The ethical problems encountered in psychiatric nursing practice with dangerous mentally ill persons.

Psychiatric nursing practice in acute inpatient and emergency settings requires that practitioners identify and manage dangerous patients. The analyses reported here are part of a broader study that sought to understand how psychiatric nurses define and manage the dangerous mentally ill. This paper identifies three ethical problems encountered in the day-to-day practices of psychiatric nurses, as they cared for and managed the dangerous mentally ill. The three ethical problems, balancing support for patient autonomy with the need to maintain unit control; balancing the need for distancing with the desire to establish therapeutic relationships; and balancing the desire to "do the right thing" with the need to get along with colleagues, have implications for psychiatric nursing practice and the institutional settings that treat the dangerous mentally ill. Additionally, this study provides direction for further inquiry into the actual ethical problems encountered in practice.