Managing Professional and Nurse–Patient Relationship Boundaries in Mental Health

2017 ◽  
Vol 55 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Sharon M. Valente
Keyword(s):  
Mental Health ◽  
Patient Relationship ◽  
Relationship Boundaries

Protecting privacy to protect mental health: the new ethical imperative

2019 ◽  
Vol 45 (9) ◽  
pp. 604-607 ◽  
Author(s):  
Elias Aboujaoude
Keyword(s):  
Mental Health ◽  
Electronic Medical Records ◽  
Psychological Health ◽  
Medical Records ◽  
Personal Data ◽  
Psychological Development ◽  
Clinical Implications ◽  
Patient Relationship ◽  
Ethical Imperative ◽  
The Individual

Confidentiality is a central bioethical principle governing the provider–patient relationship. Dating back to Hippocrates, new laws have interpreted it for the age of precision medicine and electronic medical records. This is where the discussion of privacy and technology often ends in the scientific health literature when Internet-related technologies have made privacy a much more complex challenge with broad psychological and clinical implications. Beyond the recognised moral duty to protect patients’ health information, clinicians should now advocate a basic right to privacy as a means to safeguard psychological health. The article reviews empirical research into the functions of privacy, the implications for psychological development and the resigned sentiment taking hold regarding the ability to control personal data. The article concludes with a call for legislative, educational and research steps to readjust the equilibrium between the individual and ‘Big Data’.

The patient’s perspective

2020 ◽  
pp. 3-5
Author(s):  
Kay Redfield Jamison ◽  
Adam Ian Kaplin
Keyword(s):  
Mental Health ◽  
Information Technology ◽  
Health Information ◽  
Therapeutic Relationship ◽  
Patient Relationship ◽  
Patient’S Perspective ◽  
Clinical Encounters ◽  
Ultimate Outcome ◽  
The Moment ◽  
Mutual Communication

In addition to knowledge, a physician’s ability to engage and persuade through compassionate understanding and therapeutic optimism is an indispensable skill that may determine the ultimate outcome of their patient’s illness and health. From the moment a patient is first given a psychiatric diagnosis, they embark on a path to combat personal anguish, social isolation, and stigma in an effort to regain mastery of their life. The interaction between doctor and patient and the mutual communication and trust that underlie their therapeutic relationship are at least equal in importance to the efficacy of any medication that can be prescribed. As mental health information technology evolves and becomes ever more present during clinical encounters, the importance of understanding the patient’s perspective will be critical to physicians who want to preserve what is irreplaceable and therapeutically critical to the doctor–patient relationship.

scholarly journals Sexual abuse by superintending staff in the nineteenth-century lunatic asylum: medical practice, complaint and risk

2020 ◽  
pp. 0957154X2096729
Author(s):  
Cara Dobbing ◽  
Alannah Tomkins
Keyword(s):  
Mental Health ◽  
Nineteenth Century ◽  
Health Care ◽  
Lunatic Asylum ◽  
Patient Relationship ◽  
The West ◽  
Medical Specialization ◽  
Medical Careers ◽  
The Press

The nineteenth century witnessed a great shift in how insanity was regarded and treated. Well documented is the emergence of psychiatry as a medical specialization and the role of lunatic asylums in the West. Unclear are the relationships between the heads of institutions and the individuals treated within them. This article uses two cases at either end of the nineteenth century to demonstrate sexual misdemeanours in sites of mental health care, and particularly how they were dealt with, both legally and in the press. They illustrate issues around cultures of complaint and the consequences of these for medical careers. Far from being representative, they highlight the need for further research into the doctor–patient relationship within asylums, and what happened when the boundaries were blurred.

scholarly journals The Roles of Health Literacy and Physician-Patient Relationship in Self-Reported Health Outcomes Within a Diverse Sample of Persons Living with HIV

2019 ◽  
Vol 34 (7) ◽  
pp. 1273-1273
Author(s):  
E Santana ◽  
J Gonzalez ◽  
D Byrd ◽  
M Rivera Mindt
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Health Literacy ◽  
Health Outcomes ◽  
Physical Functioning ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Persons Living With Hiv ◽  
Living With Hiv ◽  
Physician Patient

