精神科住院病房隔离的伦理挑战：挪威精神卫生专业人员经验的定性研究。
Ethical challenges of seclusion in psychiatric inpatient wards: a qualitative study of the experiences of Norwegian mental health professionals.
机构信息
Innlandet Hospital Trust, Department of Acute Psychiatry and Psychosis Treatment Sanderud, 2312, Ottestad, Norway.
Mental Health Services, Akershus University Hospital, Box 1000, 1478, Lørenskog, Norway.
出版信息
BMC Health Serv Res. 2019 Nov 21;19(1):879. doi: 10.1186/s12913-019-4727-4.
BACKGROUND
Seclusion is an invasive clinical intervention used in inpatient psychiatric wards as a continuation of milieu therapy with vast behavioural implications that raise many ethical challenges. Seclusion is in Norway defined as an intervention used to contain the patient, accompanied by staff, in a single room, a separate unit, or an area inside the ward. Isolation is defined as the short-term confinement of a patient behind a locked or closed door with no staff present. Few studies examine how staff experiences the ethical challenges they encounter during seclusion. By making these challenges explicit and reflecting upon them, we may be able to provide better care to patients. The aim of this study is to examine how clinical staff in psychiatric inpatient wards describes and assess the ethical challenges of seclusion.
METHODS
This study was based on 149 detailed written descriptions of episodes of seclusion from 57 psychiatric wards. A descriptive and exploratory approach was used. Data were analysed using qualitative content analysis.
RESULTS
The main finding is that the relationship between treatment and control during seclusion presents several ethical challenges. This is reflected in the balance between the staff's sincere desire to provide good treatment and the patients' behaviour that makes control necessary. Particularly, the findings show how taking control of the patient can be ethically challenging and burdensome and that working under such conditions may result in psychosocial strain on the staff. The findings are discussed according to four core ethical principles: autonomy, beneficence, non-maleficence, and justice.
CONCLUSION
Ethical challenges seem to be at the core of the seclusion practice. Systematic ethical reflections are one way to process the ethical challenges that staff encounters. More knowledge is needed concerning the ethical dimensions of seclusion and alternatives to seclusion, including what ethical consequences the psychosocial stress of working with seclusion have for staff.
背景
隔离是一种侵入性的临床干预措施，在住院精神病病房中作为环境治疗的延续，具有广泛的行为影响，引发了许多伦理挑战。在挪威，隔离被定义为一种干预措施，用于在有工作人员陪同的情况下将患者限制在一个单独的房间、一个单独的单元或病房内的一个区域。隔离被定义为将患者短期限制在锁着或关闭的门后，没有工作人员在场。很少有研究探讨工作人员在隔离期间所经历的伦理挑战。通过明确这些挑战并进行反思，我们也许能够为患者提供更好的护理。本研究旨在探讨精神科住院病房的临床工作人员如何描述和评估隔离的伦理挑战。
方法
本研究基于来自 57 个精神病病房的 149 个详细的隔离事件书面描述。采用描述性和探索性方法。使用定性内容分析对数据进行分析。
结果
主要发现是，隔离期间的治疗和控制之间的关系呈现出若干伦理挑战。这反映在工作人员真诚提供良好治疗的愿望与患者行为之间的平衡，这种行为需要进行控制。特别是，研究结果表明，对患者进行控制可能在伦理上具有挑战性和负担，在这种条件下工作可能会给工作人员带来心理社会压力。根据自主、善行、不伤害和公正四项核心伦理原则对研究结果进行了讨论。
结论
伦理挑战似乎是隔离实践的核心。系统的伦理反思是处理工作人员遇到的伦理挑战的一种方法。需要更多地了解隔离的伦理维度和隔离的替代方法，包括工作人员在处理隔离时的心理社会压力对其产生的伦理后果。
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