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Ethical Big Data for Personalised Mental Health Nursing: A P4 and Systems View 个性化心理健康护理的伦理大数据:P4和系统视图。
IF 2.9 4区 医学 Q1 NURSING Pub Date : 2025-10-03 DOI: 10.1111/jpm.70038
Erman Yıldız

Background

Mental health nursing faces transformation through big data and metadata integration. These technologies create new opportunities but introduce ethical and practical complexities. Digital adoption accelerated during COVID-19, making it essential to understand implications for nursing practice.

Aim

This perspective paper aims to critically examine the transformative potential and ethical dilemmas of leveraging big data in mental health nursing, guided by systems biology and P4 (Predictive, Preventive, Personalised, and Participatory) medicine principles. It seeks to define the evolving roles of mental health nurses in this new digital landscape.

Method

This perspective essay utilises a focused literature review of key studies in nursing, psychiatry, informatics, and ethics, alongside theoretical approaches including systems biology, P4 medicine, and a personalist ethical framework. The analysis explores the integration of big data, focusing on potential benefits, risks, and ethical considerations.

Results

Big data contributes meaningfully to early diagnosis, personalised treatments, and prevention strategies. However, these contributions must supplement, not substitute, traditional nursing approaches. AI diagnostic tools and digital phenotyping for relapse prediction demonstrate practical applications. Excessive algorithmic dependence risks damaging patient–nurse relationships. Data privacy, algorithmic bias, and access inequities present significant ethical challenges requiring careful attention.

Conclusion

Big data implementation should enhance, not replace, human interaction in mental health nursing. A new synthesis is proposed where data-driven insights support efficiency, allowing nurses more time for complex emotional needs. Key recommendations include strengthening data literacy in nursing education, developing robust data governance policies, and establishing comprehensive ethical principles to preserve the essential human dimension of care and ensure equitable access.

背景:心理健康护理面临大数据与元数据融合的转型。这些技术创造了新的机会,但也带来了伦理和实践的复杂性。在2019冠状病毒病期间,数字技术的采用加速,因此了解对护理实践的影响至关重要。在系统生物学和P4(预测性、预防性、个性化和参与性)医学原则的指导下,本文旨在批判性地审视在心理健康护理中利用大数据的变革潜力和伦理困境。它试图定义精神卫生护士在这个新的数字环境中不断变化的角色。方法:这篇观点文章利用了对护理、精神病学、信息学和伦理学等关键研究的重点文献综述,以及包括系统生物学、P4医学和个人伦理框架在内的理论方法。该分析探讨了大数据的整合,重点是潜在的利益、风险和道德考虑。结果:大数据有助于早期诊断、个性化治疗和预防策略。然而,这些贡献必须补充,而不是替代,传统的护理方法。人工智能诊断工具和用于复发预测的数字表型展示了实际应用。过度依赖算法有破坏医患关系的风险。数据隐私、算法偏见和访问不平等提出了重大的道德挑战,需要仔细关注。结论:大数据的实施应加强而不是取代心理健康护理中的人际互动。提出了一种新的综合,其中数据驱动的见解支持效率,使护士有更多的时间来处理复杂的情感需求。主要建议包括加强护理教育中的数据素养,制定强有力的数据治理政策,以及建立全面的道德原则,以维护护理的基本人性因素并确保公平获取。
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引用次数: 0
The Person-Centred Care Practices of Mental Health Nurses: A Cross-Sectional Study 心理健康护士以人为本的护理实践:一项横断面研究
IF 2.9 4区 医学 Q1 NURSING Pub Date : 2025-09-20 DOI: 10.1111/jpm.70033
Chantille Isler, Joy Maddigan, Donna Moralejo, Alice Gaudine, Robin Burry, Ahmad Deep, Hensley Mariathas

Introduction

Person-centred care can result in improved patient satisfaction and health outcomes; however, operationalisation has been challenging in mental health settings.

Aim

To describe person-centred mental health nursing practices and associated factors.

Methods

The study was underpinned by The Person-Centred Practice Framework. All mental health and addictions registered nurses in one Canadian province were invited to complete the Person-centred Practice Inventory-Staff (PCPI-S) and a short demographic questionnaire. EQUATOR network recommendations for quantitative (STROBE) data were followed.

Results

Nurses scored all three domains of the PCPI-S favourably, indicating strong evidence for person-centred practices; the practice environment domain was rated the lowest. There was a moderate, positive, statistically significant (rs = 0.451, p < 0.001) association between the practice environment domain score and the person-centred process domain score, which was the measure of delivery of person-centred care. A regression model explained 76.1% of the variance in delivery of person-centred care. Significant predictors were: (1) the prerequisites domain score of the PCPI-S, (2) the environment domain score of the PCPI-S and (3) nurses' relationship with their manager.

