Emergency nurses' ethical challenges with psychiatric patients: A qualitative study

BackgroundEmergency departments increasingly serve as access points for patients experiencing psychiatric crises, creating ethical challenges for nurses. These environments remain designed for biomedical acute care, fundamentally incongruent with the needs of individuals experiencing severe mental disorders. This phenomenon has rarely been explored through nurses' lived experiences.AimTo explore the structurally produced ethical conflicts and the care climate experienced by emergency nurses when caring for patients with severe mental disorders in general hospitals.Research designA qualitative study using interpretative phenomenological analysis underpinned by critical theoretical framework. Participants were purposively sampled. Data were collected through semi-structured interviews and analyzed following the six-step IPA procedure.Participants and research contextEmergency nurses (n = 15) from three tertiary general hospitals in Northeast China with experience treating patients with severe mental disorders. Data were collected through interviews lasting 29-54 min.Ethical considerationsEthical principles were observed throughout the research process, including informed consent and participant anonymity.FindingsNurses experienced a pervasive climate of structural violence manifesting through institutional oppression (structural violence reproduction in EDs), technological usurpation (digital ethical collapse in decision-making), and subjective disintegration (traumatic reconstruction of nursing relationships). These conditions were systematically produced through institutional structures, technological mediations, and identity fragmentations rather than individual moral failings. Emergency nurses navigated paradoxical spaces where institutional structures and a violent care climate rendered ethical nursing care structurally impossible rather than merely difficult.ConclusionEmergency nurses face fundamental crises in practice that cannot be addressed through conventional ethics consultations or resilience strategies. Findings indicate needs for specialized psychiatric emergency services within general EDs, revised nursing curricula, and policy reforms addressing staffing requirements to create environments where ethical care for patients with severe mental disorders becomes possible rather than exceptional.