Moral survival in a nontherapeutic environment

Area of Science:

• Nursing Ethics
• Healthcare Management
• Qualitative Research

Background:

• Ethical decision-making is crucial for psychiatric and mental health nurses.
• Understanding the impact of workplace environment on ethical practices is vital.
• Previous research has not fully explored the survival strategies employed by nurses in challenging settings.

Purpose of the Study:

• To examine the ethical decision-making processes of psychiatric and mental health nurses in Canada.
• To identify the basic social process and survival strategies used by nurses in nontherapeutic environments.
• To explore the moral dilemmas faced by nurses concerning patient care and personal responsibility.

Main Methods:

• Grounded theory approach utilizing the constant comparative method.
• Data collection through focus groups with experienced nurses.
• Supplemented by participant observation and formal/informal interviews.

Main Results:

• Identified 'moral survival' as the core process for managing ethical difficulties.
• Documented survival strategies: doctor-nurse game, covering backside, running interference, doctor/administration bashing, scapegoating, and teamwork breakdown.
• Findings highlight nurses' efforts to survive in perceived nontherapeutic environments.

Conclusions:

• Nurses develop specific strategies to cope with ethical challenges in their work environment.
• These strategies are morally significant as they address non-delegable moral responsibilities.
• Key moral dilemmas involve prioritizing self-survival versus patient care and accepting or shifting responsibility for actions.