Discussion

Findings from our study provide strong support for the use of the Person-centred Practice Framework in mental health nursing, particularly in the context of Canadian mental health and addictions services. Study results align with existing evidence that also reported generally favourable PCPI-S scores with comparatively lower scores in the practice environment domain.

Recommendations

To address practice environment concerns, future research should focus on the context within which care takes place and its impact on the delivery of person-centred care.

导言:以人为本的护理可以提高患者满意度和健康结果;然而,在精神卫生环境中,操作一直具有挑战性。目的:描述以人为本的心理健康护理实践及其相关因素。方法:本研究以“以人为本的实践框架”为基础。邀请加拿大一个省的所有心理健康和成瘾注册护士完成以人为中心的工作人员实践清单(PCPI-S)和一份简短的人口调查问卷。遵循赤道网络关于定量(STROBE)数据的建议。结果:护士在PCPI-S的所有三个领域都获得了好评,这表明以人为本的做法有强有力的证据;实践环境领域被评为最低。讨论:我们的研究结果为在心理健康护理中使用以人为本的实践框架提供了强有力的支持,特别是在加拿大心理健康和成瘾服务的背景下。研究结果与现有证据一致,也报告了总体有利的PCPI-S分数,而在实践环境领域的分数相对较低。建议:为了解决实践环境问题,未来的研究应该集中在护理发生的背景及其对以人为本的护理的影响。
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引用次数: 0
The Correlation Between Suicide Risk and Emotion Regulation Strategies in Patients With Bipolar Disorder: A Cross-Sectional Study 双相情感障碍患者自杀风险与情绪调节策略的相关性:一项横断面研究。
IF 2.9 4区 医学 Q1 NURSING Pub Date : 2025-09-19 DOI: 10.1111/jpm.70034
Sedef Tonaydin, Sibel Polat Olca

Introduction

Emotional dysregulation is among the psychological factors involved in the risk of suicide among patients with psychiatric disorders.

Aim

The present study aimed to examine the correlation between cognitive reappraisal and suppression—two strategies for emotional regulation—and the risk of suicide among patients diagnosed with bipolar disorder.

Method

This study was conducted as a cross-sectional, descriptive and correlational study. A simple random sample of 100 patients meeting the inclusion criteria and providing informed consent comprised the study sample. The Suicide Probability Scale (SPS), Emotional Regulation Questionnaire (ERQ), Young Mania Rating Scale (YMRS) and Beck Depression Inventory (BDI) were used to collect data.

Results

The participants' mean scores for reappraisal and suppression subscales of ERQ were 26.84 ± 5.8 and 14.22 ± 3.65, respectively. The SPS total mean score of the participants was 90.84 ± 5.5. The mean score of the participants who attempted suicide on the suppression subscale of the ERQ was higher than the score of those who did not attempt suicide.

Discussion

The results of the study showed that patients with euthymic bipolar disorder who were hospitalised in a psychiatric clinic and were at the discharge stage had a high risk of suicide.

Implications for Practice

Planning and implementing clinical procedures by mental health and psychiatric nurses to improve patients' emotional regulation strategies and prevent suicide will help manage suicide risk.

