激しい拒絶を示す患者の看護に関する一考察 [in Japanese] CASE STUDY OF A SIVERELY REJECTIVE PATIENT : EFFECTS OF STUDENT NURSES' PRACTICES AND CONTROVERSIES [in Japanese]
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There have been many controversies over "informed consent" of psychiatric patients. It sometimes becomes inevitable for staff to do something without a patient's consent in order to keep his/her safety. A student nurse criticzed staff for being abusive to a highly rejective and regressive female psychiatric patient. The patient did nothing by herself, so that staff had to urge her, for example, to eat or to take a medication everyday. The student nurse was also bitterly refused by her. The criticism the student nurse made arouse a serious discussion among the nurses. Some staff disagreed with her observation, but they decided to reconsider their approach to the patient. Then another student nurse took charge of the same patient, and could manage to make good relationship with her. One day the patient asked the student nurse why she hadn't pushed her hard enough, and admitted that she liked staff to be tough on herself. As a matter of fact violence was common-place in her family. It seemed that she was trying to realize her own family by the severely regressed behavior against the staff. It also became clear that some nurses were aware of and reacted instinctively to her hidden need for dependence. There remained an educational problem in this case. The student nurse who criticised the staff for the patient abuse could not understand the patient's unspoken emotional need, because she was shocked by a patient's severe rejection, although she made good contribution to making better practice of nurses. It is really a difficult matter for teachers how to do with students' straight criticism. We must deal with the students' emotional problems as well as the controversial issues they made.