以康复为导向的实践中支持同时患有精神健康和物质使用障碍者的困境：挪威工作人员经历的定性研究
Dilemmas in recovery-oriented practice to support people with co-occurring mental health and substance use disorders: a qualitative study of staff experiences in Norway.
作者信息
Brekke Eva, Lien Lars, Nysveen Kari, Biong Stian
机构信息
1Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Post box 104, 2381 Brumunddal, Norway.
Faculty of Health and Social Sciences, University of Southeast Norway, Post box 235, 3603 Kongsberg, Norway.
出版信息
Int J Ment Health Syst. 2018 Jun 7;12:30. doi: 10.1186/s13033-018-0211-5. eCollection 2018.
Abstract
BACKGROUND
Recovery-oriented practice is recommended in services for people with co-occurring mental health and substance use disorders. Understanding practitioners' perceptions of recovery-oriented services may be a key component of implementing recovery principles in day-to-day practice. This study explores and describes staff experiences with dilemmas in recovery-oriented practice to support people with co-occurring disorders.
METHODS
Three focus group interviews were carried out over the course of 2 years with practitioners in a Norwegian community mental health and addictions team that was committed to developing recovery-oriented services. Thematic analysis was applied to yield descriptions of staff experiences with dilemmas in recovery-oriented practice.
RESULTS
Three dilemmas were described: (1) balancing mastery and helplessness, (2) balancing directiveness and a non-judgmental attitude, and (3) balancing total abstinence and the acceptance of substance use.
CONCLUSIONS
Innovative approaches to practice development that address the inherent dilemmas in recovery-oriented practice to support people with co-occurring disorders are called for.
摘要
背景
对于同时患有精神健康和物质使用障碍的人群，建议采用以康复为导向的服务模式。了解从业者对以康复为导向的服务的看法，可能是在日常实践中贯彻康复原则的关键组成部分。本研究旨在探索并描述工作人员在以康复为导向的实践中处理困境的经验，以帮助同时患有多种障碍的人群。
方法
在两年时间里，对挪威一个致力于发展以康复为导向服务的社区精神健康与成瘾问题团队的从业者进行了三次焦点小组访谈。采用主题分析法来描述工作人员在以康复为导向的实践中处理困境的经验。
结果
描述了三个困境：（1）平衡掌控感与无助感；（2）平衡指导性与无评判态度；（3）平衡完全禁欲与接受物质使用。
结论
需要创新的实践发展方法，以解决以康复为导向的实践中存在的固有困境，从而帮助同时患有多种障碍的人群。
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Int J Ment Health Addict. 2018;16(1):53-65. doi: 10.1007/s11469-017-9780-9. Epub 2017 Jun 21.
2
Why Do Those With Long-Term Substance Use Disorders Stop Abusing Substances? A Qualitative Study.为何长期患有物质使用障碍的人会停止滥用物质？一项定性研究。
Subst Abuse. 2018 Feb 7;12:1178221817752678. doi: 10.1177/1178221817752678. eCollection 2018.
3
The Concept of Recovery as Experienced by Persons with Dual Diagnosis: A Systematic Review of Qualitative Research From a First-Person Perspective.双重诊断患者所体验到的康复概念：从第一人称视角对定性研究的系统综述
J Dual Diagn. 2017 Oct-Dec;13(4):264-279. doi: 10.1080/15504263.2017.1349977. Epub 2017 Jul 12.
4
Noncompliance, Nonadherence, and Dropout: Outmoded Terms for Modern Recovery-Oriented Mental Health.不依从、不坚持和脱落：过时的现代以康复为导向的心理健康术语。
Psychiatr Serv. 2017 Oct 1;68(10):1076-1078. doi: 10.1176/appi.ps.201600522. Epub 2017 Jul 3.
5
Community Mental Health Care Providers' Understanding of Recovery Principles and Accounts of Directiveness with Consumers.社区心理健康护理提供者对康复原则的理解和对消费者的直接指导。
Psychiatr Q. 2017 Dec;88(4):755-767. doi: 10.1007/s11126-017-9495-x.
6
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7
Beyond measures and monitoring: Realizing the potential of feedback-informed treatment.超越测量与监测：实现基于反馈的治疗的潜力。
Psychotherapy (Chic). 2015 Dec;52(4):449-57. doi: 10.1037/pst0000031.
8
Sample Size in Qualitative Interview Studies: Guided by Information Power.定性访谈研究中的样本量：以信息力为导向
Qual Health Res. 2016 Nov;26(13):1753-1760. doi: 10.1177/1049732315617444. Epub 2016 Jul 10.
9
"Walking alongside:" collaborative practices in mental health and substance use care.“并肩同行”：精神健康和物质使用照护中的协作实践。
Int J Ment Health Syst. 2014 Dec 17;8(1):55. doi: 10.1186/1752-4458-8-55. eCollection 2014.
10
Dual recovery among people with serious mental illnesses and substance problems: a qualitative analysis.严重精神疾病和物质问题患者的双重康复：一项定性分析。
J Dual Diagn. 2015;11(1):33-41. doi: 10.1080/15504263.2014.975004. Epub 2014 Dec 9.
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