简介:情绪失调是精神障碍患者自杀风险的心理因素之一。目的:本研究旨在探讨双相情感障碍患者的两种情绪调节策略——认知重评和抑制与自杀风险之间的关系。方法:本研究采用横断面、描述性和相关性研究。符合纳入标准并提供知情同意的100例患者的简单随机样本构成研究样本。采用自杀概率量表(SPS)、情绪调节问卷(ERQ)、青年躁狂症评定量表(YMRS)和贝克抑郁量表(BDI)收集数据。结果:被试ERQ重评分量表和抑制分量表的平均得分分别为26.84±5.8分和14.22±3.65分。受试者的SPS总平均分为90.84±5.5分。在ERQ的抑制分量表中,自杀未遂者的平均得分高于未自杀未遂者。讨论:研究结果表明,在精神病诊所住院并处于出院阶段的心境双相情感障碍患者有很高的自杀风险。对实践的启示:心理健康和精神科护士规划和实施临床程序,以改善患者的情绪调节策略和预防自杀,将有助于管理自杀风险。
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引用次数: 0
Reducing the Length of Time Psychiatric Patients Who Are Assessed as Requiring an Adult Mental Health Inpatient Bed Spend in the Emergency Department; a Systemic Quality Improvement Journey 减少被评估为需要成人精神健康住院病人在急诊科花费的时间系统的质量改进之旅。
IF 2.9 4区 医学 Q1 NURSING Pub Date : 2025-09-19 DOI: 10.1111/jpm.70028
Louise Hunter, Deborah McSparron
<div> <section> <h3> Presenting Problem</h3> <p>There are significant pressures on Adult Mental Health Crisis and Inpatient Services, which is a complex and fragile system. This has led to psychiatric patients spending protracted waits in emergency departments (ED) for access to a mental health inpatient bed. This paper describes a large-scale improvement project that adopts a systemic approach to understanding the problem and testing change ideas generated by staff to bring about improvement. The SQUIRE guidelines were followed in writing this paper.</p> </section> <section> <h3> Tests of Change</h3> <p>The change ideas tested were:</p> <div> <ol> <li>Testing of a 7 Day Assessment Centre to provide an alternative pathway for low risk patients waiting in ED. This facilitates a longer period of assessment for the patient and enables the provision of short-term intervention, stabilising the patient and decreasing the reliance on an inpatient admission.</li> <li>Testing of the Side by Side Model, which promotes joint assessment and care planning for mental health patients presenting in the ED experiencing a crisis. Adult Mental Health and ED professionals work collaboratively, thereby reducing the length of time the patient is waiting in ED to determine an assessment outcome and to find the right care pathway.</li> <li>Improved Interface working between Inpatient and Community Services to facilitate timely discharge and address the delayed discharge position, improving overall flow in the system.</li> </ol> </div> </section> <section> <h3> Outcomes</h3> <p>Quality improvement methodologies were adopted to engage staff in the process and to measure the impact of change ideas. There has been evidence of improvement in the system with regards to: a reduction in the length of time that psychiatric patients are waiting in ED to complete their assessment and determine the right care pathway, a reduction in admissions to our adult mental health inpatient wards and reduced bed occupancy, an increase in patients discharged on a community pathway, a reduction in the number of patients waiting in ED, a reduction in the delayed discharge position and the number of patients becoming delayed in adult mental health inpatient wards through better interface working. This has led to overall decreased pressures on the ED system, better utilisation of resources and improved staff and patient experience. This quality improvement journey has given staff an opportunity to build confi
目前的问题:成人心理健康危机和住院服务的压力很大,这是一个复杂而脆弱的系统。这导致精神病患者在急诊科(ED)长时间等待获得精神健康住院床位。本文描述了一个大规模的改善项目,该项目采用系统的方法来理解问题,并测试员工提出的改变想法,以实现改善。在撰写本文时遵循了SQUIRE的指导方针。改变的测试:测试的改变想法是:测试一个7天评估中心,为在急诊科等待的低风险患者提供另一种途径。这有利于对患者进行更长时间的评估,并能够提供短期干预,稳定患者并减少对住院患者的依赖。测试的并肩模式,促进联合评估和护理计划的精神健康患者呈现在急诊科经历危机。成人心理健康和急诊科专业人员协同工作,从而减少了患者在急诊科等待确定评估结果和找到正确护理途径的时间。改善住院和社区服务之间的接口工作,促进及时出院,解决延迟出院的情况,改善系统的整体流程。结果:采用了质量改进方法,让员工参与到过程中来,并衡量改变想法的影响。有证据表明,该系统在以下方面有所改善:减少精神病患者在急诊科等待完成评估并确定正确护理途径的时间,减少成人精神健康住院病房的入院人数,减少床位占用,增加社区途径出院的患者,减少在急诊科等待的患者数量,通过优化接口工作,减少成人心理健康住院病房延迟出院位置和延迟出院人数。这导致了对急诊科系统的整体压力降低,更好地利用资源,改善了工作人员和患者的体验。这次质量改进之旅让员工有机会建立对使用质量评价方法和工具的信心,测试他们认为会有所作为的想法,让他们在这个过程中发表意见,激发对未来服务的希望,庆祝他们取得的成就,并允许他们表达对他们重要的事情。所有这些都有助于在成人心理健康服务中培养一种改进文化,并使在真正具有挑战性和压力的环境中工作的工作人员重新充满活力。相关声明:本文讨论了在成人心理健康服务部门工作的一线工作人员已经测试的改变想法,以减少精神病患者在急诊科等待获得最适当护理和支持的时间长度。在这个过程中,工作人员被承认和认可为各自领域的学科专家,并被赋予自主权来测试他们自己的想法,这些想法可能会带来更好的患者结果和改善的体验。质量改进工具和方法被用来帮助员工理解他们工作的系统的复杂性,并测量他们的变更想法的影响。这项工作提供了一些有用的见解和学习,将有利于更广泛的系统,因为床位容量和流量减少而持续存在压力,导致精神病患者在急诊科等待时间延长。
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引用次数: 0
Getting Real: How Intersectionality Challenges the ‘One Size Fits All’ Approach to Global Mental Health 走向现实:交叉性如何挑战全球心理健康的“一刀切”方法。
IF 2.9 4区 医学 Q1 NURSING Pub Date : 2025-09-18 DOI: 10.1111/jpm.70031
Zaqia Rehman, Paul Illingworth

This paper offers an intersectional perspective to enable inclusivity when addressing global mental health challenges, whilst also tackling social exclusion and vulnerability. Examples are given from purposefully selected countries to demonstrate the effectiveness of exploring issues through an intersectional approach. The authors conclude that a ‘one size fits all’ approach, when working towards universal mental health, is not the best approach and cannot provide a solution for all. They suggest the WHO, UN, governments and mental health agencies need to view global mental health differently to achieve alternative and better targeted solutions.

