Moral mindfulness: The ethical concerns of healthcare professionals working in a psychiatric intensive care unit

Abstract

Healthcare professionals working on inpatient wards face the externalizing or challenging behaviour of the patients who are admitted. Ethical values and principles in psychiatric nursing have been reported to be important when approaching patients during the most acute phase of deterioration in their mental health. Hence, the aim of this study was to discover and describe staff members' ethical and moral concerns about their work as healthcare professionals in a psychiatric intensive care unit. The study has a qualitative descriptive design and makes use of Framework Analysis. Registered nurses and psychiatric aides in a psychiatric intensive care unit in Sweden were observed during ethical reflection meetings. Four to six staff attended the 90-min meetings. The data comprise observations from six meetings, which provided 94 pages of text. The results demonstrate that the work was described as being both motivating and exhausting. The staff faced ethical concerns in their daily work, as patients often demonstrated challenging behaviours. Three themes were identified as follows: (i) concerns about the staff impacting on patients' experience of care, (ii) concerns about establishing a safe working environment, and (iii) concerns about becoming unprofessional due to expectations and a high workload. Ethical concerns included simultaneously taking into account both the patients' dignity and safety aspects, while also being exposed to high workloads. These elements of work are theorized as influencing complex psychiatric nursing. If we are to bring these influential factors to light in the workplace, advanced nursing practice must be grounded in moral mindfulness.

RAISe‐ing awareness: Person‐centred care in coercive mental health care environments—A scoping review and framework development

“…The use of coercion in mental health care is discussed in the literature in relation to ethical tensions (Hem et al., 2018; Landeweer et al., 2011; Salzmann‐Erikson, 2018). Commonly, such tension arises as the principles of providing care are often perceived to be opposed to the use of coercion.…”

“…In mental health care, there are some environments that encompass elements of coercive care (Hem, Gjerberg, Husum, & Pedersen, 2018; Landeweer, Amba, & Widdershoven, 2011; Salzmann‐Erikson, 2018). The concept of coercive care is complex.…”

Experience of mental health nurses regarding mechanical restraint in patients with psychomotor agitation: A qualitative study

“…This leads to more difficulties when de-escalating psychomotor agitation and professionals may be unavoidably compromised with the application or continuation of more coercive measures (Giacchero-Vedana et al, 2018;Jalil et al, 2017). to reduce the use of MR or to legitimise it (Jalil et al, 2017;Korkeila et al, 2016;Salzmann-Erikson, 2018). There are other aspects which, though they may not be determining factors, can influence the attitude of MH nurses towards the use of MR, such as gender aspects is crucial to further reducing its incidence and negative consequences and achieving the elimination of mechanical restraints.…”

“…The attitudes of the professionals themselves regarding approach to the patient with psychomotor agitation can be modulated and influenced by their team members, creating what Keser et al (2015) called Ward culture . This occurs when a person joins a team and adjusts their values and emotions to those of the other individuals, homogenising both interventions and their attitudes, whether to reduce the use of MR or to legitimise it (Jalil et al, 2017; Korkeila et al, 2016; Salzmann‐Erikson, 2018). There are other aspects which, though they may not be determining factors, can influence the attitude of MH nurses towards the use of MR, such as gender (Kodal et al, 2018), clinical experience and training (Korkeila et al, 2016), staffing levels (McKeown et al, 2019) or even the work shift (Riahi et al, 2016).…”

“Resisting the Ban”

“…Most notably, acts of "everyday resistance" enable these nurses to "carry on". "Psychiatric nurses" often face a relentlessly gruelling job and regularly face ethically troubling situations while at the same time being subject to functional demands over which they have little influence (Lutzen, 1998;Salzmann-Erikson, 2018). "Everyday resistance" provides a means of coping.…”