送往医院的角色转变过来。在本文中,我们介绍了菲利皮项目(PP)的经验,这是一种基于社区的创新护理模式,由南非开普敦低收入社区的一线救护人员开发。我们的见解是通过观察、访谈和文件审查工作,在整体嵌入式研究方法中形成的。我们的分析借鉴了 "日常卫生系统复原力 "框架,该框架认为复原力是一个新兴过程,可通过对压力和冲击的反应激发出来。反应的形式包括吸收性、适应性或变革性策略,并以系统能力(认知能力、行为能力和环境能力)为基础。我们认为参与计划是一种潜在的变革性复原战略,它被定义为一种新的工作方式,有望为卫生系统带来长期收益。我们发现,参与计划的初步发展得到了一系列系统能力属性的支持(如有意发展关系、集体目的感以及为建设性的感性认识创造空间)。然而,随着时间的推移,参与计划难以为继,因为新出现的工作方式受到了植根于原有组织常规的其他能力属性以及两次环境冲击(科威-19 和暴力事件)的破坏。这篇论文为规模仍然很小的 EHSR 文献增添了新的实证贡献。此外,PP 的经验还为开发基于社区的紧急医疗服务模式提供了具有全球意义的借鉴。它表明,前线工作人员可以针对日常的紧张现实制定创造性的解决方案,但前提是必须创造空间并加以保护。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A community-based ambulance model: lessons for emergency medical services and everyday health systems resilience from South Africa.

The role of the emergency medical service (EMS) is changing globally as ambulance crews respond to a shifting burden of disease, as well as societal stressors such as violence and inequality. New ways of thinking about how to provide emergency care are required to shift EMS from a role primarily focused on clinical care and transporting patients to hospital. In this paper, we present the experience of the Philippi Project (PP), an innovative community-based model of care developed by front line ambulance crews in a low-income neighbourhood in Cape Town, South Africa. Our insights were developed through observational, interview and document review work, within an overall embedded research approach. Our analysis draws on the everyday health systems resilience (EHSR) framework, which sees resilience as an emergent process that may be stimulated through response to stress and shock. Responses take the form of absorptive, adaptive or transformative strategies and are underpinned by system capacities (cognitive, behavioural and contextual). We consider the PP as a potentially transformative resilience strategy, defined as a new way of working that offered the promise of long-term health system gains. We found that the PP's initial development was supported by a range of system capacity attributes (such as the intentional development of relationships, a sense of collective purpose and creating spaces for constructive sense-making). However, the PP was hard to sustain over time because emergent ways of working were undermined both by other capacity attributes rooted in pre-existing organizational routines and two contextual shocks (Coronavirus and a violent incident). The paper adds a new empirical contribution to the still-small EHSR literature. In addition, the PP experience offers globally relevant lessons for developing community-based models of EMS care. It demonstrates that front line staff can develop creative solutions to their stressful daily realities, but only if space is created and protected.

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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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