本文提供了一个交叉的视角,在应对全球心理健康挑战的同时,也解决了社会排斥和脆弱性问题。有目的地选择了一些国家作为例子,以证明通过交叉方法探讨问题的有效性。作者得出的结论是,在致力于普及精神卫生时,“一刀切”的方法并不是最好的方法,也不能为所有人提供解决方案。他们建议,世卫组织、联合国、各国政府和精神卫生机构需要以不同的方式看待全球精神卫生,以实现替代性和更有针对性的解决方案。
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引用次数: 0
Understanding Privatisation of Mental Health Services: Insights From Karl Marx's Capital 理解精神卫生服务私有化:来自卡尔·马克思《资本论》的见解。
IF 2.9 4区 医学 Q1 NURSING Pub Date : 2025-09-16 DOI: 10.1111/jpm.70032
Myles Balfe
<p>Considerable attention is being focused on the role, nature and consequences of privatised, or capitalist, health care in many countries and the role of nurses, doctors and other healthcare professionals in it. This is also the case in relation to the privatisation of mental health services (Guardian <span>2022</span>; Silver-Greenberg and Thomas <span>2024</span>). For instance in the UK, it was noted in the early 2020s that the NHS—the leading international example of universal healthcare provision—was spending billions on private health care for mental health patients (Campbell and Bawden <span>2022</span>). Karl Marx's book <i>Capital</i> (1867) provides ideas that are worth considering by mental health nurses who are interested in understanding the nature of privatised health care. This essay provides an overview of Marx's key concepts in <i>Capital</i> and how they can be used to interpret and make sense of privatised health care, mental and otherwise, and its risks. The 21st century is a time of extreme economic inequality and wealth concentration across the world, where capital is becoming increasingly dominant and embedded (McKeown <span>2024</span>; Varoufakis <span>2023</span>). This is a century where the interests of capital and capitalists are often taken as the interests of the wider public, health systems and states, and are increasingly coming to colonise these institutions. It is a time of increasing healthcare commodification and threats to universalist health care. It is a time that, increasingly, has features of Marx's time. Capitalism is now the dominant socioeconomic system in the world, so it can be useful for mental health professionals to understand it and how it can potentially impact their practice and working conditions.</p><p>The structure of this article is as follows. The first section discusses private health care as a form of what Marx refers to as a commodity. The article then discusses surplus value, which is the profit that is extracted from each commodity. After this, the idea of primitive accumulation is referenced, which refers to capitalistic colonisation of previously public entities. This is followed by a section on the impacts of capitalism on patients and mental and other health professionals. Two further concepts from Capital vol. 1 are then discussed. One is the concept of circulation, which describes the constant transformation of capital into money and commodities, and the other is constant and variable capital. The article concludes with some lessons that Capital vol. 1 might offer us in the 21st century, inheritors of this dying capitalistic world, where surplus value extraction has eclipsed all other ideals.</p><p>Marx argues in <i>Capital</i> that capitalist systems are commodity producing systems. A commodity is anything that is sold to satisfy some human want or need. Private health insurance, private health care, are examples; so would any other mental health care or medical service that
