Moral distress in acute psychiatric nursing: Multifaceted dilemmas and demands

2019 ◽  
Vol 27 (5) ◽  
pp. 1315-1326 ◽  
Author(s):  
Trine-Lise Jansen ◽  
Marit Helene Hem ◽  
Lars Johan Dambolt ◽  
Ingrid Hanssen
Keyword(s):  
Psychiatric Care ◽  
Moral Distress ◽  
Quality Care ◽  
Moral Dilemmas ◽  
Ethical Awareness ◽  
Science Data ◽  
Data Services ◽  
Definition Of ◽  
Acute Psychiatric Care

Background In this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored. Research design A qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used. Ethical considerations Approval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary. Findings Based on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or moral doubt are included. Coercive administration of medicines, coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness. Conclusion Moral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves.

scholarly journals Coping with moral distress on acute psychiatric wards: A qualitative study

2021 ◽  
pp. 096973302110102
Author(s):  
Trine-Lise Jansen ◽  
Marit Helene Hem ◽  
Lars Johan Danbolt ◽  
Ingrid Hanssen
Keyword(s):  
Coping Strategies ◽  
Moral Distress ◽  
Moral Dilemmas ◽  
Work Climate ◽  
Private Life ◽  
High Price ◽  
Science Data ◽  
Research Guidelines ◽  
Acute Psychiatric Wards ◽  
To Come

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.

Recovery Following Peer and Text Messaging Support after Discharge from Acute Psychiatric Care: A Randomized Controlled Pilot Trial (Preprint)

2021 ◽  
Author(s):  
Reham Shalaby ◽  
Marianne Hrabok ◽  
Pamela Spurvey ◽  
Rabab M. Abou El-Magd ◽  
Michelle Knox ◽  
...  
Keyword(s):  
Peer Support ◽  
Text Messaging ◽  
Psychiatric Care ◽  
Text Message ◽  
Text Messages ◽  
Treatment As Usual ◽  
Usual Condition ◽  
Randomized Controlled ◽  
Acute Psychiatric Care

BACKGROUND Peer support (PS) is emotional, social, and practical help that is provided by non-professionals to assist others in sustaining health behaviours. PS is valued in recovery-oriented models of mental health and is becoming implemented increasingly at the organizational level. Text messaging is a relatively low cost, high impact, and easily scalable program that uses existing technology, is devoid of geographic barriers, and is easily accessible to end users. OBJECTIVE This study aims to evaluate the effect of an innovative peer support system plus supportive text messaging program on the recovery of discharged patients from acute psychiatric care. METHODS This is a prospective, rater-blinded, pilot randomized controlled trial, including 180 patients discharged from acute psychiatric care. Patients were randomized to one of four conditions: treatment as usual (follow-up care), daily supportive text messages, peer-support only, or peer-support plus daily supportive text messages. A standardized self-report measure of recovery (Recovery Assessment Scale; RAS) was completed at baseline, six weeks, three months, and six months. Descriptive analysis, One-Way ANOVA, and repeated measures MANCOVA were deployed to examine the changes in RAS among the study groups and over the follow-up time points. RESULTS Sixty-five patients completed assessments at each time-point. For the overall sample, higher scores were found for the peer-support plus text message condition compared to the text message only and treatment as usual condition on several scales (i.e., Willingness to ask for help and Personal Confidence and Hope) and total score on the RAS. CONCLUSIONS Peer support plus supportive text messaging results in improved recovery compared to other interventions. It is advisable to incorporate the two interventions as a part of routine practice for patients with psychiatric disorders upon their hospital discharge. CLINICALTRIAL The study received ethical approval from the Health Ethics Research Board of the University of Alberta (Ref # Pro00078427) and operational approval from the Alberta Health Services regional health authority. All patients provided written informed consent. The study was registered with clinicaltrials.gov (Trial registration number NCT03404882).

scholarly journals Family Members’ Existential and Moral Dilemmas With Coercion in Mental Healthcare

2018 ◽  
Vol 28 (6) ◽  
pp. 900-915 ◽  
Author(s):  
Reidun Norvoll ◽  
Marit Helene Hem ◽  
Hilde Lindemann
Keyword(s):  
Moral Distress ◽  
Mental Health Problems ◽  
Family Relations ◽  
Quality Care ◽  
Family Members ◽  
Mental Healthcare ◽  
Moral Dilemmas ◽  
Narrative Study ◽  
Lack Of Information ◽  
Using Data

