Faculty of Medicine and Health Sciences, University of East Anglia, Norwich.
Sociol Health Illn. 2013 May;35(4):514-28. doi: 10.1111/j.1467-9566.2012.01511.x. Epub 2012 Aug 16.
Institutional abuse is a global issue, sometimes ascribed to the behaviour of a few wicked people. It persists despite regulatory measures, interventions from enforcement and protection agencies, organisational policies and procedures. Therefore, the accurate recognition and early detection of abuse and taking corresponding steps to deal with perpetrators are critical elements in protecting vulnerable people who live in institutions. However, research is less clear about why and how abuse (re)occurs. Using the tame and wicked problem analysis of Rittell and Webber (1973) as a lens, we examine the ways institutional abuse is formulated in care settings. Drawing on case study data from eight care homes for older people, we show how solutions seeking to reduce institutional abuse and improve care quality can cause additional problems. The article reconceptualises institutional abuse through the lens of wicked problem analysis to illustrate the multifaceted and recurring, wicked problem characteristics of residential care provision.
机构虐待是一个全球性问题,有时归因于少数邪恶之人的行为。尽管有监管措施、执法和保护机构的干预、组织政策和程序,但它仍然存在。因此,准确识别和及早发现虐待行为,并采取相应措施处理施虐者,是保护生活在机构中的弱势群体的关键要素。然而,研究对于虐待行为(再次)发生的原因和方式并不清楚。本文使用 Rittell 和 Webber(1973)提出的温和问题和恶劣问题分析,来审视机构虐待在护理环境中的制定方式。本文利用来自 8 家老年人护理院的案例研究数据,展示了旨在减少机构虐待和提高护理质量的解决方案如何会导致其他问题。本文通过恶劣问题分析的视角重新构想机构虐待,说明了养老院服务提供中多方面且反复出现的恶劣问题特征。