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Emergency nurses' ethical challenges with psychiatric patients: A qualitative study
Liying Zhang1, Yubin Chen2, Hong Su2
1Department of Emergency, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
Nursing Ethics
|April 28, 2026
Summary
Emergency nurses face ethical crises caring for psychiatric patients in general hospitals due to structural violence. Systemic issues, not individual failings, make ethical care impossible, requiring specialized services and policy reform.
Area of Science:
- Nursing Ethics
- Psychiatric Emergency Care
- Qualitative Research
Background:
- Emergency departments (EDs) are increasingly primary access points for psychiatric crises.
- Current EDs are designed for acute biomedical care, not severe mental disorders.
- Nurses' lived experiences of these ethical challenges are under-explored.
Purpose of the Study:
- To explore ethically produced conflicts and care climate for emergency nurses treating severe mental disorders.
- To understand the impact of institutional structures and technology on nursing practice in psychiatric emergencies.
Main Methods:
- Qualitative study using Interpretative Phenomenological Analysis (IPA).
- Semi-structured interviews with 15 emergency nurses in tertiary general hospitals in Northeast China.
- Data analyzed using a six-step IPA procedure within a critical theoretical framework.
Main Results:
- Nurses experienced structural violence via institutional oppression, technological usurpation, and subjective disintegration.
- Ethical care was rendered structurally impossible by institutional and care climate factors.
- Findings highlight systemic issues rather than individual moral failings.
Conclusions:
- Emergency nurses face practice crises beyond conventional ethics support or resilience.
- Need for specialized psychiatric emergency services within general EDs.
- Revisions in nursing curricula and policy reforms (staffing) are essential for enabling ethical care.
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