A matter of time: grappling with everyday ethical tensions at the confluence between policy and practice in a psychiatric unit

Abstract

ObjectiveTo provide insights on emergent ethical tensions experienced by mental health practitioners during system re-organisation, which is sufficiently grounded in empirical data at the local level to inform policy on recovery at institutional and provincial levels.MethodEthnographic methods using narrative and critical phenomenological resources over 24 months.FindingsEveryday ethical tensions emerged at the confluence of different experiences of time, for example, how a context of increasing pressure to decrease patients’ length of stay at the hospital (service-defined time) challenged efforts to listen to and advocate for what mattered to patients (personal time) and maintain the integrity of interventions (clinical time). In this context, practitioners drew on clinical language and that of personal recovery to strategically ‘push back’, ‘play with’ or ‘take back’ time.DiscussionExamining everyday practices through ethnographic methods can illuminate the everyday ethical tensions that arise when mental health professionals and psychiatrists grapple with, often competing, goods. Critical phenomenological resources can help expand the structural considerations in empirical ethics, excavate underground practices and raise questions about the conceptual categories undergirding normative ethics. Experiencing-with practitioners in clinical contexts as they encounter and creatively resolve ethical tensions also propose a normative ethics of possibility, to help bridge the gap between empirical and normative ethics.ConclusionFocus on the relationship between policy, temporal practices and ethics suggests a reconfiguration of time and re-imagination of ethics in institutional settings in ways that can ultimately benefit patients and professionals alike.

Collaborative Relationship-Focused Occupational Therapy: Evolving Lexicon and Practice

“…All relationships, whether short or long term, require time and attention to build. How time is allocated in everyday practice can create ethical tensions for therapists as time spent meeting institutional demands often takes time away from other activities including spending time with people receiving services (Motta-Ochoa et al, 2019). Although time has been cited by therapists as a barrier to developing collaborative relationships (Mortenson & Dyck, 2006), therapists can build relationships, even within very short-term services, by listening carefully to people’s experiences and concerns (Trudelle, 2016).…”

Understanding connectivity: The parallax and disruptive-productive effects of mixed methods social network analysis in occupational science

“…Yet, narrative phenomenology was also a key mechanism, itself, in the participatory process that 'opened' group members to entertain alternative perspectives and, thus, envision the possibility of realizing previously inconceivable results (Park, 2017(Park, , 2019. Findings from a parallel ethnographic study on everyday ethics during system transformation also demonstrated how the mental health professionals literally and figuratively played with time in order to do often mundane things with and for their patients in ways that intimately mattered to them (Motta-Ochoa et al, 2019).…”