Abstract
Background:Nurses working within acute psychiatric settings often face multifaceted moral dilemmas and incompatible demands.Methods:Qualitative individual and focus group interviews were conducted.Ethical considerations:Approval was received from the Norwegian Social Science Data Services. Ethical Research Guidelines were followed.Participants and research context:Thirty nurses working within acute psychiatric wards in two mental health hospitals.Results:Various coping strategies were used: mentally sorting through their ethical dilemmas or bringing them to the leadership, not ‘bringing problems home’ after work or loyally doing as told and trying to make oneself immune. Colleagues and work climate were important for choice of coping strategies.Discussion:Nurses’ coping strategies may influence both their clinical practice and their private life. Not facing their moral distress seemed to come at a high price.Conclusions:It seems essential for nurses working in acute psychiatric settings to come to terms with distressing events and identify and address the moral issues they face. As moral distress to a great extent is an organisational problem experienced at a personal level, it is important that a work climate is developed that is open for ethical discussions and nourishes adaptive coping strategies and moral resilience.
Highlights
Nurses working within acute psychiatric settings – that is, giving treatment and care during an acute phase of mental illness – often find themselves in situations facing multifaceted moral dilemmas and incompatible demands
We found that loyalty may be understood as a coping strategy, a way to disclaim responsibility, to mitigate moral distress
Sorting through the ethical dilemmas they experienced seemed to lead to moral resilience, while others tried to solve problems by bringing them to the leadership
Summary
Nurses working within acute psychiatric settings – that is, giving treatment and care during an acute phase of mental illness – often find themselves in situations facing multifaceted moral dilemmas and incompatible demands. This may cause moral distress.[1] Moral distress is an increasingly familiar term and a common phenomenon in many healthcare contexts and professional groups.[2] The concept is attributed to Jameton[3] and may be defined as an unpleasant feeling or a psychological imbalance which arises when one knows what the ethically right action is, but internal and/or external factors make it impossible to act . As moral distress to a great extent is an organisational problem experienced at a personal level, it is important that a work climate is developed that is open for ethical discussions and nourishes adaptive coping strategies and moral resilience
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