Decorte Ilse, Verfaillie Françoise, Moureau Loïc, Meynendonckx Sandrine, Van Ballaer Kim, De Geest Isabelle, Liégeois Axel
OPZ, Geel, Belgium.
Gezondheidszorg Bermhertigheid Jesu, Brugge, Belgium.
Front Psychiatry. 2020 Jun 8;11:509. doi: 10.3389/fpsyt.2020.00509. eCollection 2020.
Oyster Care is the result of the search by caregivers in Flanders, Belgium, to develop quality care for patients with a Severe and Persistent Mental Illness (SPMI). This article offers a conceptual analysis of the Oyster Care model, based on experiences, analysis, and reflection of the authors, and on several examples. The starting point of the development of this new care model is the complex and difficult context of the care for SPMI patients. Their needs and suffering are very challenging on account of a wide variety of causes. At the same time they are in danger of being neglected by the care system. Paradoxically, the development and implementation of psychosocial rehabilitation in Belgian mental health care puts the care for these patients under pressure. In practice, they are often exposed to over- or under-treatment. Another aspect that has influenced the search for more qualitative care in cases of severe psychological suffering in general and palliative approaches in particular is the background of the legal regulation of euthanasia in Belgium. Oyster Care is an innovative form of the palliative approach and philosophy, tailored to the specific target group of SPMI patients. The caregivers create an "exoskeleton" or "shell" in which SPMI patients can "come to life": they are mainly dependent on the "external structure" they receive in order to function, rather than on the "internal structure" of their abilities. It is a dynamic approach that responds to the needs, possibilities and pace of each patient: within this safety, people can fold back or take new steps. Oyster Care is also a holistic care approach, based on four pillars: physical care adequately responding to the somatic impairments of these patients; psychological care changing the scope of therapy by focusing on mental comfort and wellbeing; social care providing a structure of daily activities and contacts; existential care enhancing the experience of life as valuable and meaningful. The wellbeing of patients is paramount and requires a range of interventions, such as a highly personal approach, a flexible dealing with rules, a great dose of creativity in everyday life, extensive expertise in somatic care, and specific attention to existential needs and the search for meaning. The development of this care model in a number of care units in Flanders increases the wellbeing of the patients and creates a significant positive dynamic among caregivers. However, more research and resources are needed to further develop and integrate this model.
“牡蛎关怀”是比利时弗拉芒地区的护理人员为重度持续性精神疾病（SPMI）患者开发优质护理的成果。本文基于作者的经验、分析和思考以及若干实例，对“牡蛎关怀”模式进行了概念分析。这种新护理模式发展的起点是SPMI患者护理工作复杂且艰难的背景。由于多种原因，他们的需求和痛苦极具挑战性。与此同时，他们面临着被护理系统忽视的风险。矛盾的是，比利时精神卫生保健中社会心理康复的发展与实施给这些患者的护理带来了压力。在实践中，他们常常遭受过度治疗或治疗不足。影响人们寻求针对一般严重心理痛苦情况尤其是姑息治疗方法的更优质护理的另一个因素是比利时安乐死法律监管的背景。“牡蛎关怀”是一种创新的姑息治疗方法和理念，专门针对SPMI患者这一特定目标群体。护理人员构建了一个“外骨骼”或“外壳”，让SPMI患者能够在其中“焕发生机”：他们主要依赖所获得的“外部结构”来发挥功能，而非自身能力的“内部结构”。这是一种动态方法，能回应每位患者的需求、可能性和节奏：在这种安全环境中，人们可以退缩或迈出新的步伐。“牡蛎关怀”也是一种整体护理方法，基于四大支柱：身体护理充分应对这些患者的躯体损伤；心理护理通过关注心理舒适和幸福感来改变治疗范围；社会护理提供日常活动和社交联系的架构；存在关怀提升对有价值且有意义生活的体验。患者的幸福至关重要，需要一系列干预措施，比如高度个性化的方法、灵活对待规则、日常生活中极大的创造力、躯体护理方面的广泛专业知识，以及对存在需求和意义探寻的特别关注。在弗拉芒的一些护理单元中这种护理模式的发展提升了患者的幸福感，并在护理人员中营造了显著的积极氛围。然而，需要更多研究和资源来进一步发展和整合这一模式。