许多国家对私有化或资本主义保健的作用、性质和后果以及护士、医生和其他保健专业人员在其中的作用给予了相当大的关注。在精神卫生服务私有化方面也是如此(Guardian 2022年;Silver-Greenberg和Thomas 2024年)。例如,在英国,人们注意到,在20世纪20年代初,全民医疗保健提供的国际领先范例——国家医疗服务体系(nhs)在精神疾病患者的私人医疗保健上花费了数十亿美元(Campbell and Bawden 2022)。卡尔·马克思的书《资本论》(1867)提供了一些值得精神健康护士考虑的想法,这些护士对理解私有化医疗保健的本质感兴趣。这篇文章概述了马克思在《资本论》中的关键概念,以及如何用它们来解释和理解私有化的医疗保健,精神和其他方面,以及它的风险。21世纪是全球经济极度不平等和财富集中的时代,资本正变得越来越占主导地位和根深蒂固(McKeown 2024; Varoufakis 2023)。在这个世纪,资本和资本家的利益往往被视为更广泛的公众、卫生系统和国家的利益,并日益将这些机构殖民化。这是一个医疗保健商品化和对普遍医疗保健的威胁日益增加的时代。这个时代越来越具有马克思时代的特征。资本主义现在是世界上占主导地位的社会经济体系,所以对心理健康专业人员来说,了解资本主义以及资本主义如何潜在地影响他们的实践和工作条件是很有用的。本文的结构如下。第一部分讨论了私人医疗保健作为马克思所说的商品的一种形式。然后讨论剩余价值,即从每一种商品中提取的利润。在此之后,引用了原始积累的概念,它指的是资本主义对以前公共实体的殖民。接下来是关于资本主义对病人、精神和其他保健专业人员的影响的一节。然后讨论《资本论》第一卷中的两个进一步的概念。一个是流通的概念,它描述了资本不断地转化为货币和商品,另一个是不变和可变的资本。文章最后总结了《资本论》第一卷可能为21世纪的我们提供的一些教训,我们是这个垂死的资本主义世界的继承者,在这个世界上,剩余价值的榨取已经使所有其他理想黯然失色。马克思在《资本论》中指出,资本主义制度是商品生产制度。商品是为了满足人类的需求而出售的任何东西。私人医疗保险,私人医疗保健就是例子;其他任何以营利为目的的心理健康护理或医疗服务也会如此。因此,保健商品可以是商品或服务。生产医疗保健商品的行动者说,他们生产这些商品是为了马克思所说的使用价值(即,作为一种商品本身),但他们实际上是为了交换价值(即利润,或剩余价值)而生产这些商品。保健商品一旦交换,它就被转换成货币形式,留在那里,或者再转换回另一种商品。对马克思来说,货币和商品是同一事物的不同形式,而一切商品随时都可能脱离它们的肉体形式,采取它们的货币形式(马克思1867,33)。因此,马克思说,从资本的角度来看,每一个私人心理健康服务都是“在信仰和真理上的钱”(马克思1867,107)。他指出,如果一种商品,包括一种医疗保健商品,会说话,它会说,我们的使用价值可能是一种让人们感兴趣的东西。它不是我们的一部分……在彼此眼中,我们只是交换价值”(马克思1867,52)。马克思用M-C-M(货币-商品-货币)的公式来描述货币向医疗保健商品的不断转化。在这个体系中,流通本身就是目的,有“自己的生命过程”(马克思1867,108)。在私有化系统中控制精神保健商品生产的个人被称为保健资本家。他们雇用保健工作者,如精神保健护士、精神科医生和联合精神保健和精神病学专业人员。资本家拥有医疗保健生产的手段,生产医疗保健所需的工具、基础设施和技术。在私有化或半私有化的卫生系统中,卫生保健工作者利用生产资料为资本家生产医疗商品,然后将这些商品卖给病人、其他资本家或国家,以产生剩余价值或利润。 马克思会说,医疗保健资本家永远不应该把生产使用价值作为他们自己的目的;“资本家的真正目的是永无止境地获取利润”(马克思1867,107)。医疗保健资本家通常雇佣大量的心理健康工作者。在医疗保健雇员和资本家之间可能存在一个中间群体,马克思称之为“小主人”,他们可能拥有少量小型医疗保健机构,出售心理健康服务或商品,然后由于病人的需求或国家无法提供核心服务而开始扩张。对马克思来说,资本主义是一种对生物和精神的剥削。它依赖于工人的生命力,包括保健工作者,他们的“肌肉、神经、骨骼和大脑”(马克思1867,121),也依赖于必须购买这些保健工作者生产的保健商品的病人的生命力。马克思说,一个资本主义机构,比如私人医疗保健公司,只有一个生命冲动,那就是创造剩余价值的需要。为了做到这一点,如果允许的话,它将使精神保健护士和其他保健工作者工作更长时间(马克思称之为增加绝对剩余价值)和更密集(他称之为增加相对剩余价值)。资本主义需要这样做是根本的;它有“狼人对剩余价值的渴望”(马克思1867,179)。它将试图规范马克思所说的社会必要劳动时间,这种劳动时间用于生产每一种医疗保健商品。社会必要劳动时间是指具有一般能力的一般保健专业人员提供医疗或护理服务所需的平均时间。如果这个时间可以缩短,那么就可以提供更多的医疗服务,并从护士的工作中提取更多的剩余价值。保健工作也可以外包给社会必要劳动时间比护士便宜的工人(2020年11月)。这可以使从这些工人身上提取相对更多的剩余价值,并由雇用他们的实体投入流通。在允许的情况下,资本将寻求将公共卫生服务和体系私有化。这就是马克思所说的原始积累,他用这个词来描述资本主义对以前公共资源的殖民。卫生保健对资本具有吸引力,因为它是一个高利润部门,有能力不断生产新商品,而且需求缺乏弹性(Braverman 1998/1974)。这也是一个高周转时间的行业,这意味着在提供服务(商品)和收到钱之间通常没有太多的时间。在医疗保健领域,资本基本上不会长期停留在商品形态/生产阶段;它很快就会蜕变。一旦原始积累开始,资本将开始生产生活所需的私有化医疗商品,然后随着时间的推移,开始收取越来越多的钱。医疗行业的资本家受到竞争规律的约束,对他们来说,竞争规律就像进化规律一样真实,他们必须无情地追求剩余价值;否则,它们自己将被更具侵略性的生命形式吞噬。一些卫生系统本质上是普遍主义的,这意味着在马克思的术语中,卫生保健基本上是免费提供的,或者至少是低成本的(即卫生保健基本上是一种使用价值),并且该系统没有受到大规模原始积累的影响。其他体系则完全私有化,这意味着它们已经成功地经受了原始积累。另一些则是公共和私人医疗保健的混合体,这意味着它们部分受到原始积累的影响。国家在控制或促成原始积累方面起着至关重要的作用。资本家将倾向于寻求原始积累和私有化。然而,从理论上讲,国家可以限制这一过程。在缺乏国家干预的情况下,资本主义倾向于不受控制地剥削公众(Galbraith 1963)。然而,在过去40年里,许多国家的一个特点是,出于意识形态或自身的经济利益,许多政治和医疗保健精英已经开始接受资本主义精英的观点和医疗系统内的资本主义逻辑(Moth 2022)。马克思指出,“每当立法机关试图规范主人和工人之间的差异时,它的顾问总是主人”(马克思1867,524)。所有这些都是最近在许多州发生的有趣的历史逆转。资本主义作为一种制度早于现代公共医疗体系的出现,所以在某种程度上,公共医疗的私有
