Gorfodaeth anffurfiol
Yng nghyd-destun perthynas meddyg-claf, mae gorfodaeth anffurfiol yn broses gymdeithasol lle mae'r gofal iechyd yn ceisio gwneud i glaf gadw at y driniaeth a ddymunir heb ei orfodi. Hyn yw, ceisia'r meddyg, y nyrs neu weithiwr arall o staff gofal iechyd beidio a defnyddio gorfodaeth ffurfiol megis ymrwymiad anwirfoddol ynghyd â thriniaeth anwirfoddol.[1] Enghraifft o driniaeth anwirfoddol yw chwistrelliad mewngyhyrol o haloperidol.[2]
Enghraifft o'r canlynol | proses, triniaeth feddygol |
---|---|
Math | coercion |
Rhan o | therapi |
Mae gorfodaeth anffurfiol yn aml yn cael ei defnyddio a'i gymhwyso gan weithwyr iechyd proffesiynol fel rhan o driniaeth iechyd meddwl ond mae hefyd yn cael ei ddefnyddio gan ffrindiau a theulu defnyddiwr y gwasanaeth.[3]
Dosbarthiad
golyguMae sawl hierarchaeth o orfodaeth anffurfiol wedi'u creu. Diffiniodd Smuzkler ac Appelbaum hierarchaeth gorfodi pum lefel:[4] [5]
- perswâd
- Trosoledd rhyngbersonol (interpersonal leverage)
- cymhellion
- bygythiadau
- triniaeth orfodol
Mae Lidz et all yn diffinio naw math o orfodaeth anffurfiol:
- perswâd
- cymell
- bygythiadau,
- dangos grym
- grym corfforol
- grym cyfreithiol
- cais am ffafriaeth warediadol
- rhoi gorchmynion
- dichell.
Trosoledd rhyngbersonol
golyguOs oes gan y defnyddiwr gwasanaeth ddibyniaeth emosiynol ar y darparwr gwasanaeth, yna gall y clinigwr ddefnyddio siom i ddylanwadu ar y defnyddiwr gwasanaeth.[6] Yn syml: "Dw i'n hynod siomedig na wnest ti gymryd y tabledi, er i ti addo - gaddo wneud hynny."
Cymhellion
golyguEfallai y gofynnir i'r claf wneud yr hyn y mae clinigwr ei eisiau i gael mynediad at nwyddau o werth ariannol megis tai, arian, plant, a chyfiawnder troseddol.[7] Mynediad amodol i dai yw’r math mwyaf cyffredin o gymhelliant ymysg gorfodaeth anffurfiol, yn ôl 15-40% o'r defnyddwyr gwasanaeth. Canfu astudiaeth o orfodaeth anffurfiol yn y ddarpariaeth tai fod 60% o ddefnyddwyr gwasanaethau nad oeddent yn cydymffurfio wedi'u heithrio o'r rhaglen. Yn syml: "os cymerwch ein tabledi, yna fe gewch oriadau'r fflat."
Gall gweithiwr gofal iechyd ddefnyddio adnoddau cyffredinol megis sigaréts, bwyd neu ddiod i berswadio cleifion i gymryd eu meddyginiaeth.[8]
Bygythiadau
golyguGellir defnyddio'r bygythiad o ymrwymiad anwirfoddol neu driniaeth anwirfoddol i argyhoeddi cleifion i gydymffurfio heb ddefnyddio gorfodaeth ffurfiol.[9] Yn syml: "Os na chymeri dy dabledi, yna bydd yn rhaid i ni..."
Mynychder
golyguDengys astudiaethau fod y rhan fwyaf o weithwyr iechyd meddwl proffesiynol yn defnyddio gorfodaeth anffurfiol o ddydd i ddydd.[10]
Mae ymarferwyr yn defnyddio gorfodaeth anffurfiol yn fwy nag y maent yn ymwybodol ohono, a dangosodd astudiaeth ei fod yn cael ei tan-amcangyfrifo.[11] Mae 29-59% o ddefnyddwyr gwasanaeth yn defnyddio gorfodaeth anffurfiol. Adroddodd 11-23% o ddefnyddwyr gwasanaeth am drosoledd barnwrol (Judicial leverage), lle mae defnyddiwr gwasanaeth yn cydymffurfio i osgoi achos cyfreithiol.
Agwedd defnyddwyr gwasanaeth
golyguDywedodd 55-69% o ddefnyddwyr gwasanaeth eu bod yn gweld trosoledd rhyngbersonol yn deg a nododd 48-60% ei fod yn effeithiol. Mae astudiaethau'n dangos bod cleifion â dirnadaeth uwch yn fwy ffafriol i orfodaeth. Ystyrir bod cleifion sydd wedi eu diagnosio o sgitsoffrenia yn fwy tebygol o ddweud bod gorfodaeth anffurfiol yn digwydd, ac yn fwy negyddol am orfodaeth.[12]
Agweddau ymhlith darparwyr gwasanaethau
golyguMae darparwyr gwasanaethau’n ystyried gorfodaeth anffurfiol fel ffordd o hybu cydymffurfiaeth, ac y gallai atal gwaethygu’r symptomau a’r angen am orfodaeth ffurfiol. Teimlai gweithwyr proffesiynol y gallai gorfodaeth anffurfiol annog unigolion i gymryd mwy o gyfrifoldeb dros eu bywydau.[13]
Cyfeiriadau
golygu- ↑ Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review". Frontiers in Psychiatry 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640. https://www.researchgate.net/profile/Ana-Zaninotto-2/publication/323809188_New_models_of_care_for_patients_with_severe_mental_illness_-_bridging_in_-_and_outpatients/links/5aabe2c7a6fdcce30faafdd9/New-models-of-care-for-patients-with-severe-mental-illness-bridging-in-and-outpatients.pdf#page=19.
