Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.
Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.
J Psychiatr Ment Health Nurs. 2022 Apr;29(2):287-296. doi: 10.1111/jpm.12800. Epub 2021 Oct 1.
WHAT IS KNOWN ON THE SUBJECT?: Involuntary treatment orders are increasingly being used around the world to allow the treatment of individuals living with a mental illness deemed incapable of giving consent and who are actively refusing treatment. The use of involuntary treatment orders can impact the nurse-patient therapeutic relationship, which is essential to offer quality care and promote recovery. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Nurses and patients do not agree on the possibility to develop a therapeutic relationship, with nurses believing they can build a bond with the patients despite the challenges imposed by the involuntary treatment order, and patients rejecting this possibility. Nurses caring for patients on involuntary treatment orders feel obligated to apply the conditions of this measure, even if it damages the relationship with their patients. This difficult aspect of their work leads them to question their role in relation to the management of involuntary treatment orders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses need to be aware of the reasons why patients on involuntary treatment orders do not believe in the possibility of building a therapeutic relationship. Nurses need to reflect on and express their concerns about the damaging effects that managing involuntary treatment orders conditions can have on the nurse-patient therapeutic relationship. ABSTRACT: Introduction Involuntary treatment orders (ITO) can impact the nurse-patient therapeutic relationship (TR) negatively. Despite the increasing use of ITOs around the world, few studies have explored their influence on the TR from the perspectives of nurses and patients. Aim To describe the TR in the context of ITOs as reported by nurses and individuals living with a mental illness. Method Secondary data analysis of qualitative interviews with nurses (n = 9) and patients (n = 6) was performed using content analysis. Results Participants described the TR as fundamentally embedded in a power imbalance amplified by the ITO, which was discussed through the conflicting roles of nurses, the legal constraints imposed on patients and nurses, the complex relation between the ITO and the TR, and the influence of mental healthcare settings' context. Discussion Nurses and patients' views were opposed, questioning the authenticity of the relationship. Implications for Practice Nurses should be aware of the patients' lack of faith in the TR to ensure that they are sensitive to patients' behaviours that may falsely suggest that a relationship is established. Further studies should explore ways to alleviate the burden of the management of ITOs on nurses and allow for a trusting relationship to be build.
已知信息：在世界各地，越来越多地使用非自愿治疗令来允许对被认为无法同意治疗且积极拒绝治疗的患有精神疾病的个人进行治疗。非自愿治疗令的使用会影响护士与患者的治疗关系，这对于提供优质护理和促进康复至关重要。 新增信息：护士和患者对建立治疗关系的可能性存在分歧，护士认为他们可以与患者建立联系，尽管非自愿治疗令带来了挑战，但患者拒绝了这种可能性。尽管非自愿治疗令的条件具有挑战性，但照顾这些患者的护士仍感到有义务遵守这些条件。这项工作的困难方面使他们对自己在管理非自愿治疗令方面的角色产生了质疑。 实践意义：护士需要了解为什么接受非自愿治疗令的患者不相信建立治疗关系的可能性。护士需要反思并表达他们对管理非自愿治疗令条件对护士与患者治疗关系的破坏性影响的担忧。 摘要：引言 非自愿治疗令（ITO）会对护士与患者的治疗关系（TR）产生负面影响。尽管世界各地越来越多地使用 ITO，但很少有研究从护士和患有精神疾病的患者的角度探讨其对 TR 的影响。 目的 描述 ITO 背景下护士和患者报告的 TR。 方法 使用内容分析法对 9 名护士和 6 名患者的定性访谈进行二次数据分析。 结果 参与者描述了 TR，认为其从根本上嵌入在权力失衡中，这种失衡是由 ITO 放大的，讨论涉及护士的冲突角色、对患者和护士施加的法律限制、ITO 与 TR 之间的复杂关系以及精神卫生保健环境的影响。 讨论 护士和患者的观点存在分歧，质疑关系的真实性。 实践意义 护士应意识到患者对 TR 的缺乏信任，以确保他们对患者的行为保持敏感，这些行为可能会错误地暗示建立了关系。进一步的研究应该探索减轻管理 ITO 对护士的负担并允许建立信任关系的方法。