{"title":"Understanding Privatisation of Mental Health Services: Insights From Karl Marx's Capital","authors":"Myles Balfe","doi":"10.1111/jpm.70032","DOIUrl":"10.1111/jpm.70032","url":null,"abstract":"&lt;p&gt;Considerable attention is being focused on the role, nature and consequences of privatised, or capitalist, health care in many countries and the role of nurses, doctors and other healthcare professionals in it. This is also the case in relation to the privatisation of mental health services (Guardian &lt;span&gt;2022&lt;/span&gt;; Silver-Greenberg and Thomas &lt;span&gt;2024&lt;/span&gt;). For instance in the UK, it was noted in the early 2020s that the NHS—the leading international example of universal healthcare provision—was spending billions on private health care for mental health patients (Campbell and Bawden &lt;span&gt;2022&lt;/span&gt;). Karl Marx's book &lt;i&gt;Capital&lt;/i&gt; (1867) provides ideas that are worth considering by mental health nurses who are interested in understanding the nature of privatised health care. This essay provides an overview of Marx's key concepts in &lt;i&gt;Capital&lt;/i&gt; and how they can be used to interpret and make sense of privatised health care, mental and otherwise, and its risks. The 21st century is a time of extreme economic inequality and wealth concentration across the world, where capital is becoming increasingly dominant and embedded (McKeown &lt;span&gt;2024&lt;/span&gt;; Varoufakis &lt;span&gt;2023&lt;/span&gt;). This is a century where the interests of capital and capitalists are often taken as the interests of the wider public, health systems and states, and are increasingly coming to colonise these institutions. It is a time of increasing healthcare commodification and threats to universalist health care. It is a time that, increasingly, has features of Marx's time. Capitalism is now the dominant socioeconomic system in the world, so it can be useful for mental health professionals to understand it and how it can potentially impact their practice and working conditions.&lt;/p&gt;&lt;p&gt;The structure of this article is as follows. The first section discusses private health care as a form of what Marx refers to as a commodity. The article then discusses surplus value, which is the profit that is extracted from each commodity. After this, the idea of primitive accumulation is referenced, which refers to capitalistic colonisation of previously public entities. This is followed by a section on the impacts of capitalism on patients and mental and other health professionals. Two further concepts from Capital vol. 1 are then discussed. One is the concept of circulation, which describes the constant transformation of capital into money and commodities, and the other is constant and variable capital. The article concludes with some lessons that Capital vol. 1 might offer us in the 21st century, inheritors of this dying capitalistic world, where surplus value extraction has eclipsed all other ideals.&lt;/p&gt;&lt;p&gt;Marx argues in &lt;i&gt;Capital&lt;/i&gt; that capitalist systems are commodity producing systems. A commodity is anything that is sold to satisfy some human want or need. Private health insurance, private health care, are examples; so would any other mental health care or medical service that ","PeriodicalId":50076,"journal":{"name":"Journal of Psychiatric and Mental Health Nursing","volume":"32 6","pages":"1352-1358"},"PeriodicalIF":2.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpm.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Resilience, Qualitative Enquiry, and Global Perspectives in Violence Research: A Needed Agenda 韧性,定性调查和暴力研究的全球视角:一个必要的议程。
IF 2.9 4区 医学 Q1 NURSING Pub Date : 2025-09-15 DOI: 10.1111/jpm.70035
Dominikus David Biondi Situmorang, Rina Nurhudi Ramdhani, Ipah Saripah
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引用次数: 0
Investigation of the Role of Perceived Stigma on Family Resilience in Family Members of People With A Chronic Mental Illness: A Cross-Sectional Study 慢性精神疾病患者家庭成员的污名感对家庭弹性的影响:横断面研究。
