MORAL SURVIVAL IN A NONTHERAPEUTIC ENVIRONMENT

Abstract

The aim of this study was to examine the ethical decision-making process used by a group of psychiatric and mental health nurses in Canada. Researchers used the constant comparative method of grounded theory to simultaneously collect and analyze data. Data were collected through the use of focus groups of experienced psychiatric and mental health nurses. In addition to focus groups, participant observation and a number of formal and informal interviews were conducted. The contingency for the nurses in this study was the degree of support for professional nursing practice within the cultural context in which they worked. Moral survival in nontherapeutic environments was identified as the basic social process by which the nurses attempted to manage or ameliorate their ethical difficulties in their workplaces. Survival strategies included the doctor-nurse game, covering your backside, running interference, doctor-bashing, administration bashing, scapegoating, and the breakdown of teamwork. The findings revealed nursing strategies that were aimed at surviving in what were perceived as nontherapeutic environments. These strategies are morally significant because the dilemmas concern a moral responsibility that cannot be delegated to others. The moral dilemmas are whether to (a) promote one's own survival or to take care of patients, and (b) be held responsible for one's own actions or to place responsibility on others.