Making nursing decision for patients who cannot communicate their own wishes and needs is a common problem in psychiatric and mental health nursing. The aim of this article is to present the findings of a qualitative study focused on situations in which patients do not cooperate with a nursing decision about what should be done for them. The design of the study utilized some steps associated with the grounded theory method. Data were collected from unstructured interviews with 10 British nurses with long experience in psychiatric nursing. By implementing the strategy of constant comparative analysis of the transcribed interviews, it was found that nurses use different types of subtle coercion in order to achieve their own goals for the patient. These goals were justified as being in the best interest of the patient. The main components of subtle coercion are part of a process consisting ofassessing a patient's competency for self-choice; acting strategically; modifying the principle af autonomy; justifying strategies; and reflecting ethically on the action taken. The study indicates that further empirical investigation of clinical situations involving subtle coercion is required. Particular attention should be paid to organizational factors and how these contribute to the use of subtle coercion.

译文

为无法传达自己的意愿和需求的患者做出护理决策是精神科和精神卫生护理中的常见问题。本文的目的是介绍一项定性研究的结果,该研究侧重于患者不配合护理决定应为他们做些什么的情况。研究的设计利用了与扎根理论方法相关的一些步骤。数据是从对10名在精神病护理方面具有长期经验的英国护士的非结构化访谈中收集的。通过实施对转录访谈进行持续比较分析的策略,发现护士使用不同类型的微妙胁迫来实现患者自己的目标。这些目标被认为符合患者的最大利益。微妙胁迫的主要组成部分是评估患者自我选择能力的过程的一部分; 战略行动; 修改自主原则; 合理的策略; 并从道德上反映所采取的行动。研究表明,需要对涉及微妙胁迫的临床情况进行进一步的实证研究。应特别注意组织因素以及这些因素如何有助于使用微妙的胁迫。

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