IF 2.9 4区 医学 Q1 NURSING Pub Date : 2025-09-12 DOI: 10.1111/jpm.70029
Ayşe Sarı, Figen Şengün İnan, Zekiye Çetinkaya Duman, Erkan Ünsal
<div> <section> <h3> Introduction</h3> <p>In the provision of comprehensive care, it is important to identify factors that affect the resilience of family caregivers of people with a chronic mental illness.</p> </section> <section> <h3> Aim</h3> <p>This study was aimed at investigating the association between perceived family stigma and family resilience among family caregivers of people with a chronic mental illness.</p> </section> <section> <h3> Method</h3> <p>In the study, the cross-sectional, correlational design was used. The sample consisted of 158 family caregivers of individuals diagnosed with a chronic mental illness (schizophrenia and bipolar disorder) who were attending an outpatient unit of a university hospital. Data were collected using the stigma section of the Family Interview Schedule (FIS), and Family Hardiness Index and Sociodemographic Characteristics Form. Multiple linear regression analysis was used to analyse the data. In the reporting of the study, the STROBE checklist was used.</p> </section> <section> <h3> Results</h3> <p>Family stigma (<i>β</i> = −0.564, <i>p</i> = 0.001) and duration of caregiving (<i>β</i> = −0.396, <i>p</i> = 0.001) were associated with family resilience. In the model, family stigma and duration of caregiving accounted for 30% of the variance in family resilience (Adjusted <i>R</i><sup>2</sup> = 0.300) (<i>F</i> = 33.142, <i>p</i> = 0.001).</p> </section> <section> <h3> Conclusion</h3> <p>Perceived stigma of the family and duration of caregiving are important determinants of family resilience. There was a significant negative relationship between family stigma and family resilience.</p> </section> <section> <h3> Limitations</h3> <p>The fact that the study was conducted in a single hospital may have affected the generalisability of the results in terms of sample diversity. The hospital where the research was conducted is a university hospital and thus it is thought that supportive services for caregivers are relatively better. The other limitation is that a cross-sectional design was used, making it impossible to identify causal relationships.</p> </section> <section> <h3> Recommendations</h3> <p>It is recommended that the long-term effects of perceived stigma of caregivers on family resilience be investigated in future studies. It is recommended that mental health nurses plan nursing interventions to reduce the family's perceived stigma in order
在提供综合护理时,重要的是要确定影响慢性精神疾病患者的家庭照顾者的复原力的因素。目的:本研究旨在探讨慢性精神疾病患者家庭照顾者的家庭污名感与家庭弹性的关系。方法:采用横断面相关设计。样本包括158名被诊断患有慢性精神疾病(精神分裂症和双相情感障碍)的家庭护理人员,他们在一所大学医院的门诊就诊。数据采用家庭访谈表(FIS)的污名部分、家庭耐寒指数和社会人口学特征表收集。采用多元线性回归分析对数据进行分析。在研究报告中,使用了STROBE检查表。结果:家庭耻辱感(β = -0.564, p = 0.001)和照料时间(β = -0.396, p = 0.001)与家庭心理弹性相关。在模型中,家庭耻辱感和照顾持续时间占家庭弹性方差的30%(调整后R2 = 0.300) (F = 33.142, p = 0.001)。结论:家庭污名感和照料时间是家庭复原力的重要决定因素。家庭耻感与家庭韧性呈显著负相关。局限性:该研究是在一家医院进行的,这一事实可能影响了样本多样性方面结果的普遍性。进行这项研究的医院是一所大学医院,因此人们认为,对护理人员的支持服务相对更好。另一个限制是使用了横断面设计,因此无法确定因果关系。建议:建议在未来的研究中调查照顾者感知耻辱对家庭恢复力的长期影响。建议心理健康护士计划护理干预措施,以减少家庭的感知耻辱,以增加家庭弹性。
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引用次数: 0
Enhancing Mental Health Care Through Religious Beliefs: Insights and Future Directions 通过宗教信仰加强精神卫生保健:见解和未来方向。
IF 2.9 4区 医学 Q1 NURSING Pub Date : 2025-09-11 DOI: 10.1111/jpm.70030
Chang Hu