- ↑ Violence and aggression: short-term management in mental health, health and community settings: NICE guideline. National Institute of Clinical Excellence. 2015.
- ↑ Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review". Frontiers in Psychiatry 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640. https://www.researchgate.net/profile/Ana-Zaninotto-2/publication/323809188_New_models_of_care_for_patients_with_severe_mental_illness_-_bridging_in_-_and_outpatients/links/5aabe2c7a6fdcce30faafdd9/New-models-of-care-for-patients-with-severe-mental-illness-bridging-in-and-outpatients.pdf#page=19.Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review" (PDF). Frontiers in Psychiatry. 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640.
- ↑ Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review". Frontiers in Psychiatry 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640. https://www.researchgate.net/profile/Ana-Zaninotto-2/publication/323809188_New_models_of_care_for_patients_with_severe_mental_illness_-_bridging_in_-_and_outpatients/links/5aabe2c7a6fdcce30faafdd9/New-models-of-care-for-patients-with-severe-mental-illness-bridging-in-and-outpatients.pdf#page=19.Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review" (PDF). Frontiers in Psychiatry. 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640.
- ↑ Coercion in community mental health care : international perspectives. Andrew Molodynski, Jorun Rugkåsa, Tom Burns. Oxford. 2016. ISBN 978-0-19-103431-2. OCLC 953456448.CS1 maint: others (link)
- ↑ Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review". Frontiers in Psychiatry 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640. https://www.researchgate.net/profile/Ana-Zaninotto-2/publication/323809188_New_models_of_care_for_patients_with_severe_mental_illness_-_bridging_in_-_and_outpatients/links/5aabe2c7a6fdcce30faafdd9/New-models-of-care-for-patients-with-severe-mental-illness-bridging-in-and-outpatients.pdf#page=19.Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review" (PDF). Frontiers in Psychiatry. 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640.
- ↑ Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review". Frontiers in Psychiatry 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640. https://www.researchgate.net/profile/Ana-Zaninotto-2/publication/323809188_New_models_of_care_for_patients_with_severe_mental_illness_-_bridging_in_-_and_outpatients/links/5aabe2c7a6fdcce30faafdd9/New-models-of-care-for-patients-with-severe-mental-illness-bridging-in-and-outpatients.pdf#page=19.Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review" (PDF). Frontiers in Psychiatry. 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640.
- ↑ Pelto-Piri, Veikko; Kjellin, Lars; Hylén, Ulrika; Valenti, Emanuele; Priebe, Stefan (December 2019). "Different forms of informal coercion in psychiatry: a qualitative study" (yn en). BMC Research Notes 12 (1): 787. doi:10.1186/s13104-019-4823-x. ISSN 1756-0500. PMC 6889621. PMID 31791408. https://link.springer.com/content/pdf/10.1186/s13104-019-4823-x.pdf.
- ↑ Pelto-Piri, Veikko; Kjellin, Lars; Hylén, Ulrika; Valenti, Emanuele; Priebe, Stefan (December 2019). "Different forms of informal coercion in psychiatry: a qualitative study" (yn en). BMC Research Notes 12 (1): 787. doi:10.1186/s13104-019-4823-x. ISSN 1756-0500. PMC 6889621. PMID 31791408. https://link.springer.com/content/pdf/10.1186/s13104-019-4823-x.pdf.Pelto-Piri, Veikko; Kjellin, Lars; Hylén, Ulrika; Valenti, Emanuele; Priebe, Stefan (December 2019). "Different forms of informal coercion in psychiatry: a qualitative study" (PDF). BMC Research Notes. 12 (1): 787. doi:10.1186/s13104-019-4823-x. ISSN 1756-0500. PMC 6889621. PMID 31791408.
- ↑ Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review". Frontiers in Psychiatry 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640. https://www.researchgate.net/profile/Ana-Zaninotto-2/publication/323809188_New_models_of_care_for_patients_with_severe_mental_illness_-_bridging_in_-_and_outpatients/links/5aabe2c7a6fdcce30faafdd9/New-models-of-care-for-patients-with-severe-mental-illness-bridging-in-and-outpatients.pdf#page=19.Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review" (PDF). Frontiers in Psychiatry. 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640.
- ↑ Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review". Frontiers in Psychiatry 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640. https://www.researchgate.net/profile/Ana-Zaninotto-2/publication/323809188_New_models_of_care_for_patients_with_severe_mental_illness_-_bridging_in_-_and_outpatients/links/5aabe2c7a6fdcce30faafdd9/New-models-of-care-for-patients-with-severe-mental-illness-bridging-in-and-outpatients.pdf#page=19.Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review" (PDF). Frontiers in Psychiatry. 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640.
- ↑ Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review". Frontiers in Psychiatry 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640. https://www.researchgate.net/profile/Ana-Zaninotto-2/publication/323809188_New_models_of_care_for_patients_with_severe_mental_illness_-_bridging_in_-_and_outpatients/links/5aabe2c7a6fdcce30faafdd9/New-models-of-care-for-patients-with-severe-mental-illness-bridging-in-and-outpatients.pdf#page=19.Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review" (PDF). Frontiers in Psychiatry. 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640.
- ↑ Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review". Frontiers in Psychiatry 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640. https://www.researchgate.net/profile/Ana-Zaninotto-2/publication/323809188_New_models_of_care_for_patients_with_severe_mental_illness_-_bridging_in_-_and_outpatients/links/5aabe2c7a6fdcce30faafdd9/New-models-of-care-for-patients-with-severe-mental-illness-bridging-in-and-outpatients.pdf#page=19.Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review" (PDF). Frontiers in Psychiatry. 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640.