Cornwall Partnership Trust and Peninsula Medical School, Liskeard, UK.
Int J Soc Psychiatry. 2012 Sep;58(5):496-504. doi: 10.1177/0020764011408658. Epub 2011 Aug 3.
Trust, choice and power are critical issues in clinical practice, public policies and a post-modern understanding of mental health care. We aimed to investigate the experiences and attitudes of patients with psychosis in relation to trust, choice and power.
We conducted 20 in-depth interviews with patients with psychotic disorders in care of NHS services. The interviews were subjected to thematic analysis.
Patients discussed aspects of their care in terms of dimensions that enhance or undermine trust, choice and power. Two interpretive themes emerged from this data. First, patients perceive the need for a shifting balance of power, according to the severity of their illness and their own experience of care, but feel that threats of coercion and neglect disable them. Second, they appreciate the expertise of clinicians, but particularly value 'the personal touch' that goes beyond this expertise, including personal disclosure about their own lives, common acts of kindness and conversation outside clinical matters. Patients view trust as a two-way process with responsibility shared between patient and clinician.
The active involvement of patients with psychosis in their individual care may be strengthened, particularly when they are not acutely ill and have more experience of their illness. While patients value expertise and respect in interactions with clinicians, they also appreciate a 'personal touch', which may go beyond current notions of professionalism.
信任、选择和权力是临床实践、公共政策和后现代心理健康护理理解中的关键问题。我们旨在调查精神病患者在信任、选择和权力方面的经验和态度。
我们对 NHS 服务护理下的精神障碍患者进行了 20 次深入访谈。对访谈进行了主题分析。
患者根据增强或削弱信任、选择和权力的维度讨论了他们的护理方面。从这些数据中得出了两个解释性主题。首先，患者认为需要根据疾病的严重程度和自己的护理体验来调整权力平衡，但他们感到威胁到强制和忽视会使他们失去权力。其次，他们欣赏临床医生的专业知识，但特别重视超越这一专业知识的“个人关怀”，包括对自己生活的个人披露、常见的善举和临床事务之外的交谈。患者将信任视为患者和临床医生之间共同承担责任的双向过程。
可以加强精神病患者对其个人护理的积极参与，尤其是当他们没有急性疾病且有更多的疾病经验时。虽然患者在与临床医生的互动中重视专业知识和尊重，但他们也欣赏一种超越当前专业概念的“个人关怀”。
