People with mental illness are subjected to stigma and discrimination and constantly face restrictions in the exercise of their political, civil and social rights. Considering this scenario, mental health, ethics and human rights are key approaches to advance the well-being of persons with mental illnesses. The study was conducted to review the scope of the empirical literature available to answer the research question: What evidence is available regarding human rights and ethical issues regarding nursing care to persons with mental illnesses? (...) A scoping review methodology guided by Arksey and O’Malley was used. Studies were identified by conducting electronic searches on CINAHL, PubMed, SCOPUS and Hein databases. Of 312 citations, 26 articles matched the inclusion criteria. The central theme which emerged from the literature was “Ethics and Human Rights Boundaries to Mental Health Nursing practice”. Mental health nurses play a key and valuable role in ensuring that their interventions are based on ethical and human rights principles. Mental health nurses seem to have difficulty engaging with the ethical issues in mental health, and generally are dealing with acts of paternalism and with the common justification for those acts. It is important to open a debate regarding possible solutions for this ethical dilemma, with the purpose to enable nurses to function in a way that is morally acceptable to the profession, patients and members of the public. This review may serve as an instrument for healthcare professionals, especially nurses, to reflect about how to fulfil their ethical responsibilities towards persons with mental illnesses, protecting them from discrimination and safeguarding their human rights, respecting their autonomy, and as a value, keeping the individual at the centre of ethical discourse. (shrink)

Moral deliberation has been receiving more attention in nursing ethics. Several ethical conversation models have been developed. This article explores the feasibility of the so-called CARE (Considerations, Actions, Reasons, Experiences) model as a framework for moral deliberation in psychiatric nursing practice. This model was used in combination with narrative and dialogical approaches to foster discourse between various stakeholders about coercion in a closed admission clinic in a mental hospital in the Netherlands. The findings demonstrate that the CARE model provides a (...) substantial framework for structuring moral deliberations. Narratives and dialogue are useful tools for broadening issues in conversations, to engage various stakeholders (including patients), and to gain shared understandings. (shrink)

Background: Nursing is an occupation that deals with humans and relies upon human relationships. Nursing care, which is an important component of these relationships, involves protection, forbearance, attention, and worry. Objectives: The aim of this study is to evaluate the ethical beliefs of psychiatric nurses and ethical problems encountered. Research Design: The study design was descriptive and cross-sectional. Research context: Methods comprised of a questionnaire administered to psychiatric nurses (n = 202) from five psychiatric hospitals in Istanbul, Turkey, instruction in (...) psychiatric nursing ethics, discussion of reported ethical problems by nursing focus groups, and analysis of questionnaires and reports by academicians with clinical experience. Participants: Participants consist of the nurses who volunteered to take part in the study from the five psychiatric hospitals (n = 202), which were selected with cluster sampling method. Ethical considerations: Written informed consent of each participant was taken prior to the study. Findings: The results indicated that nurses needed additional education in psychiatric ethics. Insufficient personnel, excessive workload, working conditions, lack of supervision, and in-service training were identified as leading to unethical behaviors. Ethical code or nursing care -related problems included (a) neglect, (b) rude/careless behavior, (c) disrespect of patient rights and human dignity, (d) bystander apathy, (e) lack of proper communication, (f) stigmatization, (g) authoritarian attitude/intimidation, (h) physical interventions during restraint, (i) manipulation by reactive emotions, (j) not asking for permission, (k) disrespect of privacy, (l) dishonesty or lack of clarity, (m) exposure to unhealthy physical conditions, and (n) violation of confidence. Discussion: The results indicate that ethical codes of nursing in psychiatric inpatient units are inadequate and standards of care are poor. Conclusion: In order to address those issues, large-scale research needs to be conducted in psychiatric nursing with a focus on case studies and criteria for evaluation of service, and competency and responsibility needs to be established in psychiatric nursing education and practice. (shrink)

In the closed wards of mental health institutions, moral decisions are made concerning the use of forced seclusion. In this article we focus on how these moral decisions are made and can be improved. We present a case study concerning moral deliberations on the use of seclusion and its prevention among nurses of a closed mental health ward. Moral psychology provides an explanation of how moral judgments are developed through processes of interaction. We will make use of the Social Intuitionist (...) Model of Jonathan Haidt that emphasizes the role of emotions, intuitions and the social context in moral judgments and reasoning. We argue that this model can help to explain social dynamics in the context of enforced seclusion. In the discussion we explore how moral psychology can be complemented with the normative perspective of dialogical ethics to develop strategies for improving psychiatric practices. We conclude that social processes play an important role in moral deliberations and that moral development can be fostered by bringing in new perspectives in the dialogue. Moral case deliberation provides a practical tool to systematically organize moral reflections among nurses on the work floor. (shrink)