Nursing care in mental health: Human rights and ethical issues.

People with mental illness are subjected to stigma and discrimination and constantly face restrictions in the exercise of their political, civil and social rights. Considering this scenario, mental health, ethics and human rights are key approaches to advance the well-being of persons with mental illnesses. The study was conducted to review the scope of the empirical literature available to answer the research question: What evidence is available regarding human rights and ethical issues regarding nursing care to persons with mental illnesses? A scoping review methodology guided by Arksey and O'Malley was used. Studies were identified by conducting electronic searches on CINAHL, PubMed, SCOPUS and Hein databases. Of 312 citations, 26 articles matched the inclusion criteria. The central theme which emerged from the literature was "Ethics and Human Rights Boundaries to Mental Health Nursing practice". Mental health nurses play a key and valuable role in ensuring that their interventions are based on ethical and human rights principles. Mental health nurses seem to have difficulty engaging with the ethical issues in mental health, and generally are dealing with acts of paternalism and with the common justification for those acts. It is important to open a debate regarding possible solutions for this ethical dilemma, with the purpose to enable nurses to function in a way that is morally acceptable to the profession, patients and members of the public. This review may serve as an instrument for healthcare professionals, especially nurses, to reflect about how to fulfil their ethical responsibilities towards persons with mental illnesses, protecting them from discrimination and safeguarding their human rights, respecting their autonomy, and as a value, keeping the individual at the centre of ethical discourse.

How Can I Survive This?: Coping During Coronavirus Disease 2019 Pandemic.

Worldwide, health-care professionals are experiencing unprecedented stress related to the coronavirus disease 2019 pandemic. Responding to a new virus for which there is no effective treatment yet and no vaccine is beyond challenging. Moral distress, which is experienced when clinicians are unable to act in the way that they believe they should, is often experienced when they are dealing with end-of-life care issues and insufficient resources. Both factors have been widespread during this pandemic, particularly when patients are dying alone and there is a lack of personal protection equipment that plagues many overburdened health-care systems. We explore here, guided by evidence, the concept and features of moral distress and individual resilience. Mitigation strategies involve individual and institutional responsibilities; the importance of solidarity, peer support, psychological first aid, and gratitude are highlighted.

Communities of practice: acknowledging vulnerability to improve resilience in healthcare teams.

The majority of healthcare professionals regularly witness fragility, suffering, pain and death in their professional lives. Such experiences may increase the risk of burnout and compassion fatigue, especially if they are without self-awareness and a healthy work environment. Acquiring a deeper understanding of vulnerability inherent to their professional work will be of crucial importance to face these risks. From a relational ethics perspective, the role of the team is critical in the development of professional values which can help to cope with the inherent vulnerability of healthcare professionals. The focus of this paper is the role of Communities of Practice as a source of resilience, since they can create a reflective space for recognising and sharing their experiences of vulnerability that arises as part of their work. This shared knowledge can be a source of strength while simultaneously increasing the confidence and resilience of the healthcare team.

Conflicts of conscience in the neonatal intensive care unit: Perspectives of Alberta.

BACKGROUND:: Limited knowledge of the experiences of conflicts of conscience found in nursing literature. OBJECTIVES:: To explore the individual experiences of a conflict of conscience for neonatal nurses in Alberta. RESEARCH DESIGN:: Interpretive description was selected to help situate the findings in a meaningful clinical context. PARTICIPANTS AND RESEARCH CONTEXT:: Five interviews with neonatal nurses working in Neonatal Intensive Care Units throughout Alberta. ETHICAL CONSIDERATION:: Ethics approval from the Health Research Ethics Board at the University of Alberta. FINDINGS:: Three common themes emerged from the interviews: the unforgettable conflict with pain and suffering, finding the nurse's voice, and the unique proximity of nurses. DISCUSSION AND CONCLUSION:: The nurses described a conflict of conscience when the neonate in their care experienced undermanaged pain and unnecessary suffering. During these experiences, they felt guilty, sad, hopeless, and powerless when they were unable to follow their conscience. Informal ways to follow their conscience were employed before declaration of conscientious objection was considered. This study highlights the vital importance of respecting a conflict of conscience to maintain the moral integrity of neonatal nurses and exposes the complexities of conscientious objection.

