Beine K H
Hans-Prinzhorn-Klinik, Hemer.
Wien Med Wochenschr. 1995;145(6):143-7.
The phenomenon of patient homicides committed by health service employees has, in the previous years, repeatedly aroused much attention. The cases made known in Germany, the USA, Holland, Norway, and Austria appear to provide evidence to the effect that we are not only dealing with unique incidents. The scientific investigation of this especially sensitive taboo-topic is, to date, missing. The judicial trials carried out emphatically indicate that culprit motives, colleague behavior, but also to a large extent decisions made by superiors remain unclear. It remains controversial, what effect working conditions, strain of employees, their level of education and personal viewpoints over such criminal acts they possess. Finally, the long latency period between the first internal suspicions and the responsible parties' appropriate reactions requires duplicatable explanation. The following paper presents a German single-case study of patient homicide by a female nurse. The focus on causality rests on the presentation of developments up to the point where the long-fermenting suspicion could no longer be dismissed, and appropriate consequences took place. The account largely avoids the "definite" findings required during the judicial process. It concerns rather above all an open, uncertain, and possibly without external influence course of development which in stages each colleague in the health professions can trace, to the point where the uncertain and horrifying suspicion became a certainty. With this single-case study in hand it is made understandable in which ways personal circumstances and professional conditions at the worksituation can intertwine in such a way that the original motivation to help turns into its abysmal opposite. It is the author's intention to make preventive learning possible through this single case study. Every employee in the health professions should proceed on the assumption that such occurrences could also in his own field of work come to pass. In this respect, it is of considerable importance to differentiate between hasty and untenable incriminations and original increasing early-warning signs.
在过去几年中，医疗卫生服务人员实施的患者凶杀现象屡屡引发广泛关注。德国、美国、荷兰、挪威和奥地利披露的相关案例似乎表明，此类事件并非个例。然而，迄今为止，针对这一特别敏感的禁忌话题仍缺乏科学调查。已开展的司法审判明确显示，犯罪动机、同事行为，乃至上级在很大程度上所做的决策都尚不明确。工作条件、员工压力、他们的教育水平以及个人观点对此类犯罪行为究竟有何影响，这一点仍存在争议。最后，从首次内部怀疑到责任方做出适当反应之间漫长的潜伏期，需要得到可重复验证的解释。以下论文呈现了一个德国女护士杀害患者的单案例研究。对因果关系的关注聚焦于事件发展过程的呈现，直至长期酝酿的怀疑再也无法被忽视，并产生了相应后果。该叙述在很大程度上避免了司法程序所需的“确定性”结论。它主要涉及一个开放、不确定且可能不受外部影响的发展过程，医疗卫生行业的每位同事都能逐步追溯到这一过程，直至不确定且可怕的怀疑变成确定无疑的事实。通过这个单案例研究，可以理解工作环境中的个人情况和职业条件是如何相互交织，致使最初的助人动机转变为其截然相反的极端情况。作者旨在通过这个单案例研究促成预防性学习。医疗卫生行业的每位员工都应假定此类事件也可能在自己的工作领域发生。在这方面，区分草率且站不住脚的指控与最初不断增加的早期预警信号至关重要。
