Johansson Inger M, Skärsäter Ingela, Danielson Ella
The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden. inger.x.johansson.vgregion.se
Int J Ment Health Nurs. 2006 Dec;15(4):242-50. doi: 10.1111/j.1447-0349.2006.00430.x.
Recent changes in psychiatric hospital care involving a reduction in the number of beds and time spent in hospital motivated the study of conditions of inpatient care on such wards. An ethnographic study of a locked, acute psychiatric ward in a department of psychiatry was performed with the aim of describing the health-care environment in such a ward. The ward admitted patients on both a voluntarily and involuntarily basis. Data were collected by means of 3.5 months of participant observations. The results showed a health-care environment that was overshadowed by control. Staff were in control but they also lacked control; they attempted to master the situation in line with organizational demands and they sometimes failed. At the same time, the staff tried to share the responsibility of caring for patients and next of kin. Patients were controlled by staff; they were the underdogs and dependent on staff for their care and the freedom to leave the ward. Patients tried to make themselves heard and reacted to the control by developing counter-strategies. What this study adds to earlier research is patients' pressure on staff and sometimes quite an open struggle for more control, which may be an expression for an unacceptable imbalance in power between patients and staff.
近期精神病院护理方面的变化，包括床位数量减少以及住院时间缩短，促使人们对这类病房的住院护理条件展开研究。对一家精神病科封闭急性病房进行了一项人种志研究，目的是描述此类病房的医疗环境。该病房接收自愿和非自愿住院的患者。通过3.5个月的参与观察收集数据。结果显示，该医疗环境被控制所笼罩。工作人员处于控制地位，但他们也缺乏控制能力；他们试图按照组织要求掌控局面，有时却未能成功。与此同时，工作人员试图分担照顾患者及其家属的责任。患者受到工作人员的控制；他们处于弱势，在护理和离开病房的自由方面依赖工作人员。患者试图表达自己的意见，并通过制定应对策略来应对这种控制。这项研究相较于早期研究的补充之处在于，患者对工作人员施加的压力，以及有时为争取更多控制权而展开的公开斗争，这可能体现了患者与工作人员之间权力失衡到了令人无法接受的程度。