What Is the Role of Ethics Consultation in the Moral Habitability of Health Care Environments?

Ethics consultation has traditionally focused on the provision of expert guidance to health care professionals when challenging quandaries arise in clinical cases. Its role, however, is expanding as demands on health care organizations are negatively impacting their moral habitability. A sign of this impact can be seen in the moral distress experienced by staff and administrators, such that some leave their positions and their organizations. Ethics consultation, more broadly conceived, can be a major asset in ensuring that ethical practice is meaningfully supported, that moral distress is mitigated, and that the organizational environment is morally habitable.

Le risque de détresse morale dans la pratique contemporaine des soins de santé.

Les professionnels de la santé sont des agents moraux dont la relation fiduciaire avec le public est animée par la responsabilité et la promesse de puiser dans leurs connaissances et leurs habiletés pour aider les personnes sous leurs soins. Lorsque leur capacité à tenir cette promesse est freinée ou compromise, ils risquent de souffrir de détresse morale. Le concept de détresse morale est défini et mis en contexte dans le milieu de la santé. Les contraintes et les facteurs qui en sont à l'origine sont présentés, de même que les moyens utilisés par les professionnels de la santé et les organisations de santé pour la soulager. Un changement transformateur s'impose pour vaincre la culture du silence et maintenir un système de santé où il est possible de vivre avec sa conscience.

Contemporary healthcare practice and the risk of moral distress.

Healthcare professionals are moral agents whose fiduciary relationship with the public is animated by responsibility and the promise to use knowledge and skills to aid those in their care. When their ability to keep this promise is constrained or compromised, moral distress can result. Moral distress in healthcare is defined and outlined. Constraints and factors that lead to moral distress are identified as are the means that individual professionals and organizations use to address it. A call is made for transformative change to overcome a culture of silence and to sustain a healthcare system that is morally habitable.

Organizational Influences on Health Professionals' Experiences of Moral Distress in PICUs.

This article reports the findings of a qualitative study (secondary analysis) that explored the organizational influences on moral distress for health professionals working in pediatric intensive care units (PICUs) across Canada. Participants were recruited to the study from PICUs across Canada. The PICU is a high-tech, fast-paced, high-pressure environment where caregivers frequently face conflict and ethical tension in the care of critically ill children. A number of themes including relationships with management, organizational structure and processes, workload and resources, and team dynamics were identified. This study provides a rare and important multi-disciplinary perspective on this topic and the findings have implications for administrators and leaders who seek to improve the moral climate of healthcare delivery.

Canadian Nurse Practitioners' Therapeutic Commitment to Persons with Mental Illness.

The purpose of this study was to determine how Canadian nurse practitioners (NPs) rate their levels of therapeutic commitment, role competency, and role support when working with persons with mental health problems. A cross-sectional descriptive, co-relational design was used. The Therapeutic Commitment Model was the theoretical framework for the study. A sample of 680 Canadian NPs accessed through 2 territorial and 9 provincial nursing jurisdictions completed a postal survey. NPs scored highest on the therapeutic commitment subscale and lowest on the role support subscale. The 3 subscales were correlated: role competency and therapeutic commitment were the most strongly associated (r = .754, p < .001). To have a positive impact on the care of persons with mental health problems, educators, policy-makers, and NPs need to assess and support therapeutic commitment, role support, and role competency development.

Cette étude a pour objectif de déterminer la façon dont les infirmières praticiennes canadiennes (IP) déterminent leur degré d'engagement thérapeutique, leur compétence de rôle et leur soutien de rôle dans des contextes de travail avec des personnes atteintes de troubles de santé mentale. Un cadre descriptif transversal corelationnel a été utilisé. Le modèle d'engagement thérapeutique a servi de cadre théorique. Un échantillon de 680 IP canadiennes recrutées dans deux juridictions territoriales et neuf juridictions provinciales infirmières ont rempli un sondage envoyé par la poste. Les IP ont obtenu le score le plus élevé quant à la sous-échelle de l'engagement thérapeutique et le score le plus faible quant à la sous-échelle du soutien de rôle. Les trois sous-échelles ont été corrélées: la compétence de rôle et l'engagement thérapeutique affichaient l'association la plus élevée (r = 0,754, p < 0,001). Pour assurer un impact positif sur les soins aux personnes atteintes de troubles de santé mentale, les éducateurs, les décideurs et les IP doivent évaluer et soutenir l'engagement thérapeutique, le soutien de rôle et le développement de compétences de rôle.

