Empowerment og disempowerment i psykiatriatrisk sygepleje - imellem muligheder og barrierer

Transkript

1 Empowerment og disempowerment i psykiatriatrisk sygepleje - imellem muligheder og barrierer Kristian A. J. Paaske, cand.cur., adjunkt på UCL Enheden for Sygeplejeforskning, Syddansk Universitet

2 Introduktion Af-institutionalisering Flere debuterer med psykiske lidelser Nyt patientsyn

3 Mental sundhed En tilstand af trivsel, hvor individet kan udfolde sine evner, kan håndtere dagligdags udfordringer og stress samt indgå i menneskelige fællesskaber En tilstand af velvære, i hvilken den enkelte udnytter sine evner, kan klare livets normale belastninger, arbejde produktivt og frugtbart og er i stand til at yde et bidrag til samfundet

4 Empowerment Et omdiskuteret begreb

5 Deltagelse Ægte deltagelse Symbolsk deltagelse

6 Deltagelseskontinuum Ingen kontrol Modtager information konsulteres rådgiver Planlægger sammen Har uddelegeret autoritet Har kontrol

7 Et deltagelseskontinuum Information og forklaring Konsultation Partnerskab Patient/borgerkontrol

8 Hvordan arbejdes, der med patientdeltagelse i behandlingspsykiatrien? Mellem barrierer og muligheder

9 Barrier Begrebet deltagelse Patienten Organisationskulturen Professionskulturen Omkringliggende samfund

10 Deltagelse Begrebet er ikke entydigt

11 Patienten Patienten ønsker ikke at blive inddraget Patienten kan være for syg til at blive inddraget. Usikkerhed/tvivl om hvordan planlægningen af egne mål skulle kunne hjælpe De oplever at mangle evner og viden

12 Organisationskulturen Ofte er rammerne så fastsatte, at der ikke er noget at deltage i Der mangler tid Sygeplejerskerne oplever, at de selv mangler mulighed for deltagelse og ejerskab i eget arbejde

13 Professionskulturen Patientsyn Paternalisme Kommunikation Patienter oplever sig presset til at vælge behandlingsplaner

14 Samfundet NIMBY

15 Muligheder Anerkendelse & Kærlighed

16 Anerkendelse He talks about what he has done and stuff, and not just what I ve done all the time. It is much easier when we can talk back and forth. We talk together. If we are wondering about something, we try to figure it out. Without fussing about it. So there is cooperation; that s what it is about. He talked to you in a very different way. He was completely on ground level. He discussed. He took people seriously no matter what they said I like that people ask me for advice and stuff. 16

17 Kærlighed This means the person with the illness is to be respected as the primary decision-maker in and author of his or her own life. For the practitioner, in addition to honoring each person s autonomy, this requires a rethinking of the traditional therapeutic stance of abstinence or neutrality, inherited from psychoanalysis, in favor of a more engaged, compassionate stance that we suggest falls under the broad rubric of love.

18 Hvordan kan vi i fremtiden arbejde med patientdeltagelse? Et kritisk aktionsforskningsperspektiv

19 Mange tak

20 Litteratur Bennetts, W., Cross, W., & Bloomer, M. (2011). Understanding consumer participation in mental health: Issues of power and change. International Journal of Mental Health Nursing, 20(3), doi: /j x Corrigan, P. W., & Miller, F. E. (2004). Shame, blame, and contamination: A review of the impact of mental illness stigma on family members. Journal of Mental Health, 13(6), Davidson, L., Lawless, M. S., & Leary, F. (2005). Concepts of recovery: Competing or complementary? Current Opinion in Psychiatry, 18(6), Davidson, L., O'Connell, M., Tondora, J., Styron, T., & Kangas, K. (2006). The top ten concerns about recovery encountered in mental health system transformation. Psychiatric Services, 57(5), Davidson, L., Stayner, D. A., Lambert, S., Smith, P., & Sledge, W. H. (2010). Phenomenological and participatory research on schizophrenia: Recovering the person in theory and practice. Journal of Social Issues, 53(4), nurses' attitudes toward consumer and carer participation in care: Part 1 exploring the issues. Policy, Politics, & Nursing Practice, 8(4), Goodwin, V., & Happell, B. (2008). Psychiatric nurses' attitudes toward consumer and carer participation in care part 2 Barriers to participation. Policy, Politics, & Nursing Practice, 9(4),

21 Happell B. (2008). Polarisation and political correctness: Subtle barriers to consumer participation in mental health services. Australian ejournal for the Advancement of Mental Health, 7(3) Lewis, M., & Urmston, J. (2000). Flogging the dead horse: The myth of nursing empowerment? Journal of Nursing Management, 8(4), doi: /j x Lindhardt, A. (2008). Mental sundhed og folkesundhed: Effekt af interventioner til fremme af mental sundhed og forebyggelse af psykiske forstyrrelser blandt voksne: Et kommenteret resumé (Version: 1,0 ed.) Sundhedsstyrelsen. Linhorst, D. M., Hamilton, G., Young, E., & Eckert, A. (2002). Opportunities and barriers to empowering people with severe mental illness through participation in treatment planning. Social Work, 47(4), doi: /sw/ Simovska, V., & Jensen, J. M. (2012). Sundhedspædagogik i sundhedsfremme (1. udgave ed.). [Kbh.]: Gad. SPENCE LASCHINGER, H. K., GILBERT, S., SMITH, L. M., & LESLIE, K. (2010). Towards a comprehensive theory of nurse/patient empowerment: Applying kanter?s empowerment theory to patient care. Journal of Nursing Management, 18(1), doi: /j x Stenhouse, R. C. (2011). They all said you could come and speak to us : Patients' expectations and experiences of help on an acute psychiatric inpatient ward. Journal of Psychiatric and Mental Health Nursing, 18(1), STRINGER, B., VAN MEIJEL, B., DE VREE, W., & VAN DER BIJL, J. (2008). User involvement in mental health care: The role of nurses. A literature review. Journal of Psychiatric and Mental Health Nursing, 15(8), doi: /j x