Coercion in mental healthcare does not only affect the patient, but also the patient’s families. Using data from interviews with 36 family members of adult and adolescent people with mental health problems and coercion experiences, the present narrative study explores family members’ existential and moral dilemmas regarding coercion and the factors influencing these dilemmas. Four major themes are identified: the ambiguity of coercion; struggling to stay connected and establishing collaboration; worries and distress regarding compulsory care; and dilemmas regarding initiating coercion. Subsequently, coercion can reduce, but also add burden for the family by creating strains on family relations, dilemmas, (moral) distress, and retrospective regrets; this is reinforced by the lack of information or involvement and low-quality care. Subsequently, it is a moral obligation to develop more responsive health services and professionals who provide more guidance and balanced information to increase the possibilities for voluntary alternatives and informed decision making.

Ethics and quality care in nursing homes: Relatives’ experiences

2017 ◽  
Vol 26 (3) ◽  
pp. 767-777 ◽  
Author(s):  
Rita Jakobsen ◽  
Gerd Sylvi Sellevold ◽  
Veslemøy Egede-Nissen ◽  
Venke Sørlie
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Staff ◽  
Quality Care ◽  
Science Data ◽  
Data Services ◽  
Nursing Home Patients ◽  
Positive Experiences ◽  
Close Relatives

Background: A total of 71,000 people in Norway suffer from some form of dementia in 2013, of whom approximately 30,000 are in nursing homes. Several studies focus on the experiences of those who have close relatives and who are staying in a nursing home. Results show that a greater focus on cooperation between nursing staff and relatives is a central prerequisite for an increased level of care. Benefits of developing systematic collaboration practices include relief for nursing staff, less stress, and greater mutual understanding. Going through studies focusing on the experiences of nursing home patients’ relatives, negative experiences are in the majority. In this study, relatives are invited to share positive experiences regarding the care of their loved ones; a slightly different perspective, in other words. Aim: The aim of the study is to investigate relatives of persons with dementia’s experiences with quality care in nursing homes. Method: The study is a part of a larger project called Hospice values in the care for persons with dementia and is based on a qualitative design where data are generated through narrative interviews. The chosen method of analysis is the phenomenological–hermeneutical method for the study of lived experiences. Participants and research context: Participants in the project were eight relatives of persons with dementia who were living in nursing homes, long-term residences. The sampling was targeted, enrolment happened through collective invitation. All relatives interested were included. Ethical considerations: The Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services approve the study. Findings: Findings show that relatives have certain expectations as to how their loved ones ought to be met and looked after at the nursing home. The results show that in those cases where the expectations were met, the relatives’ experiences were associated with engagement, inclusion and a good atmosphere. When the expectations were not met, the relatives experienced powerlessness, distrust and guilt. Discussion: The results are discussed considering the concepts of trust, power and asymmetry. Conclusion: When asked about experiences with quality care, the relatives spoke both of expectations met and of expectations not met. Results in this study are important knowledge for developing units where performing quality care is the overall aim.

scholarly journals Quality dementia care: Prerequisites and relational ethics among multicultural healthcare providers

2017 ◽  
Vol 26 (2) ◽  
pp. 504-514 ◽  
Author(s):  
Gerd Sylvi Sellevold ◽  
Veslemøy Egede-Nissen ◽  
Rita Jakobsen ◽  
Venke Sørlie
Keyword(s):  
Quality Care ◽  
Healthcare Providers ◽  
Working Environment ◽  
Working Relationships ◽  
Ethical Challenges ◽  
Participatory Action ◽  
Action Research Project ◽  
Science Data ◽  
Data Services ◽  
People With Dementia

Background: Many nursing homes appear as multicultural workplaces where the majority of healthcare providers have an ethnic minority background. This environment creates challenges linked to communication, interaction and cultural differences. Furthermore, the healthcare providers have varied experiences and understanding of what quality care of patients with dementia involves. Purpose: The aim of this study is to illuminate multi-ethnic healthcare providers’ lived experiences of their own working relationship, and its importance to quality care for people with dementia. Research design: The study is part of a greater participatory action research project: ‘Hospice values in the care for persons with dementia’. The data material consists of extensive notes from seminars, project meetings and dialogue-based teaching. The text material was subjected to phenomenological-hermeneutical interpretation. Participants and research context: Participants in the project were healthcare providers working in a nursing home unit. The participants came from 15 different countries, had different formal qualifications, varied backgrounds and ethnic origins. Ethical considerations: The study is approved by the Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services. Findings: The results show that good working relationships, characterized by understanding each other’s vulnerability and willingness to learn from each other through shared experiences, are prerequisites for quality care. The healthcare providers further described ethical challenges as uncertainty and different understandings. Discussion: The results are discussed in the light of Lögstrup’s relational philosophy of ethics and the concepts of vulnerability, ethic responsibility, trust and openness of speech. Conclusion: The prerequisite for quality care for persons with dementia in a multicultural working environment is to create arenas for open discussions between the healthcare providers. Leadership is of great importance.

