Dalhousie University, Halifax, Nova Scotia, Canada.
Arch Psychiatr Nurs. 2010 Aug;24(4):216-26. doi: 10.1016/j.apnu.2009.07.002. Epub 2009 Oct 15.
The role of inpatient mental health units is changing. Increasingly, people with acute and severe mental illness are admitted for short periods of intense treatment and are discharged quickly to community-based care. Reduction in average lengths of stay for psychiatric inpatients has been accompanied by a marginalization of the concept of therapeutic milieu in the mental health discourse. This phenomenological inquiry focuses on understanding the life-world of six people with acute psychiatric illness who were hospitalized on an acute inpatient psychiatric unit. Working together, a team of four, including mental health clinicians and consumers, developed and implemented this interpretive study using the phenomenology of Heidegger and Taylor. The principle investigator conducted the interviews, and the research team engaged in a complex interpretive process, reviewing narrative accounts, exploring personal meanings and key themes, and reconstructing shared meaning as lived and shared by participants. In this report, the authors describe patient experiences of a rule-bound, controlling, and sometimes oppressive milieu while highlighting patient experiences of healing and health as lived within that same milieu. The authors describe patients' embodied, dialectical, and often paradoxical experiences of fear and affirmation, alienation and connection, and abandonment and healing. The authors share selected narrative accounts to generate new understanding of patient experiences and suggest that the inpatient psychiatric milieu remains an important but often neglected component of psychiatric treatment.
住院精神卫生病房的角色正在发生变化。越来越多的患有急性和严重精神疾病的人被收治住院，接受短时间的强化治疗，然后迅速出院到社区护理。精神科住院患者的平均住院时间缩短，同时也导致治疗环境的概念在精神卫生领域边缘化。本现象学研究聚焦于理解六名患有急性精神疾病的患者的生活世界，他们在急性精神病住院病房住院。由四名包括精神科临床医生和患者在内的人员组成的团队共同使用海德格尔和泰勒的现象学理论，开发并实施了这项解释性研究。首席研究员进行了访谈，研究团队进行了复杂的解释性过程，回顾了叙事描述，探索了个人意义和关键主题，并将参与者的生活和共同经历重建为共同的意义。在本报告中，作者描述了患者在规则约束、控制且有时具有压迫性的环境中的体验，同时强调了患者在同一环境中体验到的治愈和健康。作者描述了患者的身体、辩证且常常自相矛盾的恐惧和肯定、疏远和联系以及被抛弃和治愈的体验。作者分享了一些精选的叙事描述，以产生对患者体验的新理解，并表明住院精神科病房仍然是精神科治疗的一个重要但经常被忽视的组成部分。
