Ambivalent connections: a qualitative study of the care experiences of non-psychotic chronic patients who are perceived as 'difficult' by professionals

BMC Psychiatry

Research Article

Joyce van Ommen¹  Aart Schene²  Berno van Meijel³  Ad Kaasenbrood⁴  Renske Pennings⁴  Giel Hutschemaekers⁵  Bauke Koekkoek⁶ 

[1] Centrum Maliebaan Addiction Care, Tolsteegsingel 2a, 3582, Utrecht, AC, The Netherlands;Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands;InHolland University for Applied Sciences, Mental Health Nursing Research Group, De Boelelaan 1109, 1081, Amsterdam, HV, The Netherlands;ProPersona Mental Health Care, Pro Persona Centre for Education and Science, Wolfheze 2, 6874, Wolfheze, BE, The Netherlands;ProPersona Mental Health Care, Pro Persona Centre for Education and Science, Wolfheze 2, 6874, Wolfheze, BE, The Netherlands;Academic Centre of Social Sciences, Radboud University, Montessorilaan 10, 6525, Nijmegen, HR, The Netherlands;ProPersona Mental Health Care, Pro Persona Centre for Education and Science, Wolfheze 2, 6874, Wolfheze, BE, The Netherlands;Altrecht Mental Health Care, Griffensteijnselaan 202, 3704, Zeist, GA, The Netherlands;

关键词: Mental Health Care;    Personality Disorder;    Psychiatric Service;    Ground Theory;    Psychiatric Clinician;   

DOI  :  10.1186/1471-244X-10-96

 received in 2010-05-26, accepted in 2010-11-24,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundLittle is known about the perspectives of psychiatric patients who are perceived as 'difficult' by clinicians. The aim of this paper is to improve understanding of the connections between patients and professionals from patients' point of view.MethodsA Grounded Theory study using interviews with 21 patients from 12 outpatient departments of three mental health care facilities.ResultsPatients reported on their own difficult behaviours and their difficulties with clinicians and services. Explanations varied but could be summarized as a perceived lack of recognition. Recognition referred to being seen as a patient and a person - not just as completely 'ill' or as completely 'healthy'. Also, we found that patients and professionals have very different expectations of one another, which may culminate in a difficult or ambivalent connection. In order to explicate patient's expectations, the patient-clinician contact was described by a stage model that differentiates between three stages of contact development, and three stages of substantial treatment. According to patients, in each stage there is a therapeutic window of optimal clinician behaviour and two wider spaces below and above that may be qualified as 'toxic' behaviour. Possible changes in clinicians' responses to 'difficult' patients were described using this model.ConclusionsThe incongruence of patients' and professionals' expectations may result in power struggles that may make professionals perceive patients as 'difficult'. Explication of mutual expectations may be useful in such cases. The presented model gives some directions to clinicians how to do this.

【 授权许可】

CC BY   
© Koekkoek et al; licensee BioMed Central Ltd. 2010