School of Health Sciences, Institute of Mental Health, University of Nottingham, Innovation Park, Nottingham, UK.
ImRoC, Nottingham, UK.
Int J Ment Health Nurs. 2018 Jun;27(3):1137-1148. doi: 10.1111/inm.12430. Epub 2017 Dec 26.
Despite significant changes to mental health services, nurses remain the professional group most likely to be in close contact with people who experience mental health problems. A core part of the contemporary identity of the mental health nurse is one who is able to provide acceptance and support for an individual's recovery through the therapeutic relationship. Yet there have always been some tensions with the mental health nursing role that can appear to challenge this relational focus. An increasing prominence of risk management in mental health care can position mental health nurses as responsible for enacting restrictions and has reignited interest in the role of mental health professionals in social control. This paper reports on one part of a multiple case study, which aimed to explore mental health professionals' experiences of such tensions in the context of decision-making. Interviews and observations were undertaken in acute ward and assertive outreach settings. Findings suggested that risk dominated decision-making to such an extent it defined the way service users were understood and treated. A distant relationship between professionals and service users helped to create and maintain this situation. There needs to be a greater focus on service users' subjective experiences in the decision-making process to challenge the definition of people with mental health problems as risky.
尽管精神卫生服务发生了重大变化，但护士仍然是最有可能与经历精神健康问题的人密切接触的专业群体。精神卫生护士的当代特征的核心部分是能够通过治疗关系为个人的康复提供接受和支持。然而，精神卫生护理角色一直存在一些紧张关系，这似乎对这种关系焦点构成了挑战。精神卫生保健中风险管理的重要性日益增加，这使得精神卫生护士负责实施限制，并重新引发了人们对精神卫生专业人员在社会控制中的作用的兴趣。本文报告了一项多案例研究的一部分，该研究旨在探讨精神卫生专业人员在决策背景下对这种紧张关系的体验。在急性病房和坚定的外展环境中进行了访谈和观察。研究结果表明，风险在决策中占据主导地位，以至于它定义了服务使用者被理解和对待的方式。专业人员和服务使用者之间的疏远关系有助于创造和维持这种情况。需要更加关注服务使用者在决策过程中的主观体验，以挑战将精神健康问题患者定义为风险的做法。
