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EETILISED PROBLEEMID JA MORAALNE DÜSTRESS PSÜHHIAATRIAÕDEDE TÖÖS Ethical problems and moral distress in psychiatric nursing Marit Reier, Reet Urban
Abstract Psychiatric nurses encounter unique ethical problems while providing care to mentally ill patients. Unresolved ethical problems can lead to nurses’ moral distress. The aim of the study was to describe moral distress experienced by psychiatric nurses and to describe ethical problems leading to moral distress in psychiatric nursing. This study is a theoretical literature review based on 15 peer-reviewed articles, two master theses, one doctoral thesis and one diploma paper. Additionally, one web-based dictionary and materials from approved organisations were used. Psychiatric nurses experience moral distress at different levels and frequencies, depending on their working environments and culture in the wards. Nurses’ personal ideals and moral sensitivity play also an important role in developing moral distress. Psychiatric nurses experience moral distress through negative emotions, which may lead to depression and burnout syndrome. Nurses who experience moral distress are less satisfied with their work and may decide to leave their specialty. The main ethical problems that lead to moral distress in psychiatric nurses are related to practices of restricting patient autonomy and usage of restraints as well as concerns about stigmatization and discrimination of patients. Additionally, some ethical problems are related to difficulties in maintaining patients’ safety due to constraints deriving from nurses’ working
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