Coleman M, Jenkins E
School of Health Science, University of Wales, Swansea.
J Psychiatr Ment Health Nurs. 1998 Oct;5(5):355-9. doi: 10.1111/jpm.1998.5.5.355.
This paper examines stances that are being adopted in relation to the current and future direction of mental health nursing practice. The argument is made that mental health nursing is being pushed into a direction that is essentially positivistic and narrow in its focus, stating that the current hegemony of thinking which dictates that our primary focus of concern should be with individuals suffering from severe or recurring mental illness, allied with the drive towards 'evidence based practice' is symptomatic of wider issues that should be of concern to all parties interested in the issue of mental health care. The authors examine the context and rationale for these developments from socio-political, philosophical and ethical viewpoints, highlighting that their logical outcome is the exclusion of individuals from the right to health care and question the motives underpinning what could be considered a fundamental shift in the provision of mental health services. The argument is then advanced that caution should be adopted by mental health nursing services before abandoning what Gournay (1994) described as 'redundant ideologies' and that a broader view of mental health nursing action should be accommodated. The validity of trying to account for mental nursing action in quantifiable and biomechanistic terms is questioned and an alternative paradigm of accounting for such action is suggested.
本文探讨了针对心理健康护理实践的当前及未来方向所采取的立场。文中指出，心理健康护理正被推向一个本质上实证主义且关注点狭窄的方向，称当前主导性的思维方式规定我们主要关注的应是患有严重或复发性精神疾病的个体，再加上对“循证实践”的推动，这体现了更广泛的问题，所有关注精神卫生保健问题的各方都应予以关注。作者从社会政治、哲学和伦理视角审视了这些发展的背景及基本原理，强调其逻辑结果是将个体排除在获得医疗保健的权利之外，并质疑了作为精神卫生服务提供方面一项根本转变背后的动机。接着提出论点，心理健康护理服务在摒弃古尔奈（1994年）所描述的“冗余意识形态”之前应谨慎行事，且应接纳对心理健康护理行动更广泛的观点。试图以可量化和生物力学的方式解释精神护理行动的有效性受到质疑，并提出了一种解释此类行动的替代范式。
