Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden.
Int J Ment Health Nurs. 2018 Dec;27(6):1851-1860. doi: 10.1111/inm.12494. Epub 2018 Jun 22.
Healthcare professionals working on inpatient wards face the externalizing or challenging behaviour of the patients who are admitted. Ethical values and principles in psychiatric nursing have been reported to be important when approaching patients during the most acute phase of deterioration in their mental health. Hence, the aim of this study was to discover and describe staff members' ethical and moral concerns about their work as healthcare professionals in a psychiatric intensive care unit. The study has a qualitative descriptive design and makes use of Framework Analysis. Registered nurses and psychiatric aides in a psychiatric intensive care unit in Sweden were observed during ethical reflection meetings. Four to six staff attended the 90-min meetings. The data comprise observations from six meetings, which provided 94 pages of text. The results demonstrate that the work was described as being both motivating and exhausting. The staff faced ethical concerns in their daily work, as patients often demonstrated challenging behaviours. Three themes were identified as follows: (i) concerns about the staff impacting on patients' experience of care, (ii) concerns about establishing a safe working environment, and (iii) concerns about becoming unprofessional due to expectations and a high workload. Ethical concerns included simultaneously taking into account both the patients' dignity and safety aspects, while also being exposed to high workloads. These elements of work are theorized as influencing complex psychiatric nursing. If we are to bring these influential factors to light in the workplace, advanced nursing practice must be grounded in moral mindfulness.
从事住院病房工作的医疗保健专业人员面临着入院患者的外化或挑战行为。据报道，在精神科护理中，当患者的心理健康恶化到最严重的阶段时，伦理价值观和原则对于接近患者非常重要。因此，本研究旨在发现和描述工作人员在精神病重症监护病房作为医疗保健专业人员工作时的道德和伦理关注。本研究采用定性描述设计，并使用框架分析。在瑞典的一家精神病重症监护病房观察注册护士和精神科助手在伦理反思会议期间的表现。每次会议有 4 到 6 名员工参加，每次会议时长 90 分钟。数据包括六次会议的观察结果，提供了 94 页的文本。研究结果表明，这项工作既有动力又很辛苦。工作人员在日常工作中面临着道德方面的担忧，因为患者经常表现出挑战性行为。确定了以下三个主题：（i）工作人员对患者护理体验的担忧，（ii）建立安全工作环境的担忧，以及（iii）由于期望和高工作量而变得不专业的担忧。道德方面的担忧包括同时考虑到患者的尊严和安全方面，同时还要面对高工作量。这些工作元素被理论化为影响复杂的精神科护理。如果我们要在工作场所中揭示这些有影响力的因素，那么高级护理实践必须以道德意识为基础。
