Manuel Jenni, Crowe Marie
Canterbury District Health Board, Christchurch, New Zealand.
Int J Ment Health Nurs. 2014 Aug;23(4):336-43. doi: 10.1111/inm.12063. Epub 2014 Feb 18.
A number of recent, highly-publicized, perceived health-care service failures have raised concerns about health professionals' accountabilities. Relevant to these concerns, the present study sought to examine how mental health nurses understood clinical responsibility and its impact on their practice. A descriptive, qualitative design was used, and a convenience sample of 10 mental health nurses was recruited from specialist inpatient and outpatient mental health settings in Canterbury, New Zealand. Data were collected using semistructured interviews, and the transcriptions were analysed using an inductive, descriptive approach. Three major themes were identified: being accountable, fostering patient responsibility, and shifting responsibility. Being accountable involved weighing up patients' therapeutic needs against the potential for blame in an organizational culture of risk management. Fostering patient responsibility described the process of deciding in what situations patients could take responsibility for their behaviour. Shifting responsibility described the culture of defensive practice fostered by the organizational culture of risk aversion. The present study highlighted the challenges mental health nurses experience in relation to clinical responsibility in practice, including the balancing required between the needs of patients, the needs of the organization, and the perceived need for self-protection.
近期一些备受关注的、被认为是医疗服务失败的事件引发了对医疗专业人员问责制的担忧。与这些担忧相关，本研究旨在探讨心理健康护士如何理解临床责任及其对他们实践的影响。采用了描述性的定性设计，从新西兰坎特伯雷的专科住院和门诊心理健康机构中招募了10名心理健康护士作为便利样本。通过半结构化访谈收集数据，并使用归纳性、描述性方法对转录内容进行分析。确定了三个主要主题：承担责任、培养患者责任感和转移责任。承担责任涉及在风险管理的组织文化中权衡患者的治疗需求与可能受到指责的可能性。培养患者责任感描述了决定患者在何种情况下可以对自己的行为负责的过程。转移责任描述了由规避风险的组织文化所促成的防御性实践文化。本研究强调了心理健康护士在实践中与临床责任相关所面临的挑战，包括在患者需求、组织需求以及自我保护的感知需求之间进行平衡的必要性。
