Rugkåsa Jorun, Canvin Krysia, Sinclair Julia, Sulman Anna, Burns Tom
Health Services Research Unit, Akershus University Hospital, 1478, Lørenskog, Norway,
Community Ment Health J. 2014 Nov;50(8):886-95. doi: 10.1007/s10597-014-9720-0. Epub 2014 Mar 25.
The emphasis on care in the community in current mental health policy poses challenges for community mental health professionals with responsibility for patients who do not wish to receive services. Previous studies report that professionals employ a range of behaviors to influence reluctant patients. We investigated professionals' own conceptualizations of such influencing behaviors through focus groups with community teams in England. Participants perceived that good, trusting relationships are a prerequisite to the negotiation of reciprocal agreements that, in turn, lead to patient-centred care. They described that although asserting professional authority sometimes is necessary, it can be a potential threat to relationships. Balancing potentially conflicting processes-one based on reciprocity and the other on authority-represents a challenge in clinical practice. By providing descriptive accounts of micro-level dynamics of clinical encounters, our analysis shows how the authoritative aspect of the professional role has the potential to undermine therapeutic interactions with reluctant patients. We argue that such micro-level analyses are necessary to enhance our understanding of how patient-centered mental health policy may be implemented through clinical practice.
当前心理健康政策对社区护理的强调，给负责那些不愿接受服务患者的社区心理健康专业人员带来了挑战。以往研究报告称，专业人员会采用一系列行为来影响不情愿的患者。我们通过与英格兰社区团队进行焦点小组讨论，调查了专业人员对这类影响行为的自身概念化理解。参与者认为，良好、信任的关系是协商互惠协议的先决条件，而这反过来又会带来以患者为中心的护理。他们描述说，虽然有时有必要维护专业权威，但这可能对关系构成潜在威胁。平衡可能相互冲突的过程——一个基于互惠，另一个基于权威——是临床实践中的一项挑战。通过提供临床接触微观层面动态的描述性说明，我们的分析表明，专业角色的权威性方面有可能破坏与不情愿患者的治疗互动。我们认为，这种微观层面的分析对于增强我们对如何通过临床实践实施以患者为中心的心理健康政策的理解是必要的。
