Schippert Ana Carla S P, Grov Ellen Karine, Dahl-Michelsen Tone, Silvola Juha, Sparboe-Nilsen Bente, Danielsen Stein Ove, Lie Irene, Bjørnnes Ann Kristin
Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway; Akershus University Hospital, Oslo, Norway.
Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.
Soc Sci Med. 2023 Apr;323:115775. doi: 10.1016/j.socscimed.2023.115775. Epub 2023 Feb 25.
The number of torture survivors is on the rise, posing issues for their care in healthcare settings. Even healthcare experts with training in refugee care are unaware of the health difficulties faced by torture survivors. Any medical evaluation or treatment has the potential to re-traumatize torture survivors, thereby reactivating trauma symptoms without applicable guidelines to prevent re-traumatization.
Our objective was to identify, characterize, evaluate, and organize current, available evidence presenting existing recommendations and suggestions to prevent re-traumatization during the treatment of torture survivors' physical diseases in healthcare services.
A comprehensive search of electronic databases was conducted. Gray literature coverage was obtained by searching for publications from relevant associations and healthcare organizations focusing on torture survivors. Clinical practice guidelines (CPGs) and research focusing on somatic healthcare services for adult torture survivors, regardless of study design, were eligible for review. Studies that concentrated on psychiatric departments were excluded. To conduct an overview of the available research and describe the scope and distribution of evidence, a mapping review methodology was used.
Forty out of 13,111 initial citations met our criteria. There were two guidelines, and text and opinion statements predominated. Two authors independently assessed the risk of bias in each primary research study using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for the research design.
This mapping review identifies triggers that may re-traumatize torture survivors during treatment and makes recommendations for prevention. Only a few studies have considered torture survivors' perspectives on treatment and re-traumatization. According to the findings of the mapping review, healthcare providers should consider survivors' biopsychosocial situations, demonstrate cultural sensitivity, and change theirpersonal attitudes . They must also identify tortured patients and determine when professional interpreters should be used.
酷刑幸存者的数量在不断增加，这给医疗环境中对他们的护理带来了问题。即使是接受过难民护理培训的医疗专家，也不清楚酷刑幸存者所面临的健康困境。任何医学评估或治疗都有可能再次伤害酷刑幸存者，从而在没有适用指南来防止再次创伤的情况下重新引发创伤症状。
我们的目的是识别、描述、评估和整理当前现有的证据，提出在医疗服务中治疗酷刑幸存者身体疾病时预防再次创伤的现有建议。
对电子数据库进行了全面搜索。通过搜索关注酷刑幸存者的相关协会和医疗组织的出版物，获取灰色文献。纳入审查的是针对成年酷刑幸存者躯体医疗服务的临床实践指南（CPG）和研究，无论其研究设计如何。专注于精神科的研究被排除。为了对现有研究进行概述并描述证据的范围和分布，采用了映射综述方法。
13111条初始引文中有40条符合我们的标准。有两项指南，文本和意见陈述占主导。两位作者使用乔安娜·布里格斯研究所（JBI）研究设计批判性评估清单，独立评估了每项主要研究中的偏倚风险。
这项映射综述确定了在治疗过程中可能再次伤害酷刑幸存者的触发因素，并提出了预防建议。只有少数研究考虑了酷刑幸存者对治疗和再次创伤的看法。根据映射综述的结果，医疗服务提供者应考虑幸存者的生物心理社会状况，表现出文化敏感性，并改变个人态度。他们还必须识别受折磨的患者，并确定何时应使用专业口译员。
