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肉中刺?普通精神病学中的法医住院患者。

A Thorn in the Flesh? Forensic Inpatients in General Psychiatry.

作者信息

Møllerhøj Jette, Stølan Liv Os, Brandt-Christensen Mette

机构信息

Competence Centre for Forensic Psychiatry, Mental Health Centre Sct. Hans, Capital Region of Denmark.

Mental Health Centre Glostrup, Capital Region of Denmark.

出版信息

Perspect Psychiatr Care. 2016 Jan;52(1):32-9. doi: 10.1111/ppc.12099. Epub 2015 Jan 26.

Abstract

PURPOSE

To illuminate whether and how taking care of forensic inpatients is experienced as a burden among staff and managers in general psychiatry.

DESIGN AND METHODS

Qualitative analytical strategies based on interviews and questionnaires.

FINDINGS

The interplay between physical environment, bottlenecks, poor information exchange, lack of knowledge and competences, complex psychopathology, and a vague and therefore uncomfortable task of nursing leads to a focus on criminal offenses rather than mental disorders and an increased risk of brutalization and stigmatization in nursing practices. Members of staff identify the care of mentally disordered offenders in general psychiatric units as either "a parking space" or a very difficult or frightening course, where staff members tend to behave like pleasers in order to avoid risks of conflict or physical violence. Either way, it seems hard to provide sufficient mental health care.

PRACTICE IMPLICATIONS

Nationwide training and teaching as well as knowledge exchange between specialized forensic psychiatry and general psychiatry are recommended. Further exploration is needed on patient perspectives and on avenues to increase efficiency and decrease bottlenecks throughout the clinical pathways. Furthermore, we need additional knowledge of the impact on general patient populations' resources for treatment and their safety.

摘要

目的

阐明在普通精神病学领域,照顾法医住院患者对工作人员和管理人员而言是否以及如何被视为一种负担。

设计与方法

基于访谈和问卷调查的定性分析策略。

研究结果

物理环境、瓶颈问题、信息交流不畅、知识与能力欠缺、复杂的精神病理学以及模糊因而令人不安的护理任务之间的相互作用,导致护理工作侧重于刑事犯罪而非精神障碍,且在护理实践中出现暴力化和污名化风险增加的情况。工作人员将普通精神科病房中对精神错乱罪犯的护理视为“一个停车位”,或是一个非常困难或可怕的过程,在此过程中工作人员往往表现得像取悦者,以避免冲突或身体暴力风险。无论哪种情况,似乎都难以提供充分的心理健康护理。

实践意义

建议在全国范围内开展培训与教学,并促进专门法医精神病学与普通精神病学之间的知识交流。需要进一步探索患者的观点以及提高临床路径效率和减少瓶颈的途径。此外,我们还需要更多关于对普通患者群体治疗资源及其安全影响的知识。

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