Remaining in the nursing profession: The relevance of strong evaluations

2016 ◽  
Vol 25 (7) ◽  
pp. 928-938
Author(s):  
Margareth Kristoffersen ◽  
Febe Friberg
Keyword(s):  
Empirical Study ◽  
Research Question ◽  
Qualitative Interviews ◽  
Charles Taylor ◽  
Nursing Profession ◽  
Science Data ◽  
Data Services ◽  
Research Context ◽  
Complex Question

Background: Why nurses remain in the profession is a complex question. However, strong values can be grounds for their remaining, meaning nurses evaluate the qualitative worth of different desires and distinguish between senses of what is a good life. Research question: The overall aim is to explore and argue the relevance of strong evaluations for remaining in the nursing profession. Research design: This theoretical article based on a hermeneutical approach introduces the concept strong evaluations as described by the Canadian philosopher Charles Taylor and provides examples of nurses’ experiences in everyday nursing care drawn from a Norwegian empirical study. Participants and research context: Data collected in the original study consisted of qualitative interviews and qualitative follow-up interviews with 13 nurses. The research context was the primary and secondary somatic and psychiatric health service, inside as well as outside institutions. Ethical consideration: The article uses data from an original empirical study approved by the Norwegian Social Science Data Services. Information was given and consent obtained from the participants. Findings: Remaining in the nursing profession can be understood as revolving around being a strong evaluator. This has been concretized in issues of being aware of different incidents in life and having capacities as a nurse. Discussion: Why nurses remain is discussed in relation to how nurses have shaped themselves by reflecting on what is of significance in their life. However, being a strong evaluator cannot be seen as the casual condition for remaining. Conclusion: Remaining in the nursing profession is obviously not a contingent matter, rather it is a matter concerned with the qualitative worth of different desires and values. Nurses’ awareness of a life choice impacts on whether they remain or not. Consequently, nurses may need to articulate and reflect on their priorities for remaining.

Evaluation of ethical reflections in community healthcare

2014 ◽  
Vol 22 (2) ◽  
pp. 194-204 ◽  
Author(s):  
Ulrika Söderhamn ◽  
Helga Tofte Kjøstvedt ◽  
Åshild Slettebø
Keyword(s):  
Healthcare Services ◽  
Healthcare Personnel ◽  
Care Practice ◽  
Ethical Awareness ◽  
Science Data ◽  
Community Healthcare ◽  
Electronic Questionnaire ◽  
Data Services ◽  
Group Interviews ◽  
Ethical Reflections

Background: Ethical reflections over care practices are important. In order to be able to perform such reflections, healthcare professionals must learn to think critically about their care practice. Aim: The aim of this study was to evaluate whether an introduction to and practice in ethical reflections in community healthcare have consequences for the healthcare personnel’s practice. Research design: A mixed-methods design was adopted with five focus group interviews and an electronic questionnaire based on results from the interviews. Participants and research context: A total of 29 community healthcare personnel with experience in ethical reflections participated in the interviews. The electronic questionnaire was sent via email to 2382 employees in community healthcare services in 13 municipalities in southern part of Norway. Ethical considerations: The study was guided by the intentions of the Declaration of Helsinki and ethical standard principles and approved by the Norwegian Social Science Data Services. Results: An introduction to and practice in performing ethical reflections brought about an ethical awareness with understanding and respect for both colleagues and patients. The leader had a key role. Lack of time was a hindrance for ethical reflections. Three factors could predict meaningful ethical reflections: higher age of personnel, higher percentage of employment and longer experience with ethical reflections. Discussion: According to other studies, ethical reflections may enhance moral development of colleagues and their actions as advocates for the patients. A deepened ethical awareness, professional competency and sufficient time resources will guarantee proper caregiving. Conclusion: A supportive environment that prioritizes participation in reflection meetings is decisive. To practice ethical reflections will provide better care for patients. A challenge for the community healthcare system is to offer adequate positions that provide the personnel an opportunity to be involved as caregivers and to participate in ethical reflections.

