Kronick Rachel, Kakish Isabella, Gomèz-Carrillo Ana
Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada.
Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.
BMC Health Serv Res. 2024 Dec 6;24(1):1556. doi: 10.1186/s12913-024-11899-9.
Changing public health and hospital protocols during the height of the COVID-19 pandemic shaped the provision of inpatient mental health care. While a growing body of research explores the challenges of restrictions on adult psychiatric wards, the impact on clinical teams and epidemiological trends in youth mental health, no research has explored inpatient psychiatric hospital services for child and adolescent psychiatry during the pandemic. This study seeks to understand how clinicians in Canada working in child and adolescent mental health wards experienced caring for their patients while navigating pandemic hospital restrictions. Following a qualitative descriptive methodology and also drawing on institutional ethnography we generated data using two methods: 1) an online survey of clinicians across the country asking about experiences providing care and COVID restrictions and 2) in-depth, semi-structured interviews with clinicians. Data from 54 surveys and 14 interviews were analyzed using thematic analysis yielding two major themes. First, clinicians felt that clinical care was compromised with likely impact on patient outcomes. Second, respondents reported that the context of the pandemic provoked tensions and resistance within the clinical teams and the institution. Our findings have important implications not only for future public health crises, but also for rethinking how psychiatric care is provided and prioritized. This study points to the need for 1) mechanisms which support collaborative decision making at the institutional level, to ensure regulations are more flexible and can adapt to the needs of child mental health patients; and 2) that child psychiatry prioritize generating spaces of ethical reflection for clinical teams and institutional decision-makers so that paternalism does not trump principles of primum non-nocere (first, do no harm), autonomy and reciprocity.
在新冠疫情高峰期，公共卫生和医院规程的变化影响了住院精神卫生保健的提供。虽然越来越多的研究探讨了成人精神科病房限制措施带来的挑战、对临床团队的影响以及青少年心理健康的流行病学趋势，但尚无研究探讨疫情期间儿童和青少年精神病学的住院精神科医院服务。本研究旨在了解加拿大儿童和青少年精神卫生病房的临床医生在应对疫情期间医院限制措施的同时，是如何照顾患者的。遵循定性描述方法并借鉴机构人种学，我们使用两种方法收集数据：1）对全国临床医生进行在线调查，询问提供护理的经历和新冠疫情限制措施；2）对临床医生进行深入的半结构化访谈。使用主题分析法对54份调查问卷和14次访谈的数据进行分析，得出两个主要主题。首先，临床医生认为临床护理受到了影响，可能对患者预后产生影响。其次，受访者报告称，疫情背景在临床团队和机构内部引发了紧张关系和抵触情绪。我们的研究结果不仅对未来的公共卫生危机具有重要意义，而且对于重新思考精神科护理的提供方式和优先次序也具有重要意义。本研究指出需要：1）建立支持机构层面协作决策的机制，以确保规定更加灵活，能够适应儿童精神卫生患者的需求；2）儿童精神病学应优先为临床团队和机构决策者营造道德反思的空间，以免家长式作风凌驾于“不伤害原则”（首要的是不造成伤害）、自主性和互惠原则之上。