More than information: a qualitative study of parents' perspectives on neonatal intensive care at the extremes of prematurity.

PURPOSE: To describe parental perceptions of decision making concerning their extremely premature newborns who received care in a level III neonatal intensive care unit (NICU). SUBJECTS: Seven parents of preterm infants who were born at 24 to 26 weeks' gestation at a western Canadian tertiary NICU. DESIGN: Qualitative, interpretive description, semistructured interviews. METHODS: The first author conducted interviews with both parents together or the mother alone. Interviews were recorded, transcribed, and analyzed. RESULTS: Three main themes related to decision making, culture shock, and relationships emerged: (1) decision making before and in the NICU: moving beyond information, (2) culture shock in the NICU: plunging into a strange land, and (3) relationships in the NICU: enduring in a strange land. CONCLUSIONS: Although information and decision making are interconnected and fundamental to parents' experiences of their preterm baby's NICU stay, they also identified the culture and language of the NICU and genuine relationships formed with healthcare professionals as significantly influencing their experiences.

Moral distress and the contemporary plight of health professionals.

Once a term used primarily by moral philosophers, "moral distress" is increasingly used by health professionals to name experiences of frustration and failure in fulfilling moral obligations inherent to their fiduciary relationship with the public. Although such challenges have always been present, as has discord regarding the right thing to do in particular situations, there is a radical change in the degree and intensity of moral distress being expressed. Has the plight of professionals in healthcare practice changed? "Plight" encompasses not only the act of pledging, but that of predicament and peril. The author claims that health professionals are increasingly put in peril by healthcare reform that undermines their efficacy and jeopardizes ethical engagement with those in their care. The re-engineering of healthcare to give precedence to corporate and commercial values and strategies of commodification, service rationing, streamlining, and measuring of "efficiency," is literally demoralizing health professionals. Healthcare practice needs to be grounded in a capacity for compassion and empathy, as is evident in standards of practice and codes of ethics, and in the understanding of what it means to be a professional. Such grounding allows for humane response to the availability of unprecedented advances in biotechnological treatments, for genuine dialogue and the raising of difficult, necessary ethical questions, and for the mutual support of health professionals themselves. If healthcare environments are not understood as moral communities but rather as simulated marketplaces, then health professionals' moral agency is diminished and their vulnerability to moral distress is exacerbated. Research in moral distress and relational ethics is used to support this claim.

Nursing under the influence: a relational ethics perspective.

When nurses have active and untreated addictions, patient safety may be compromised and nurse-health endangered. Genuine responses are required to fulfil nurses' moral obligations to their patients as well as to their nurse-colleagues. Guided by core elements of relational ethics, the influences of nursing organizational responses along with the practice environment in shaping the situation are contemplated. This approach identifies the importance of consistency with nursing values, acknowledges nurses interdependence, and addresses the role of nursing organization as moral agent. By examining the relational space, the tension between what appears to be opposing moral responsibilities may be healed. Ongoing discourse to identify authentic actions for the professional practice issue of nursing under the influence is called upon.

Walking a fine line: Forensic mental health practitioners' experience of working with correctional officers.

This paper explores mental health professionals' experiences working with correctional staff--one aspect of an interdisciplinary phenomenological study of ethical practice in forensic psychiatry. Professionals describe this relationship as coexisting within the system, despite their often conflicting roles. In correctional officers' overt concern for custody and control, practitioners can perceive a "paramilitary mentality" with which they struggle to work. Conversely, practitioners can experience conflict with security personnel for appearing "too caring" or "too sympathetic" to offenders--being "con-lovers." The balance practitioners establish between working with inmates and working alongside facility security is one of walking a fine line.

The incommensurability of nursing as a practice and the customer service model: an evolutionary threat to the discipline.

