近亲在非自愿住院和强制治疗期间的参与经历。
Next of kin's experiences of involvement during involuntary hospitalisation and coercion.
作者信息
Førde Reidun, Norvoll Reidun, Hem Marit Helene, Pedersen Reidar
机构信息
Centre for Medical Ethics, Institute for Health and Society, University of Oslo, Oslo, Norway.
出版信息
BMC Med Ethics. 2016 Nov 24;17(1):76. doi: 10.1186/s12910-016-0159-4.
BACKGROUND
Norway has extensive and detailed legal requirements and guidelines concerning involvement of next of kin (NOK) during involuntary hospital treatment of seriously mentally ill patients. However, we have little knowledge about what happens in practice. This study explores NOK's views and experiences of involvement during involuntary hospitalisation in Norway.
METHODS
We performed qualitative interviews-focus groups and individual-with 36 adult NOK to adults and adolescents who had been involuntarily admitted once or several times. The semi-structured interview guide included questions on experiences with and views on involvement during serious mental illness and coercion.
RESULTS
Most of the NOK were heavily involved in the patient's life and illness. Their conceptions of involvement during mental illness and coercion, included many important aspects adding to the traditional focus on substitute decision-making. The overall impression was, with a few exceptions, that the NOK had experienced lack of involvement or had negative experiences as NOK in their encounters with the health services. Not being seen and acknowledged as important caregivers and co sufferers were experienced as offensive and could add to their feelings of guilt. Lack of involvement had as a consequence that vital patient information which the NOK possessed was not shared with the patient's therapists.
CONCLUSIONS
Despite public initiatives to improve the involvement of NOK, the NOK in our study felt neglected, unappreciated and dismissed. The paper discusses possible reasons for the gap between public policies and practice which deserve more attention: 1. A strong and not always correct focus on legal matters. 2. Little emphasis on the role of NOK in professional ethics. 3. The organisation of health services and resource constraints. 4. A conservative culture regarding the role of next of kin in mental health care. Acknowledging these reasons may be helpful to understand deficient involvement of the NOK in voluntary mental health services.
背景
挪威有广泛而详细的法律要求和指导方针，涉及在对严重精神疾病患者进行非自愿住院治疗期间近亲（NOK）的参与情况。然而，我们对实际发生的情况了解甚少。本研究探讨了挪威近亲在非自愿住院期间参与的观点和经历。
方法
我们对36名成年近亲进行了定性访谈——焦点小组访谈和个人访谈，这些近亲涉及曾一次或多次非自愿住院的成年人及青少年。半结构化访谈指南包括关于在严重精神疾病和强制治疗期间参与的经历及观点的问题。
结果
大多数近亲深度参与了患者的生活和疾病治疗。他们对精神疾病和强制治疗期间参与的概念，包括许多重要方面，这增加了对传统替代决策重点的关注。总体印象是，除了少数例外，近亲在与医疗服务机构接触时，经历了参与不足或作为近亲有负面经历。未被视为重要照顾者和共同受苦者并得到认可，被视为冒犯行为，可能会增加他们的内疚感。参与不足导致近亲掌握的重要患者信息未与患者的治疗师共享。
结论
尽管有公共举措来改善近亲的参与情况，但我们研究中的近亲感到被忽视、未得到赏识和被轻视。本文讨论了公共政策与实践之间差距的可能原因，这些原因值得更多关注：1. 对法律事务的强烈且并非总是正确的关注。2. 对近亲在职业道德中作用的重视不足。3. 医疗服务的组织和资源限制。4. 在精神卫生保健中关于近亲角色的保守文化。认识到这些原因可能有助于理解近亲在自愿精神卫生服务中参与不足的情况。
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