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Negotiating The Ethical Minefield Of Psychiatric Nursing Practice   

Richard Lakeman, DipCompN, BN, BA Hons Currently: Clinical Nurse Consultant, Mobile Intensive Treatment Team, Townsville Integrated Mental Health Services, Queensland, Australia   (At time of article submission author was Senior Lecturer, Faculty of Health Studies, Eastern Institute of Technology, Hawke’s Bay )

Abstract

Psychiatric nursing practice can be likened to an ethical minefield. Nurses are often in the middle of the minefield and are pushed and pulled by forces, which are sometimes beyond their control. This paper signposts some of the more problematic areas of practice so that nurses may be equipped with at least a broad over-view of the ethical terrain.  

Key Words: Ethics, psychiatric nursing, mental health.  

Introduction

Psychiatric nursing has been described as an ethical ‘minefield’ (Byrt, 1993). This description sits uncomfortably alongside the ideals of nursing or the rhetoric of care. Nevertheless, extending this metaphor may provide a useful beginning point and rationale for exploring ethical problems in the psychiatric nurse - person relationship. A minefield implies a perilous place, fraught with a very real danger of being literally torn apart or irreparably damaged by the placing of one’s foot in the wrong place. Like mental distress or illness, a minefield represents a place which most people wish to avoid. Only a fool would knowingly enter a minefield without a map, or at least some expertise in recognising signs of the hidden dangers. People with mental distress find themselves at the centre of this metaphorical minefield and the nurse has the choice to watch passively from the margins or actively engage with the person in order to facilitate their safe passage. This paper aims to explore some of the ethical hazards inherent in the business of engaging with the person and negotiating a passage through the experience of mental distress and the mental health system itself.   

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