在挪威临床实践中评估决策能力:对利益相关者的观点进行定性探索
Jacob Jorem1,2,3, Reidun Førde4, Tonje Lossius Husum5
1Institute of Health and Society, University of Oslo, Oslo, Norway. jacob.jorem@medisin.uio.no.
BMC psychiatry
|October 11, 2025
概括
挪威的决策能力 (DMC) 评估尽管有新法律,但仍面临挑战. 使用四个能力模型,但需要更好的培训和工具,以保持心理健康护理的质量.
科学领域:
- 心理健康法 心理健康法
- 临床心理学 临床心理学
- 医疗保健政策 医疗保健政策
背景情况:
- 挪威于2017年修改了心理健康护理法,将决策能力 (DMC) 作为非自愿护理的标准.
- 尽管有修正案,但强迫照顾率有所增加,这表明在实际应用中存在挑战.
- 评估DMC通常涉及评估理解,推理,欣赏信息和沟通选择.
研究的目的:
- 探讨在挪威2017年精神卫生法改革后,在临床实践中如何评估决策能力 (DMC).
- 了解DMC评估在非自愿护理和治疗过程中的利益相关者的整合.
主要方法:
- 2018年与44个主要利益相关者 (精神病医生,心理学家,全科医生,律师) 进行了半结构化访谈和重点小组.
- 在2022-23年与21名参与者进行后续的个人采访.
- 对转录的采访数据进行主题分析.
主要成果:
- 四种能力模型是DMC在专科护理方面的评估的主要依据,但其重要性随着时间的推移而下降,质量变化,特别是在初级保健中.
- 确定的主要挑战包括缺乏培训,所有权问题,护理连续性,信息共享,患者合作以及与特定患者群体 (例如,躁狂,物质滥用) 的困难.
- 强调需要采取质量保证措施,包括系统培训和验证的评估工具.
结论:
- 挪威医疗保健系统的DMC评估显示了整个挪威医疗保健系统的变化和挑战.
- 系统的培训,验证的工具和进一步的研究对于提高DMC评估质量至关重要.
- 成功实施卫生法改革需要了解法律,卫生服务和社会因素的相互作用.
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