Brimblecombe Neil R
Mental Health, Hertfordshire Partnership NHS Trust, Mental Health Services, St Albans, Hertfordshire, UK.
J Adv Nurs. 2005 Feb;49(4):344-53. doi: 10.1111/j.1365-2648.2004.03298.x.
This paper illustrates key developments in the changing relationship between the two professions over the last 200 years.
To understand the current relationship between mental health nurses and psychiatrists within the UK, it is necessary to understand the historical development of that relationship.
Information was sought from a range of primary documentary sources, including contemporary journals, asylum documents and official governmental and health service reports. Secondary sources, such as histories of medicine, nursing and individual asylums provided further supportive information.
Psychiatry emerged as a profession at the end of the 18th century and found a power base within county asylums from the middle of the 19th century. Medical superintendents, the doctors in charge of asylums, had strict control over the activities of attendants, the justification for which was the need to protect patients from cruelty and neglect. Superintendents' desire for their own enhanced professional status led to formalized training for attendants at the end of the 19th Century, in which training materials again reinforced the importance of obedience by nurses (as attendants had become known). During the 1920s, trade unions struggled for improved pay and conditions, whilst professionalizing mental health nursing was a secondary priority. Reorganization following creation of the National Health Service in 1948 lessened superintendents' authority, and ultimately the management of mental health nursing shifted from them. The move towards community care allowed mental health nurses to develop greater independence, which was supported by changes in nurse education.
Psychiatrists in the UK remain highly influential, despite the move from their traditional power base in hospitals. Changes in mental health care, such as new nurse prescribing powers and the loss of psychiatrists' control over admission of patients to hospital, will continue to change the relationship between mental health nursing and psychiatry.
本文阐述了过去200年里这两个职业之间不断变化的关系中的关键发展情况。
为了解英国心理健康护士与精神科医生之间的当前关系，有必要了解这种关系的历史发展。
从一系列原始文献资料中获取信息，包括当代期刊、精神病院文件以及官方政府和卫生服务报告。诸如医学史、护理史和个别精神病院史等二手资料提供了进一步的支持性信息。
精神病学在18世纪末成为一门职业，并在19世纪中叶在郡立精神病院建立了权力基础。负责精神病院的医生——医务主任，对护理人员的活动进行严格控制，其理由是需要保护患者免受虐待和忽视。医务主任对自身职业地位提升的渴望导致在19世纪末对护理人员进行正规化培训，培训材料再次强化了护士（当时已被称为护理人员）服从的重要性。在20世纪20年代，工会为提高工资和改善工作条件而斗争，同时将心理健康护理专业化是次要优先事项。1948年国家医疗服务体系建立后的重组削弱了医务主任的权力，最终心理健康护理的管理从他们手中转移。向社区护理的转变使心理健康护士能够发展出更大的独立性，护士教育的变革对此起到了支持作用。
尽管英国精神科医生已从其在医院的传统权力基础上撤离，但他们仍然极具影响力。心理健康护理方面的变化，如新的护士处方权以及精神科医生对患者住院收治控制权的丧失，将继续改变心理健康护理与精神病学之间的关系。
