Decisions and justifications by community mental health providers about hypothetical ethical dilemmas.
Decisions and justifications by community mental health providers about hypothetical ethical dilemmas.
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社区心理健康提供者关于假设的道德困境的决定和理由。
DOI：
10.1176/ps.49.10.1317
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
Stewart,M
中科院分区：
文献类型：
--
作者：
Perkins,DV;Hudson,BL;Gray,DM;Stewart,M
OBJECTIVECommunity-based treatment of persons with serious mental illness requires providers to become involved in clients' personal lives to a greater degree than does hospital-based treatment. The study examined attendant ethical dilemmas, especially for staff who lack professional training or work in rural communities.METHODSA total of 95 staff members from five community mental health centers read 14 vignettes describing ambiguous ethical dilemmas involving professional role boundaries or client confidentiality. Twenty-seven staff members were from rural agencies, and 68 from urban-suburban agencies; 60 were direct care staff, and 35 were supervisory. Participants were asked to make and justify a more conservative or a less conservative decision in response to each dilemma.RESULTSYears of experience as a mental health provider and previous ethics training correlated positively with staff having experienced more situations similar to those in the vignettes; however, these variables were not related to the decision made or the type of ethical justification for it. When the analysis controlled for experience and previous ethics training, staff made fewer conservative decisions in boundary dilemmas than in confidentiality dilemmas. Compared with nonrural providers, rural providers had experienced more boundary dilemmas and made fewer conservative decisions in response to them.CONCLUSIONSBoundary problems occur frequently in community-based services, especially in rural settings, and may or may not be handled conservatively. With the expansion of case management and other in vivo services, better understanding of ethical risks and informal practices will help improve services and provide appropriate training and supervision of staff.
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