Multi-Disciplinary Studies, Achva Academic College, Shikmim, Israel.
Educational Psychology, Achva Academic College, Shikmim, Israel.
Front Public Health. 2022 Jul 8;10:919516. doi: 10.3389/fpubh.2022.919516. eCollection 2022.
Patient-centered care calls to contain patients in their time of crisis. This study extends the knowledge of provider patient interactions in the hectic environment of acute care applying Bion's container-contained framework from psychoanalysis.
Following ethical approval, we performed a narrative inquiry of the experiences of ten patients upon discharge from lengthy hospitalizations in acute care. Interviews were conducted upon discharge and about one-month post-discharge.
Data analysis suggests four modes of containing of patients by providers. In nurturing interactions, typical of an active container-contained mode, patients experienced humanized care, symptom control, hope, and internal locus of control. This mode yielded patient gratitude toward providers, wellbeing, and post-discharge self-management of diseases. In rigid and wall-free modes of containing, patients experienced a sense of powerlessness and discomfort. A new mode of container-contained was identified, the "Inverted Container", which extends Bion's theory and contradicts patient-centered care. In inverted containers, patients contained the providers yet reported feeling gratitude toward providers. The gratitude constitutes a defense mechanism and reflects a traumatic experience during hospitalization, which led to post-discharge distrust in providers and hospitals and poor self-management of illness.
To effectively provide patient-centered care, provider-patient interaction in lengthy hospitalizations must move along a clinical axis and a relationship axis. This shifting may facilitate containing patients in their time of crisis so essential processes of reflection, projection, and transference are facilitated in-hospital care.
以患者为中心的护理呼吁在患者危机时期对其进行护理。本研究扩展了在急性护理繁忙环境中提供者与患者互动的知识，应用了从精神分析中借鉴而来的 Bion 的容器-被容器容纳框架。
在获得伦理批准后，我们对 10 名患者在急性护理中长时间住院后的出院经历进行了叙述性探究。在出院时和出院后大约一个月进行了访谈。
数据分析表明，提供者对患者有四种容纳方式。在培育性互动中，提供者以积极的容器-被容器容纳模式为患者提供人性化的护理、控制症状、给予希望并增强其内部控制感。这种模式使患者对提供者产生感激之情，感到健康，并在出院后自我管理疾病。在刚性和无墙的容纳模式中，患者感到无能为力和不适。识别出一种新的容器-被容器容纳模式，即“倒置容器”，它扩展了 Bion 的理论并与以患者为中心的护理相矛盾。在倒置容器中，患者容纳提供者，但仍对提供者表示感激。这种感激是一种防御机制，反映了住院期间的创伤经历，导致患者在出院后对提供者和医院失去信任，并自我管理疾病的能力较差。
为了有效地提供以患者为中心的护理，在长时间住院期间，提供者与患者的互动必须沿着临床轴和关系轴进行。这种转变可以促进在患者危机时期对其进行护理，从而在住院期间促进反思、投射和转移等必要过程。
