Nurses experiences of working in Crisis Resolution Home Treatment Teams with its additional gatekeeping responsibilities.

Authors: Begum R, Riordan S.

Source: J Psychiatr Ment Health Nurs. 2016 Feb;23(1):45-53. doi: 10.1111/jpm.12276.

WHAT IS KNOWN ON THE SUBJECT?: Community care has evolved beyond recognition since the closure of the asylums and the introduction of a socially inclusive concept of care. Through their gatekeeping role, Crisis Resolution Home Treatment Teams (CRHTT) aim to reduce inappropriate admissions, facilitate early discharge and maximize the ability of service users to live independently within their own communities. It is evident that there is a vast array of literature on CRHTT internationally, however, little evidence on nurses experiences of working within CRHTT and gatekeeping. In light of limited research, this study aims to expand the current evidence base by exploring nurse’s experiences of working in CRHTT with its additional gatekeeping responsibilities.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The findings from this study provide a valuable contribution to the existing international literature base, highlighting the experiences of nurses as gatekeepers within CRHTT. It also helps to identify further gaps in the literature that can be addressed through future research.

WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This research study has a number of academic and clinical implications. As gatekeeping is an integral aspect of the work conducted by CRHTT, a closer look at nurse’s experiences of working in CRHTT with its additional gatekeeping responsibilities can help inform future developments within the service whilst identifying the necessary improvements to current working practices. It can also add to the existing evidence base on CRHTT and gatekeeping.

ABSTRACT:

Introduction Through their gatekeeping role, CRHTT aim to reduce inappropriate admissions, facilitate early discharge from hospital and maximize the ability of service users to live independently within their own communities. It is evident that there is a vast array of literature on CRHTT internationally, however, little evidence on nurses experiences of working within CRHTT and gatekeeping. Therefore, in the light of limited research, this study aims to expand the current evidence base by exploring nurse’s experiences of working in CRHTT with its additional gatekeeping responsibilities. Methodology Six nurses working across two CRHTT’s were interviewed using semi-structured interviews. Data were analysed through the use of thematic analysis. Results Four key themes emerged which were, ‘CRHTT as a specialist role’, ‘core principles of the gatekeeping role’, ‘redefining risk management for gatekeepers in CRHTT’ and ‘the future of gatekeeping’. Discussion It is evident through nurse’s experiences of working within CRHTT and gatekeeping that their roles were very dynamic and challenging. A positive risk-taking approach contributed towards the success of CRHTT as gatekeepers. Family members played a significant role in ensuring gatekeeping remained a priority consistent with Government targets. Clinical Implications and recommendations for future research are discussed.

© 2016 John Wiley & Sons Ltd.

PMID:

26799055
[PubMed – in process]

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