An exploration of how mental health professionals position themselves in relation to advance statements: and Clinical Research Portfolio

BF Psychology

Glasgow, Angela ; Gumley, Andrew

University:University of Glasgow

Department:Institute of Health and Wellbeing

关键词: advance statements, discourse analysis, professionals.;   

Others  :  http://theses.gla.ac.uk/81329/8/2020GlasgowDClinPsyc.pdf

来源: University of Glasgow

【 摘 要 】

Background & Aims:Despite progressive legislative provisions for Advance Statements (AS), the uptake remains low. This suggests aims of empowering people with human rights on an equal basis with others are not being realised in practice. This study aimed to interview mental health professionals about AS to increase our understanding of low rates of implementation.Methods:Thirteen participants (4 Mental health nurses, 6 community psychiatric nurses and 3 psychiatrists) were recruited. They were purposively sampled because of their involvement in making treatment decisions. They participated in a semi-structured interview which was audio-recorded and transcribed. The data were analysed using Discourse Analysis to explore how participants used language to position themselves in relation to AS.Results:Five positions emerged from the data: Taking Account of Peoples’ Wishes where participants described their understanding of AS; Enabling People to Have Their Say (to a Point), where participants explained that they enable people to become involved in treatment decisions, but only when professionals judged it to be appropriate; We Know What’s Best, where participants used medical discourse when explaining what is best for people, limiting the credibility of AS; Firefighting with Risk where participants described the need to prioritise risk and crisis management over AS; and Leverage and Liability, where participants spoke of the different influences in their work.Conclusions:Legislation is not enough to improve implementation of AS and improving knowledge is unlikely to lead to change. Interventions designed to address the low uptake must consider the complexity of the system which it hopes to change while addressing the disparity in how knowledge derived from lived experience is valued. It is crucial that all stakeholders are involved in these endeavours.