Background

The study by Hennipman-Herweijer et al. documents the experiences of Dutch Protestant Christians living with a suicidal relative, revealing the complex role of religious beliefs in coping with suicidality.

Objective

To contextualise these findings within the global mental health care framework and highlight the universal importance of addressing religious beliefs in mental health care.

Content

Drawing on Dutch studies and international literature, this letter underscores the dual role of religious beliefs in coping with suicidality. The study finds that religious beliefs can provide support and comfort to Christian relatives of suicidal individuals but may also induce guilt and fear due to religious interpretations of suicide. International studies indicate that the role of religion in mental health care is universal, and strategies targeting religious coping and spiritual support can significantly improve the quality of mental health care.

Implications

Mental health care providers worldwide should integrate religious beliefs and spiritual support, develop training programmes targeting religious coping strategies, and offer structured psychosocial skills training to enhance mental health care outcomes for individuals with religious backgrounds.

Conclusion

Shared challenges demand globally informed yet locally adapted mental health policies to better meet the needs of individuals with religious backgrounds.

背景:Hennipman-Herweijer等人的研究记录了荷兰新教基督徒与自杀亲属一起生活的经历,揭示了宗教信仰在应对自杀行为中的复杂作用。目的:将这些发现置于全球精神卫生保健框架内,并强调在精神卫生保健中解决宗教信仰问题的普遍重要性。内容:根据荷兰的研究和国际文献,这封信强调了宗教信仰在应对自杀方面的双重作用。研究发现,宗教信仰可以为自杀者的基督徒亲属提供支持和安慰,但也可能由于宗教对自杀的解释而引起内疚和恐惧。国际研究表明,宗教在精神卫生保健中的作用是普遍的,以宗教应对和精神支持为目标的策略可以显著提高精神卫生保健的质量。含义:世界各地的精神卫生保健提供者应将宗教信仰和精神支持结合起来,制定针对宗教应对策略的培训方案,并提供结构化的社会心理技能培训,以提高具有宗教背景的个人的精神卫生保健结果。结论:共同的挑战需要全球知情和适应当地的精神卫生政策,以更好地满足具有宗教背景的个人的需求。
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引用次数: 0
Core Purposes of Mental Health Peer Work: Empowerment, Stigma Reduction, Relational Safety and Walking Alongside People 心理健康同伴工作的核心目的:赋权、减少耻辱、关系安全和与人同行。
IF 2.9 4区 医学 Q1 NURSING Pub Date : 2025-08-27 DOI: 10.1111/jpm.70027
Nicholas Haines

Background

Mental health peer work harnesses personal experience of distress and recovery to support others. While growing evidence highlights its benefits, little is known about how individual narratives map onto core peer work functions in everyday practice.

Aim

To present an autoethnographic narrative that embodies four fundamental purposes of mental health peer work—empowerment, stigma reduction, relational safety and walking alongside—in a manner that is instructive to mental health nurses who have peer workers as colleagues.

Approach

Drawing on my lived experience—from a year of my childhood in France to severe illness as a university student, through diverse roles culminating in peer work—I use illustrative client vignettes to show how shared experience fosters connection and recovery.

Findings

(1) Empowerment: Gentle, consistent support enabled a woman with complex trauma to participate in art shows. (2) Stigma reduction: Normalising lithium use helped a young man face bipolar disorder treatment with confidence. (3) Relational safety: Incorporating client-led rituals (e.g., tarot readings) built the trust needed for deeper conversations. (4) Walking alongside: Presence and honest advocacy offered meaning to a man grappling with poverty and despair.

Conclusion

Lived experience is a unique resource that enriches mental health teams. Sharing peer principles with mental health clinicians can facilitate the process of integrating peer workers into mental health teams.

背景:心理健康同伴工作利用个人痛苦和恢复的经验来支持他人。尽管越来越多的证据强调了它的好处,但人们对个人叙述如何映射到日常实践中的核心同伴工作功能知之甚少。目的:提出一种自我民族志叙述,体现了精神健康同伴工作的四个基本目的-授权,减少耻辱,关系安全和同行-以一种对有同伴工作人员作为同事的精神健康护士有指导意义的方式。方法:根据我的生活经历——从我在法国度过的一年童年,到在大学期间患上重病,再到在同伴工作中扮演不同的角色——我用说明性的客户小故事来展示共同的经历如何促进联系和恢复。研究发现:(1)赋权:温柔、持续的支持使有复杂创伤的女性能够参与艺术展览。(2)减少耻辱感:锂盐使用正常化帮助一名年轻人自信地面对双相情感障碍治疗。(3)关系安全:结合客户主导的仪式(如塔罗牌占卜),建立更深层次对话所需的信任。(4)并肩同行:存在和诚实的倡导为一个与贫困和绝望作斗争的人提供了意义。结论:生活经验是丰富心理健康队伍的独特资源。与心理健康临床医生分享同伴原则可以促进同伴工作者融入心理健康团队的过程。
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引用次数: 0
期刊
Journal of Psychiatric and Mental Health Nursing
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