Ethics support in community care makes a difference for practice

2016 ◽  
Vol 25 (2) ◽  
pp. 165-173 ◽  
Author(s):  
Morten Magelssen ◽  
Elisabeth Gjerberg ◽  
Lillian Lillemoen ◽  
Reidun Førde ◽  
Reidar Pedersen
Keyword(s):  
Large Scale ◽  
Response Rate ◽  
Ethical Challenges ◽  
Next Of Kin ◽  
Science Data ◽  
Data Services ◽  
Care Services ◽  
Ethics Support ◽  
Community Sector

Background: Through the Norwegian ethics project, ethics activities have been implemented in the health and care sector in more than 200 municipalities. Objectives: To study outcomes of the ethics activities and examine which factors promote and inhibit significance and sustainability of the activities. Research design: Two online questionnaires about the municipal ethics activities. Participants and research context: A total of 137 municipal contact persons for the ethics project answered the first survey (55% response rate), whereas 217 ethics facilitators responded to the second survey (33% response rate). Ethical considerations: Based on informed consent, the study was approved by the Data Protection Official of the Norwegian Social Science Data Services. Findings: Around half of the respondents found the ethics project to have been highly significant for daily professional practice. Outcomes include better handling of ethical challenges, better employee cooperation, better service quality, and better relations to patients and next of kin. Factors associated with sustainability and/or significance of the activities were sufficient support from stakeholders, sufficient available time, and ethics facilitators having sufficient knowledge and skills in ethics and access to supervision. Discussion: This study shows that ethics initiatives can be both sustainable and significant for practice. There is a need to create regional or national structures for follow-up and develop more comprehensive ethics training for ethics facilitators. Conclusion: It is both possible and potentially important to implement clinical ethics support activities in community health and care services systematically on a large scale. Future ethics initiatives in the community sector should be designed in light of documented promoting and inhibiting factors.

Short-Term Acute Psychiatric Care: A Follow-Up Study

1971 ◽  
Vol 127 (12) ◽  
pp. 1626-1630 ◽  
Author(s):  
S. B. PENICK ◽  
NANCY BUONPANE ◽  
R. N. CARRIER
Keyword(s):  
Psychiatric Care ◽  
Short Term ◽  
Follow Up Study ◽  
Acute Psychiatric Care

Comparison of Fluorine(18)-fluorodeoxyglucose and Gallium(68)-citrate PET/CT in patients with tuberculosis

2019 ◽  
Vol 58 (05) ◽  
pp. 371-378
Author(s):  
Alfred O. Ankrah ◽  
Ismaheel O. Lawal ◽  
Tebatso M.G. Boshomane ◽  
Hans C. Klein ◽  
Thomas Ebenhan ◽  
...  
Keyword(s):  
Tracer Uptake ◽  
Pet Ct ◽  
The Mean ◽  
18F Fdg ◽  
Definition Of ◽  
Gallium 68 ◽  
Attending Physician ◽  
Pet Scans ◽  
The Brain

Abstract 18F-FDG and 68Ga-citrate PET/CT have both been shown to be useful in the management of tuberculosis (TB). We compared the abnormal PET findings of 18F-FDG- and 68Ga-citrate-PET/CT in patients with TB. Methods Patients with TB on anti-TB therapy were included. Patients had a set of PET scans consisting of both 18F-FDG and 68Ga-citrate. Abnormal lesions were identified, and the two sets of scans were compared. The scan findings were correlated to the clinical data as provided by the attending physician. Results 46 PET/CT scans were performed in 18 patients, 11 (61 %) were female, and the mean age was 35.7 ± 13.5 years. Five patients also had both studies for follow-up reasons during the use of anti-TB therapy. Thirteen patients were co-infected with HIV. 18F-FDG detected more lesions than 68Ga-citrate (261 vs. 166, p < 0.0001). 68Ga-citrate showed a better definition of intracerebral lesions due to the absence of tracer uptake in the brain. The mean SUVmax was higher for 18F-FDG compared to 68Ga-citrate (5.73 vs. 3.01, p < 0.0001). We found a significant correlation between the SUVmax of lesions that were determined by both tracers (r = 0.4968, p < 0.0001). Conclusion Preliminary data shows 18F-FDG-PET detects more abnormal lesions in TB compared to 68Ga-citrate. However, 68Ga-citrate has better lesion definition in the brain and is therefore especially useful when intracranial TB is suspected.

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