Abstract Objective Barriers like poor health literacy and patient-provider communication add to health disparities in diverse populations. Perceived autonomy has been shown to improve patients’ health satisfaction and knowledge of their illness. However, no studies have examined these issues in HIV patients. This study examined the roles of health literacy and physician-patient relationship in health outcomes (e.g., mental health and emotional/physical functioning) in persons living with HIV (PLWH). Participants and Method This cross-sectional study included 91 PLWH (74% Latinx and 26% non-Latinx White; 68% Male) who completed the Test of Functional Health Literacy in Adults (TOFHLA), Physician–Patient Relationship Scale (PPRS), and Medical Outcomes Study-HIV Health Survey (MOS). The study variables included: TOFHLA total score, PPRS Part Decision- Making (PDM) and Trust subscales, and MOS Mental Health and Health Transition subscales. Results A linear regression showed that our model (ethnicity, TOFHLA, PPRS PDM and Trust) predicted MOS HT (R2 = .14, p < 0.05), such that Latinx ethnicity (β = .30) and better TOFHLA scores (β = -.22) predicted better MOS HT scores (ps < .05). Another regression showed that our model predicted MOS MH (R2 = 0.07, p = <.01), such that greater PPRS PDM scores predicted better MOS MH scores (β = .27, p = <.01). Conclusions Ethnicity and better health literacy were related to improved emotional/physical functioning over a 4-week period and greater shared decision-making was related to better overall mental health. These findings highlight the importance of identifying sociocultural factors and interpersonal processes of care to inform culturally-tailored interventions that can result in enhanced and effective treatment for PLWH patients and in improved physical and mental health outcomes.

scholarly journals Mental Health Nurses’ Experiences of Caring for Patients Suffering from Self-Harm

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Randi Tofthagen ◽  
Anne-Grethe Talseth ◽  
Lisbeth Fagerström
Keyword(s):  
Mental Health ◽  
Well Being ◽  
Nursing Interventions ◽  
Patient Relationship ◽  
Mental Health Nurses ◽  
Recovery Processes ◽  
Semistructured Interviews ◽  
Centered Care ◽  
Self Harm ◽  
Alternative Activities

The aim of this study was to explore mental health nurses’ experiences of caring for inpatients who self-harm during an acute phase. The setting was four psychiatric clinics in Norway. Fifteen mental health nurses (MHNs) were recruited. Semistructured interviews comprised the method for data collection, with content analysis used for data analysis. Two main categories emerged: challenging and collaborative nurse-patient relationship and promoting well-being through nursing interventions. The underlying meaning of the main categories was interpreted and formulated as a latent theme: promoting person-centered care to patients suffering from self-harm. How MHNs promote care for self-harm patients can be described as a person-centered nursing process. MHNs, through the creation of a collaborative nurse-patient relationship, reflect upon nursing interventions and seek to understand each unique patient. The implication for clinical practice is that MHNs are in a position where they can promote patients’ recovery processes, by offering patients alternative activities and by working in partnership with patients to promote their individual strengths and life knowledge. MHNs strive to help patients find new ways of living with their problems. The actual study highlighted that MHNs use different methods and strategies when promoting the well-being of self-harm patients.

Ethical Self-Evidence and the Principle of Proportionality: Two Fundamental Ethical Principles Applied to a Psychiatric Case Report

2011 ◽  
Vol 13 (1) ◽  
pp. 29-45 ◽  
Author(s):  
Barbara Andrade ◽  
Oscar Ugalde
Keyword(s):  
Mental Health ◽  
Practical Reasoning ◽  
Ethical Principles ◽  
Ethical Question ◽  
Patient Relationship ◽  
Ethical Problems ◽  
Medical Associations ◽  
Ethical Norms ◽  
Principle Of Proportionality ◽  
Ethical Systems

