Temporising and respect for patient self-determination

Lindberg, Jenny; Johansson, Mats; Broström, Linus

doi:10.1136/medethics-2018-104851

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…Patient participation is emphasized as a principle of high‐quality care (OECD, 2017; WHO, 2018). It is based on the right of patients to make their own choices and to be actively involved in making decisions concerning them (Lindberg et al, 2019; UN, 2007). Furthermore, patient participation has been found to have positive impacts on clinical care, treatment outcomes (Huang et al, 2020) and patient empowerment (Castro et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Nurses' and patient' descriptions about forms of power in pro re nata medication participation in forensic psychiatric care: A qualitative secondary analysis

Hipp,

Kangasniemi,

Varpula

et al. 2023

Int J Mental Health Nurs

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Despite there being an emphasis on patient participation in their own care, it has been a challenge in pro re nata (PRN, as the circumstance arises) medication in forensic psychiatric care. The power imbalance in treatment relationships can be a barrier to patient participation and should therefore be further explored. This qualitative descriptive study aimed to explore the aspect of power in the descriptions of patients and nurses interviewed in a Finnish forensic psychiatric hospital about patient participation in PRN. A qualitative secondary analysis was conducted through the semi‐structured interviews of the patients (n = 34) and nurses (n = 19). The data were analysed with deductive content analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were used to ensure comprehensive reporting. The findings revealed that patients and health professionals may have conflicting goals in PRN and that they both use power to try to achieve them. Power in PRN was described in different forms, including authority, force, manipulation and persuasion. Based on our results, the power that health professionals have in PRN medication is particularly based on their legitimate authority and the hierarchical structures of the hospital environment. Patients also hold power in the dynamics of PRN medication care, but their position as a power holder can vary individually and situationally. Recognizing different forms of power and supporting patients with a decreased capacity for decision‐making is essential for promoting high‐quality and patient‐centred forensic psychiatric nursing.

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Section: Introductionmentioning

confidence: 99%

Nurses' and patient' descriptions about forms of power in pro re nata medication participation in forensic psychiatric care: A qualitative secondary analysis

Hipp,

Kangasniemi,

Varpula

et al. 2023

Int J Mental Health Nurs

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“…Lindberg et al [ 18 ] considered that the first factor of analysis arises when self-determination is offered to the patient. The professionals consider the patient sufficiently prepared to decide or a circumstance that they believe the patient should decide.…”

Section: Introductionmentioning

confidence: 99%

“…Self-determination has been conceptualised but little investigated, affected by traditional paternalism[ 18 ] as indicated among other reasons along with legitimisation of limiting freedom through the defense of prospective self-determination by considering the professional where the patient, in the future, might prefer another decision, is contradictory, even if it is good for the patient. Our responsibility to respect others must be durable in time to achieve real self-determination and not in a portion of time[ 20 - 22 ], as defended by Foucault's proposal of the subjective construction.…”

Section: Introductionmentioning

confidence: 99%

Grounded theory qualitative approach from Foucault's ethical perspective: Deconstruction of patient self-determination in the clinical setting

Molina-Mula

2021

WJCC

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This paper aims to explain the construction of the autonomous subject from Foucault's ethical perspective for the qualitative analysis of interprofessional relationships, patient-professional relationships, and moral ethics critique. Foucault tried to break loose from the self, which is merely the result of a biopolitical subjectivation and constituted an interpersonal level. From this, different elements involved in the decision-making capacity of patients in a clinical setting were analysed. Firstly, the context in which decision-making occurs has been explained, distinguishing between traditional practices involved in self-care and the more modern conceptions that make certain possible transformations. Secondly, an attempt is made to explain the formation of the medicalisation of society using the transformations of what Foucault called "techniques of the self". Finally, the ethical framework for a subject's "self-creation", insisting more on the exercises of self-subjectivation, reinforcing the ethics of the self by itself, the "care of the self", has been explained. The role of the patient is understood as an autonomous subject to the extent that the clinical institution and the professionals involved comprehend how the patient’s autonomy in the clinical environment is constituted. All these elements could generate grounded theory on the qualitative methodology of this phenomenon. The current ethical model based on universal principles is not useful to provide a capacity for patients decision-making, relegating to the background their opinions and beliefs. Consequently, a new ethical perspective emerges that aims to return the patient to the fundamental axis of attention.

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“…The participation of patients in the prescription and administration of their pro re nata (PRN, as-needed) medication has been emphasized in psychiatric care (Baker et al, 2007). In addition to being an ethical right (Lindberg et al, 2019), involving patients in decisions on their medication can support their adherence to treatment (NICE, 2009;Torrecilla-Olavarrieta et al, 2020) and help them to learn how to safely and effectively use PRN, based on their individual medication needs, to improve their quality of life. However, forensic psychiatric patients are particularly vulnerable when it comes to participation due to their poor mental health status and the involuntary nature of treatment (Selvin et al, 2016(Selvin et al, , 2021.…”

mentioning

confidence: 99%

Patient Participation in Pro Re Nata Medication in Forensic Psychiatric Care: Interview Study with Patients and Nurses

Hipp

Kangasniemi

2021

International Journal of Forensic Mental Health

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Pro re nata (PRN, as-needed) medication is commonly used in forensic psychiatric inpatient care, but little is known about the participation of patients in its prescription and administration. This study describes patient participation in PRN medication treatment in forensic psychiatric inpatient care. Data were collected during interviews with 34 inpatients and 19 registered nurses in a Finnish forensic psychiatric hospital. The data underwent inductive content analysis. We found that patient participation in PRN was related to patients' individual needs and health conditions, and the use of PRN involved private decisions made in the social context of the ward. PRN was an integrated part of daily care, and it involved three stakeholders, namely patients, nurses, and physicians; however, the role of patients in this collaboration was undefined. The administration events for PRN were multiform, and depended on the level of agreement between patients and nurses on the need for PRN. In the future, more attention should be paid to how to motivate patients and provide them with equal opportunities to be involved in the planning of PRN, and to optimize shared decision making so that the expertise of both patients and nurses is utilized in the administration and evaluation of PRN.

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Temporising and respect for patient self-determination

Cited by 5 publications

References 16 publications

Nurses' and patient' descriptions about forms of power in pro re nata medication participation in forensic psychiatric care: A qualitative secondary analysis

Nurses' and patient' descriptions about forms of power in pro re nata medication participation in forensic psychiatric care: A qualitative secondary analysis

Grounded theory qualitative approach from Foucault's ethical perspective: Deconstruction of patient self-determination in the clinical setting

Patient Participation in Pro Re Nata Medication in Forensic Psychiatric Care: Interview Study with Patients and Nurses

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