Centre for Non-Adversarial Justice, Law School, Auckland University of Technology, Auckland, New Zealand.
Faculty of Law, University of Otago, Dunedin, New Zealand.
Int J Ment Health Nurs. 2019 Dec;28(6):1296-1305. doi: 10.1111/inm.12637. Epub 2019 Jul 30.
Advance directives allow users of mental health services to make statements for their future care. In New Zealand, use of advance directives is supported by the Health and Disability Commissioner and was identified in the 2012 Blueprint as a key mechanism for service users to advocate for responses they find most helpful. This study used a qualitative descriptive methodology involving focus groups to explore the perceptions of service users, whānau and peer support workers concerning advance directives. Thematic analysis revealed certain belief patterns about what should or could be included in an advance directive, and about how and with whom one should be created. It revealed generally positive perceptions about how they can uphold service users' right to have preferences considered, to plan flexibly around dynamic needs, and about their value and utility. We conclude that advance directives can support services users' expressions of their preferences for care, but they need to be supported by clinicians if they are to realize this potential. Our findings can also inform service provision in New Zealand, and the planned reform of mental health legislation.
预先指示允许精神卫生服务使用者为未来的护理做出陈述。在新西兰，健康和残疾专员支持使用预先指示，并在 2012 年的蓝图中确定其为服务使用者倡导他们认为最有帮助的反应的关键机制。本研究采用定性描述性方法，包括焦点小组，探讨了服务使用者、whānau 和同伴支持工作者对预先指示的看法。主题分析揭示了关于预先指示中应包含或可以包含哪些内容，以及应如何以及与谁一起创建的某些信念模式。它普遍对如何维护服务使用者考虑其偏好、灵活规划动态需求以及其价值和实用性的权利持积极看法。我们的结论是，预先指示可以支持服务使用者表达他们对护理的偏好，但如果要实现这一潜力，就需要临床医生的支持。我们的研究结果还可以为新西兰的服务提供提供信息，并为精神卫生立法的计划改革提供信息。
