Moral sensing and ideological conflict. Aspects of the therapeutic relationship in psychiatric nursing.

A qualitative research study was conducted for the purpose of gaining knowledge of the therapeutic relationship as experienced by the psychiatric nurse. Deinstitutionalisation of the mentally ill, one of the goals of the mental health policy in Sweden, has broadened the field for psychiatric nurses. Nursing education on an academic level has prepared the nurse theoretically for increased responsibility in a variety of psychiatric settings. A general psychiatric ward in a large mental institution was chosen for the field work in this study. A phenomenological perspective and aspects of Grounded Theory were combined in the research strategy of participant observation. Data were collected and analysed simultaneously. The emerging conceptual categories were abstracted to two core concepts, moral sensing and ideological conflict. These were seen as central themes of the nurse-patient relationship as experienced by the psychiatric nurse. The nurse experienced that the dominant psychiatric ideology contradicted her own ideology. In order to reduce tension caused by this conflict, the nurse sought emotional support and encouragement from her co-workers. Alliance with the group could be seen as one strategy to reduce tensions but not necessarily to solve moral issues. The implication of this study is that although there may be a change in attitudes and approaches to mental illness and health, there are areas in psychiatric nursing which have not been fully explored. The nurse experiences many conflicts which can be described as ideological. This indicates the need to examine further the value and belief system upon which ethical decision-making is based and its effect on the nurse-patient relationship in psychiatric nursing.