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首页> 外文期刊>The Australian and New Zealand journal of psychiatry >Impact and management of dual relationships in metropolitan, regional and rural mental health practice.
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Impact and management of dual relationships in metropolitan, regional and rural mental health practice.

机译：都市，区域和农村心理健康实践中双重关系的影响和管理。

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OBJECTIVE: To explore the extent and impact of professional boundary crossings in metropolitan, regional and rural mental health practice in Victoria and identify strategies mental health clinicians use to manage dual relationships. METHOD: Nine geographically located focus groups consisting of mental health clinicians: four focus groups in rural settings; three in a regional city and two in a metropolitan mental health service. A total of 52 participants were interviewed. RESULTS: Data revealed that professional boundaries were frequently breached in regional and rural settings and on occasions these breaches had a significantly negative impact. Factors influencing the impact were: longevity of the clinician's relationship with the community, expectations of the community, exposure to community 'gossip' and size of the community. Participants reported greater stress when the boundary crossing affected their partner and/or children. Clinicians used a range of proactive and reactive strategies, such as private telephone number, avoidance of social community activities, when faced with a potential boundary crossing. The feasibility of reactive strategies depended on the service configuration: availability of an alternative case manager, requirement for either patient or clinician to travel. The greater challenges faced by rural and regional clinicians were validated by metropolitan participants with rural experience and rural participants with metropolitan experience. CONCLUSIONS: No single strategy is used or appropriate for managing dual relationships in rural settings. Employers and professional bodies should provide clearer guidance for clinicians both in the management of dual relationships and the distinction between boundary crossings and boundary violation. Clinicians are clearly seeking to represent and protect the patients' interests; consideration should be given by consumer groups to steps that can be taken by patients to reciprocate.
机译：目的：探讨维多利亚州大都会，区域和农村心理健康实践中专业边界穿越的程度和影响，并确定心理健康临床医生用来管理双重关系的策略。方法：由精神卫生临床医生组成的九个地理位置集中的焦点小组：农村地区的四个焦点小组;三个在一个地区性城市，两个在大都会精神卫生服务机构。总共采访了52名参与者。结果：数据显示，专业界限在区域和农村环境中经常被违反，有时这些违反会产生严重的负面影响。影响影响的因素包括：临床医生与社区的关系的寿命，社区的期望，社区“八卦”的暴露程度以及社区的规模。与会人员报告说，越境影响其伴侣和/或孩子时，他们承受的压力更大。临床医生在面对潜在的跨越边界时使用了一系列主动和被动的策略，例如私人电话号码，避免社交活动。反应性策略的可行性取决于服务配置：可替代病例经理的可用性，患者或临床医生出差的要求。具有农村经验的大都市参与者和具有大城市经验的农村参与者证明了农村和区域临床医生面临的更大挑战。结论：在乡村环境中，没有使用单一策略来管理双重关系，也没有合适的策略。雇主和专业机构应为临床医生提供更清晰的指导，包括双重关系的管理以及界线和界线的区别。临床医生显然正在寻求代表和保护患者利益;消费者群体应考虑患者可以采取的相应措施。

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