Department of Nursing, Umeå University, Umeå, Sweden.
Department of Paediatrics, Umeå University, Umeå, Sweden.
Int J Ment Health Nurs. 2019 Feb;28(1):7-21. doi: 10.1111/inm.12519. Epub 2018 Jul 5.
Historically, people with mental ill-health have been isolated from society. Although mental health care has moved from closed to more open forms of care, in many societies care is still provided in locked wards, and people with mental ill-health are sometimes secluded from their fellow patients, families, friends, and visitors. The aim of this study was to illuminate patients' experiences of isolation in psychiatric inpatient care. A systematic review of qualitative research was conducted, and the key findings were subjected to meta-ethnographic synthesis. The findings were twofold: 'being admitted to prison' and 'having access to shelter'. The experience of isolated care as prison-like symbolizes patients' longing for freedom and feeling restricted and limited by rules, stripped of rights, abandoned, controlled, powerless, and unsupported. In contrast, the experience of isolation as shelter symbolizes safety and the opportunity to regain control over one's own situation. A stigmatizing public view holds that people with mental ill-health are dangerous and unpredictable and, therefore, unsafe to themselves and others. Being placed in isolation because these fears contribute to self-stigma among patients. Promoting a sheltered experience in which isolation is used with respect for patients and the reasons are made explicit may encourage recovery. A shift in emphasis in ward culture from observation to engagement is needed to reduce blame, shift patient experiences from prison to shelter, and to support autonomy as a therapeutic intervention.
从历史上看，心理健康状况不佳的人被社会隔离。尽管精神卫生保健已经从封闭的护理形式转变为更加开放的护理形式，但在许多社会中，护理仍然在封闭的病房中提供，而且心理健康状况不佳的人有时会与其他患者、家人、朋友和访客隔离开来。本研究旨在阐明精神科住院患者的隔离体验。对定性研究进行了系统综述，对关键发现进行了元民族志综合。研究结果有两方面：“被送进监狱”和“获得庇护”。隔离护理的体验就像监狱一样，象征着患者对自由的渴望，以及感到受到规则的限制和限制，被剥夺权利、被抛弃、被控制、无能为力和得不到支持。相比之下，隔离作为庇护所的体验象征着安全和重新掌控自己处境的机会。公众对精神疾病患者的污名化观点认为，他们是危险的和不可预测的，因此对自己和他人都不安全。由于这些恐惧导致患者产生自我污名化，因此将患者隔离。提倡尊重患者并明确隔离原因的庇护体验，可能会鼓励康复。需要改变病房文化的重点，从观察转向参与，以减少指责，将患者的体验从监狱转变为庇护所，并将自主权作为一种治疗干预措施。
