Ethical decision making among psychiatric high and intensive care nurses when confronted with moral dilemmas in daily practise, a grounded theory approach

Abstract

Title Ethical decision making among psychiatric high and intensive care nurses when confronted with moral dilemmas in daily practice, a grounded theory approach Background Acute psychiatry in the Netherlands is currently shaped as secluded high- and intensive care wards (HIC). Crucial to the HIC wards is an emphasis on empathy and contact with the patients, providing a safe and benign environment for recovery. Consequently, the use of coercion and restraint is limited. An environment of empathy and contact, may be at odds with the provision of safety. Nurses are faced with these dilemma’s on a daily basis and can hence have a substantial effect on the patient’s wellbeing and recovery. Aim To provide a theory of ethical decision making of nurses working on HIC wards when they are confronted with ethical dilemmas in daily care Methods A constructivist grounded theory methodology was used. A total of fourteen nurses in active duty were interviewed. Participants were recruited from a sample of HIC wards throughout the Netherlands. Results A model of ethical decision making emerged comprised of three elements. 1) The values regarding good care as held by the nurse, 2) the context within which nurses have to act, 3) the dynamics between these values and the context of everyday care. This dynamic affects the autonomy to act, limited autonomy is experienced as burdensome. Emotions can motivate to act. Conclusions Ethical decision making in daily practice is complex, highly personal and often burdensome. Nurses should be aware of this complexity within themselves to make better decisions and to relieve the burden

Implications of key findings Ethical reflection, particularly regarding the intricacies of ethical decision making in daily care, remains imperative on the ethically challenging wards that HIC wards are.