Rydon-Grange Michelle
J Med Ethics. 2015 Nov;41(11):880-4. doi: 10.1136/medethics-2015-102922. Epub 2015 Sep 23.
The National Health Service (NHS) has, for over four decades, been beset with numerous 'scandals' relating to poor patient care across several diverse clinical contexts. Ensuing inquiries proceed as though each scandal is unique, with recommendations highlighting the need for more staff training, a change of culture within the NHS based upon a 'duty of candour', and proposed criminal sanctions for employees believed to breach good patient care. However, mistakes reoccur and failings in patient safety continue. While inquiries describe what went awry in each case, questions of how and why such failures came to be remain unanswered. Psychology has a role in answering these questions. Applying psychological theory can guide an understanding of the causes that lead to catastrophic failures in healthcare settings. Indeed, what is often neglected in inquiries is the role of human behaviour in contributing to these failures. Drawing upon behavioural, social and cognitive theories, a psychological analysis of key factors, typically present in clinical contexts where serious failures of care occur, is presented. Applying theory and models from the field of psychology can guide further understanding of the precipitants to poor care.
四十多年来,英国国民医疗服务体系(NHS)一直饱受诸多“丑闻”困扰,这些丑闻涉及多种不同临床环境下的患者护理不善问题。随后展开的调查仿佛每起丑闻都是孤立事件,提出的建议强调需要加强员工培训,基于“坦诚义务”改变NHS内部的文化,并对被认为违反优质患者护理原则的员工实施刑事制裁。然而,错误依旧反复出现,患者安全方面的失误仍在继续。虽然调查描述了每起事件中出了什么差错,但对于这些失误是如何以及为何发生的问题,仍然没有答案。心理学在回答这些问题方面可以发挥作用。应用心理学理论能够引导人们理解导致医疗环境中灾难性失误的原因。事实上,调查中常常被忽视的是人类行为在促成这些失误方面所起的作用。本文运用行为、社会和认知理论,对严重护理失误的临床环境中通常存在的关键因素进行了心理学分析。应用心理学领域的理论和模型可以进一步引导人们理解导致护理不善的诱因。