Ethical Problems Encountered by Mental Health Nurses

Abstract

This descriptive study examines ethical conflicts reported by psychiatric-mental health nurses in community and inpatient settings. Generalist community nurses were included for comparison. The analysis of cases included reviewing general descriptions of the cases and identifying decision maker, principles involved, and type of moral conflicts. Fifty-seven case situations were collected: 20 cases from a psychiatric hospital, 18 cases from community mental health programs, and 19 cases from a general public health program. Fifty-one of the 57 cases reflected ethical problems. Using Jameton's (1984) categories, 30 of the 57 cases were rated as a dilemma, 18 were rated as moral uncertainty, and 3 were rated as examples of distress. The mental health nurses indicated that they believed they were the decision maker in the majority of cases. The general community nurses were more likely to believe the client was the decision maker. The identified principles, based on Batch and Fry (1987), were doing good, or beneficence (26); confidentiality (10); autonomy (9); avoiding deception (4); and preventing killing (2). In the remaining 6 cases no principles were identified. Staff conflict was present in 13 of 20 inpatient cases, as compared with only 3 cases in each of the community settings (p > .005).