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护士在与表现出冲突行为的患者合作时培养治疗性护患关系的观点。

Nurses' Perspectives on Fostering Therapeutic Relationships While Working With Clients Who Display Conflict Behaviour.

作者信息

Overpelt Nick, Kool-Goudzwaard Nienke, Stringer Barbara, van Meijel Berno

机构信息

Centre for Intensive Treatment, Parnassia Group, The Hague, The Netherlands.

Centre for Consultation and Expertise, Gouda, The Netherlands.

出版信息

Int J Ment Health Nurs. 2025 Feb;34(1):e13441. doi: 10.1111/inm.13441. Epub 2024 Sep 27.

Abstract

Therapeutic relationships are critical in the treatment of mental health disorders. Some clients experiencing mental health disorders display conflict behaviour-for example, suicidal or self-harming behaviour, threats of or actual aggression, and various psychotic behaviours-which presents significant challenges for care professionals. In inpatient mental health units, where interactions with mental health nurses are frequent, managing conflict behaviour is crucial to maintaining care quality and fostering therapeutic progress. This study aims to describe nurses' perspectives on fostering therapeutic relationships while working with clients who display conflict behaviour. Qualitative research was conducted in a specialised treatment setting for such clients by means of individual semi-structured interviews and a focus group interview with nurses. The results show that the nurses' primary focus is on cooperating with clients and colleagues. Regardless of conflict behaviour, nurses consistently invite clients to cooperate. To do so, they must manage their own emotions and expectations, emphasise the clients' responsibility and reduce the opportunities for conflict behaviour. The unit structure helps nurses by reducing ambiguity regarding treatment policies and inconsistencies in nurse-client interactions and allows nurses and clients to experience feelings of safety. To work with conflict behaviour, nurses need to feel valued and supported by their colleagues and have adequate time and resources. In conclusion, this study shows how nurses foster therapeutic relationships with clients who display conflict behaviour by focusing on cooperation, structure and safety.

摘要

治疗关系在心理健康障碍的治疗中至关重要。一些患有心理健康障碍的客户表现出冲突行为,例如自杀或自伤行为、威胁或实际攻击行为以及各种精神病行为,这给护理专业人员带来了重大挑战。在住院心理健康病房,与心理健康护士的互动频繁,管理冲突行为对于维持护理质量和促进治疗进展至关重要。本研究旨在描述护士在与表现出冲突行为的客户合作时对建立治疗关系的看法。通过对护士进行个人半结构化访谈和焦点小组访谈,在针对此类客户的专门治疗环境中进行了定性研究。结果表明,护士的主要重点是与客户和同事合作。无论冲突行为如何,护士始终邀请客户合作。为此,他们必须管理自己的情绪和期望,强调客户的责任,并减少冲突行为的机会。病房结构通过减少治疗政策的模糊性和护患互动中的不一致性来帮助护士,并让护士和客户体验到安全感。为了应对冲突行为,护士需要感到得到同事的重视和支持,并拥有足够的时间和资源。总之,本研究展示了护士如何通过关注合作、结构和安全来与表现出冲突行为的客户建立治疗关系。

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