Kumpula Esa, Gustafsson Lena-Karin, Ekstrand Per
School of Health, Care and Social Welfare, Mälardalens University Västerås.
School of Health, Care and Social Welfare, Mälardalens University Eskilstuna, Sweden.
J Forensic Nurs. 2019 Jan/Mar;15(1):52-59. doi: 10.1097/JFN.0000000000000227.
Although forensic psychiatric care is located at the intersection of health care and the Swedish legal system, nursing research has not yet evaluated how language is context bound or its consequences for understanding patient care. The aim of this study was to explore how nursing staff talk about patient care in Swedish forensic psychiatric care and the implications for the care given to patients. The theoretical framework is based on social constructionism and sheds light on how language use can be understood as a social action. Twelve interviews were conducted with nursing staff working in forensic psychiatric settings. The questions focused on patient care in relation to activities, security, relationships with patients, and rules and routines. The results show that nursing staff assignments are encouraging them to use various interpretative repertoires to make meaning about their practice. The three interpretative repertoires were "taking responsibility for correcting patients' behavior," "justifying patient care as contradictory practice," and "patients as unpredictable." However, although forensic psychiatric care emphasizes both security and care, nursing staff's use of these interpretative repertoires provided multiple interpretations that lead to contradictory ways of understanding patient care. These findings show that talk itself can be understood as problematic in various situations. A possible implication for clinical forensic nursing practice might be that the nurse-patient relationship does not support patients' best interests. For example, when language endows the patient with certain characteristics, this talk is justified and given meaning by its context and thus has an influence on a patient's individual need for care.
尽管法医精神病护理处于医疗保健与瑞典法律体系的交叉点，但护理研究尚未评估语言是如何受情境限制的，以及其对理解患者护理的影响。本研究的目的是探讨瑞典法医精神病护理中的护理人员如何谈论患者护理，以及这对给予患者的护理有何影响。理论框架基于社会建构主义，揭示了语言使用如何可被理解为一种社会行为。对在法医精神病环境中工作的护理人员进行了12次访谈。问题集中在与活动、安全、与患者的关系以及规则和常规相关的患者护理方面。结果表明，护理人员的任务促使他们使用各种解释性方法来理解自己的实践。三种解释性方法分别是“负责纠正患者行为”、“将患者护理视为矛盾的实践进行辩护”以及“患者不可预测”。然而，尽管法医精神病护理强调安全和护理，但护理人员对这些解释性方法的使用提供了多种解释，导致对患者护理的理解相互矛盾。这些发现表明，在各种情况下，言语本身可能被视为有问题的。对临床法医护理实践的一个可能影响可能是护患关系并不支持患者的最大利益。例如，当语言赋予患者某些特征时，这种言语会因其情境而被合理化并赋予意义，从而对患者的个体护理需求产生影响。