When confronting ethical problems, clinicians generally feel both unprepared as well as in need of orientation. Ethical norms issued by medical associations are necessary and helpful but insufficient: by definition, codes and norms arepreethical; that is, they establish guidelines before the truly ethical question even arises. To arrive at a clear ethical formulation and to bridge the gap between a set of rules and their application in particular cases are essential. This article discusses some problems with ethical systems and then demonstrates that it is possible to formulate two fundamental ethical principles—ethical self-evidence and the principle of proportionality—applicable to treatment situations in a process of effective practical reasoning. Such a process forms an integral part of the doctor–patient relationship and can be practiced individually, and in staff and treatment sessions. The principles and the reasoning process are valid in all medical and mental health fields. The example shown here is their application in psychiatry, specifically, in a case of Huntington’s disease.

scholarly journals Communication patterns in the doctor–patient relationship: evaluating determinants associated with low paternalism in Mexico

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Eduardo Lazcano-Ponce ◽  
Angelica Angeles-Llerenas ◽  
Rocío Rodríguez-Valentín ◽  
Luis Salvador-Carulla ◽  
Rosalinda Domínguez-Esponda ◽  
...  
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Healthcare Professionals ◽  
Communication Patterns ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Open Communication ◽  
Explicit Communication

Abstract Background Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician’s personal choices. The goal of this study was to contribute to knowledge on the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor–patient relationship characterized by low paternalism/autonomy. Methods A self-report study on communication patterns in a sample of 761 mental healthcare professionals in Central and Western Mexico was conducted. Multiple ordinal logistic regression models were used to analyse paternalism and associated factors. Results A high prevalence (68.7% [95% CI 60.0–70.5]) of paternalism was observed among mental health professionals in Mexico. The main determinants of low paternalism/autonomy were medical specialty (OR 1.67 [95% CI 1.16–2.40]) and gender, with female physicians being more likely to explicitly share diagnoses and therapeutic strategies with patients and their families (OR 1.57 [95% CI 1.11–2.22]). A pattern of highly explicit communication was strongly associated with low paternalism/autonomy (OR 12.13 [95% CI 7.71–19.05]). Finally, a modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomy was observed. Conclusions Among mental health professionals in Mexico, high paternalism prevailed. Gender, specialty, and a pattern of open communication were closely associated with low paternalism/autonomy. Strengthening health professionals’ competencies and promoting explicit communication could contribute to the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.

scholarly journals Engaging patients as teachers of clinical interview skills

2003 ◽  
Vol 27 (08) ◽  
pp. 312-315 ◽  
Author(s):  
George Ikkos
Keyword(s):  
Mental Health ◽  
Health Services ◽  
Vocational Training ◽  
Point Of View ◽  
Clinical Implications ◽  
Patient Relationship ◽  
Small Minority ◽  
Training Scheme ◽  
Overall Evaluation ◽  
Training Schemes

Aims and Method To engage patients as teachers of psychiatrists in training and non-consultant career grades, for the purpose of enhancing doctors' understanding of the patient point of view and of the complexity of the doctor–patient relationship. Patients have been engaged as teachers in a recurrent cycle of ‘Basic Interview Skills' workshops and the views of the doctors about this initiative have been elicited through a brief anonymous and confidential questionnaire. Results Thirty-six psychiatric senior house officers (SHOs), general practitioners, Vocational Training Scheme SHOs in psychiatry, and staff grade and trust doctors in psychiatry have participated in four cycles of workshops. Five patients have engaged in the workshops as teachers, alongside the clinical tutor. Questionnaire feedback indicated some specific criticisms of a number of participants and dissatisfaction by a small minority of doctors, but the overall evaluation of the experience was positive. Clinical Implications Engagement of patients as teachers of psychiatrists in training and other new doctors in mental health services is desirable, feasible and welcomed by most doctors. With due attention to the legitimate sensitivities of participants, the practice of engaging patients as teachers of doctors working in psychiatry could be generalised in training schemes and services across the country.

Sign in / Sign up

Export Citation Format

Share Document