Corporate and commercial values are inducing some healthcare organizations to prescribe a customer service model that reframes the provision of nursing care. In this paper it is argued that such a model is incommensurable with nursing conceived as a moral practice and ultimately places nurses at risk. Based upon understanding from ongoing research on compassion fatigue, it is proposed that compassion fatigue as currently experienced by nurses may not arise predominantly from too great a demand for compassion, but rather from barriers to enacting compassionate care. These barriers are often systemic. The paradigm shift in which healthcare environments are viewed as marketplaces rather than moral communities has the potential to radically affect the evolution of nursing as a discipline.

Electrocardiogram and echocardiogram findings in runners completing a half marathon.

OBJECTIVE: The purpose of this study was to prospectively evaluate electrocardiograms (ECGs) before and after running a half marathon to characterize the changes that occur after exertion. Echocardiograms were also done postrace on selected runners. METHODS: Volunteer runners older than 18 years completed a questionnaire detailing demographic and medical history. Prerace ECGs were performed at a prerace symposium and postrace ECGs were performed within 15 minutes of the participants' completion of the race. Echocardiograms were performed on a random sampling of runners who were judged to have abnormal or changed postrace ECGs. RESULTS: Eighty-seven runners were enrolled and completed the study. There were 46 males (53%) and 41 females (47%). Fifty-four (62%) runners had changes noted in their ECGs. The most common changes noted were atrial enlargement (37 runners). Other abnormalities seen on the ECGs included new conduction abnormalities, new Q waves, nonspecific ST/T-wave changes, and resolution of previous abnormalities that were seen on initial ECG. There was no statistically significant difference between runners with ECG changes and runners without ECG changes when comparing sex, age, previous marathon experience, exercise, history of exercise-induced chest pain, medical history, and family history of heart disease. Twenty runners with changed or abnormal postrace ECGs had postrace echocardiograms, and 8 were abnormal. Of the abnormal echocardiograms, 2 runners had normal but changed postrace ECGs and 4 runners had abnormalities that were inconsistent with what was seen on ECG. CONCLUSION: Our study suggests that ECG abnormalities and changes can occur in distance runners, but their significance is unclear.

Uncovering the lived experience of well-being.

The words well-being, health, and wellness are commonly used in an interchangeable manner by health care professionals and the lay public. We undertook a hermeneutic phenomenological study of well-being and discovered a soulful strength and a rhythmic flow to this lived experience. There is a letting go that is experienced as a tension and rhythmic interchange, as in breathing. Harmony and balance lie at its foundation. Well-being requires a personal drive to exist. It is not experienced through purposeful means; rather, it is experienced in a self-forgetful way, in the free space where life unfolds and where people come to see their worlds in different ways. The results of this research suggest the experience of well-being holds a significant place within nursing practice for clients and for nurses.

Unresolved pain in children: a relational ethics perspective.

It is considered the right of children to have their pain managed effectively. Yet, despite extensive research findings, policy guidelines and practice standard recommendations for the optimal management of paediatric pain, clinical practices remain inadequate. Empirical evidence definitively shows that unrelieved pain in children has only harmful consequences, with no benefits. Contributing factors identified in this undermanaged pain include the significant role of nurses. Nursing attitudes and beliefs about children's pain experiences, the relationships nurses share with children who are suffering, and knowledge deficits in pain management practices are all shown to impact unresolved pain in children. In this article, a relational ethics perspective is used to explore the need for nurses to engage in authentic relationships with children who are experiencing pain, and to use evidence-based practices to manage that pain in order for this indefensible suffering of children to end.

Novice nurses' first death in critical care.

BACKGROUND: The curative focus of critical care and the advanced technology may overshadow the fact that critically ill patients die. Research investigating critical care nurses involvement with death has predominately focused on experienced nurses, but these findings may not be applicable to novice nurses. Increasingly, novice nurses are beginning their careers in critical care and there is minimal research describing their experiences with death. PURPOSE: To explore the experiences of novice nurses with their first patient death in critical care. METHOD: Approval was received by the University of Alberta Health Research Ethics Board and the health region's Nursing Division Administration to conduct a qualitative research study. Five nurses, employed in a medical-surgical intensive care unit, participated in the study. Data collection involved an unstructured interview with each participant. FINDINGS: Analysis of the data revealed five themes: anticipating death, transition from life to death, the moment of death, being with the family, and carrying on. These findings are discussed with implications for academic and clinical settings and suggestions for future nursing research.