Patient participation: causing moral stress in psychiatric nursing?

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Trine Jansen and Ingrid Hanssen
This study describes psychiatric nurses’ experiences and thoughts regarding patient participation. The topic is important because participation is a complex phenomenon both in clinical practice and on the organisational level. Although it has been recognised in policy level in Great Britain, USA, Finland, Sweden and Norway, there is not enough research results on patients’ participation in psychiatric care.
In the pilot study, the focus has been that of the professionals and the data were collected using focus group interviews. Thematic analytic approach was chosen after an explorative quantitative pilot study and a hermeneutic analytic approach as the data analysis method.
The results show that patient participation differed: sometimes it is superficial and the content is vague. Nurses felt that they are patients’ spokespersons and have a great responsibility to contribute to patients’ participation. Nurses had to follow their ethical values and those of the organisation. Nurses had also a role of the negotiator when collaborating with other healthcare workers and patients. Even though there is legislation concerning the patient participation, nurses were looking for guidelines to implement it, that is how patient participation it to be measured or attained.
The authors conclude that nurses had a certain ethical responsibility towards vulnerable people. In the same time, they felt moral stress when their own professional and ethical values were threatened. The study context is in psychiatric nursing; however, the patient participation is an important issue in other nursing context, especially when caring for children or elderly people. The participation can also be broadened to include not only patients, but also their families.
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