I went to a workshop on CBT (cognitivebehavioural therapy) for psychosis this week and it was very well done. The presenter was a Dr from Britain and he was lovely-down to earth, funny, with a lot of good information. As he presented you could easily understand his perspective on mental illness/psychiatry-which was that the person with the disorder was the expert in their life and what they needed to be well-rather than the medical system telling people what they needed to improve things.
This is a perspective that I believe is sorely needed in health care and especially psychiatry. I suppose by my statement it could be presumed that *I* am the one calling the shots by telling health care providers what they need to do, but to be honest I think that ethics and ethical care are not relative theories based upon what each person deems ethical. I think that ethical care can be brought down to right/wrong, good/bad in some situations. We need to be gathering perspectives, respect different cultures, and respect individual choice, but in the case of people providing care I believe that there should not be an option in terms of whether following ethical practice. Too often in psychiatry I think that we dismiss the patient's rights/beliefs/thoughts/ choice and cover ourselves with the thought that 'oh, they can't decide that right now, they aren't capable of making that decision' and don't look for ways in which people can manage their own care. We have case conferences where everyone except the patient is there determining the course of their life. We force people to take medications that we ourselves wouldn't touch with a 10 foot pole and then wonder why they 'go off their meds'. We enforce blanket rules with little consideration for individual need and then wonder whay someone 'acts out' when getting frustrated. We certify people, taking away their right to move freely, make life impacting decisions about own health care and then wonder why they get mad at us and resist being involved in the health system.
I get frustrated when our college of nursing responds to poor ethical practice with the reply, 'well, you have to work within the system, it'll confuse the patient if you don't follow the system's way of doing things' even when the way of doing things does not fall within best practice, prudent nursing, or minimal ethical standards. Can someone explain to me how this is OK? Why is this allowed? Why aren't people fighting this?
Before you know it, I'll be the weird activist standing outside health care facilities with a sign, people giving me funny looks as they make a large circle to avoid me.
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This is very interesting. I have often heard the statement that a person cannot be forced into change; that she/he must make that decision (in the context of addiction, etc.). But even when someone makes the decision to try and kick a habit or look after their health, they haven't made that decision in full awareness of all the demands and restrictions within the healthcare system. So perhaps we are not aware of the ways in which the system makes people's attempts for getting well harder, rather than helpful.
ReplyDeleteAlso; could you insert more paragraph breaks or greater line spacing so your posts are easier to read? I really like reading this but sometimes it's a bit dense. Or I am.
ReplyDeleteI'll refrain from commenting. ha. Thanks for info!
ReplyDeleteBut I thought in health care the professionals have gone to school for years so they know how to give people what works. What's all this about doing it ourselves? What do we know about anything? I am not being tongue-in-cheek here. I really mean it.
ReplyDeleteWell, idea is that we offer knowledge to people-but that people know best how they feel and what helps them feel better as after all-how could we know that? And also involved in that is the idea that health and well being are not a either or thing-health is a continuum and everyone finds themselves in different places within that line. This could mean that though I might look at you as a nurse and think, 'sheesh, you're sure making poor health choices and don't have good health' and you might say, 'thanks very much, I'm actually pretty good' As health care professionals we do have lots of info to share-but also need to learn from person what it is that they see as the issue and what they need. If I presume that the problem is one thing-like say, patient needs to learn about their new diagnosis of diabetes and how to inject insulin, but that all they can think about right now is how much they hate needles and are worried that they will die-I need to learn from them what is going on and share information that they determine is important. Obviously I need to ensure that they know what is happening and how to look after themselves, but focus is on what person needs, rather than my schedule or what I think is important. So, I would spend more time talking about their fears and go over realistic prognosis for diabetes and help them adjust to having injections. rather than here's the needle and here's how you do it.
ReplyDeleteMake sense?