Analyzing an Ethical Decision

http://www.jhealthres.org J Health Res  vol.29 no.3 June 2015

ETHICAL ISSUES AND MORAL DISTRESS

IN PSYCHIATRIC AND MENTAL HEALTH NURSING:

A LITERATURE REVIEW

Ratchaneekorn Kertchok*

Faculty of Nursing, Chulalongkorn University, Bangkok 10330, Thailand

ABSTRACT:

This review focuses on ethical issues in psychiatric and mental health nursing and moral distress that

occurs with psychiatric nurses. Literature published between 2000 and 2014 was identified using the

PubMed, CINAHL, ScienceDirect, and by hand search in the library before being analyzed under themes

related to ethical issues and moral distress in psychiatric and mental health nursing. A summary of the

existing literature related to challenges in psychiatric mental health nursing practiced; ethical issues in

psychiatric and mental health nursing; moral distress, its definition, associated situations and

consequences, and moral distress literature; and the findings need to be shared to increase awareness

of the moral distress experienced in psychiatric and mental health nursing. However, the related

literature does not address support strategies to help reduce moral stress. There is a growing need to

better understand moral distress in psychiatric mental health nursing in order to identify ways to

support encountered situations.

Keywords: Moral distress, Mental health, Nursing, Ethical issue

DOI: 10.14456/jhr.2015.10 Received: August 2014; Accepted: December 2014

INTRODUCTION

Mental illness is a significant problem across

countries and worldwide. People with mental illness

need to be treated and rehabbed by mental health

professionals. It can be a challenge for these

practitioners when providing care for people with

mental illness. Mental illness is defined as

“A diagnosable mental disorder that affects

thinking, mood, behaviors, relationships

with others, and ability to function”, (p 503)

[1] .

Psychiatric nurses are a group of mental health

professionals who take actively important roles in

providing care for people with mental illness [2].

Psychiatric nurses uphold nursing regulations/

codes, ethics, and institutional rules that guide them

in providing care for clients. They also need to work

with multidisciplinary teams when caring for clients

to achieve optimal health and well-being [3].

* Correspondence to: Ratchaneekorn Kertchok

E-mail: rkertchok@yahoo.com

In the real world of psychiatric nursing practice, however, psychiatric nurses have to confront

complex situations when caring for patients with

severe mental illness at all stages (acute, sub-acute,

and rehabilitation phase). They also have to deal

with families who are suffering as they care for

their ill family members [1, 3, 4]. In addition, they

must often work under internal and external

constraints. Consequently, psychiatric nurses may

experience moral distress caused by caring for

people with mental illness and helping their

families. This article aims to share the descriptions

of psychiatric and mental health nursing practice and

moral distress.

SEARCH METHODS

Qualitative and quantitative studies and

relevant literature were identified using the PubMed,

CINAHL, ScienceDirect, and by hand search in the

library. Key words that were used to search the

literature are moral distress, ethical issue, moral

dilemma, ethical problems, moral difficulties, moral

stress and psychiatric nursing. The studies that

related to ethical problems and moral distress in

Cite this article as: Kertchok R. Ethical issues and moral distress in psychiatric and mental health nursing: a

literature review. J Health Res. 2015; 29(3): 227-34.

228

J Health Res  vol.29 no.3 June 2015 http://www.jhealthres.org

Table 1 Number of studies for review

Category Studies in total Studies that met

criteria

1. Challenges in psychiatric and mental health nursing (Key

words: Psychiatric nursing, mental health nursing practice,

and challenge in mental health)

7,207 350

2. Ethical issues in psychiatric and mental health nursing (Key

words: Ethical problem, ethical difficulty, ethical issues, and

psychiatric nursing)

2.1 Compulsory treatment

2.2 Institute constrains

2.3 Dealing with family’s need

2.4 Power imbalances among healthcare providers

2.5 Perceived inability to maintain safety

2.6 Conflict with patient’s needs

2.7 Lack of evidence based treatment

2.8 Time limitation

364 129

3. Moral distress (Key words: Moral distress, psychiatric nursing,

moral stress, moral value, and moral conflict)

3.1 Situations associated with moral distress

3.2 Consequences of Moral

3.3 Distress

3.4 Experiencing moral distress in psychiatric and mental

health nursing

1,827 57

nursing practice, including psychiatric and mental

health nursing practice, were selected in order to

analyze themes related to ethical issues and moral

distress. The search was limited to material

published from 2000 to 2014. The exception to this

is the inclusion of four articles presenting classic

ideas and concepts on psychiatric and mental health

nursing and ethics. The articles obtained in full text

were selected. Inclusion criteria of the studies for the

review include: 1) studies were required to apply a

qualitative or quantitative design; 2) studies were

required to explain addressing of ethical issues in

psychiatric and mental health nursing; 3) studies had

investigated mental health nurses’ experience of

moral distress; 4) studies had to be presented in

English.

FINDINGS

In total, 536 articles that met the criteria were

selected for review. The findings were organized

into three major categories and eleven sub-

categories. These categories and sub-categories are

presented in Table 1.

CHALLENGES IN PSYCHIATRIC AND

MENTAL HEALTH NURSING

Challenges in psychiatric and mental health

nursing are likely the same worldwide [1].

Psychiatric nurses have to encounter many