INFLUENCE OF PSYCHIATRIC INPATIENT ENVIRONMENTS ON ETHICAL DECISION MAKING OF PSYCHIATRIC NURSES (RESTRICTIVENESS, LEGAL, PHILOSOPHY).
Contributors: University of California, San Francisco.
Published: 1985
Number of pages: 187
Subjects: Health Sciences, Nursing.
Description: This study examined the relationship of inpatient psychiatric treatment environments and ethical decision making in psychiatric nursing practice. The psychiatric treatment environment was defined by six restrictiveness dimensions: structure, institutional policy, enforcement, treatment, patient demographic characteristics, and staff characteristics. Ethical decision making was depicted by items representing the principles of beneficence, autonomy, and distributive justice.

A conceptual framework based on a human/environment interaction model and the prima facie principles of beneficence, distributive justice, and autonomy formed the basis for three study questions: (1) What are the restrictiveness qualities of psychiatric inpatient units? (2) How are the ethical principles of beneficence, autonomy, and distributive justice represented in clinical decisions by psychiatric nurses? (3) Is there a relationship between the restrictiveness of psychiatric inpatient environments and ethical principles of beneficence, autonomy, and distributive justice in psychiatric nursing practice?.

The convenience sample consisted of 177 registered nurses from 29 units representing private, county, university, and veterans administration psychiatric inpatient settings. No statistically significant differences between nurse demographic categories for staff from locked and unlocked units were noted.

Data were gathered for nurse subjects and the psychiatric units using the following eight instruments: Inventory of Structural and Treatment Restrictiveness, Opinions about Mental Illness, Resident Control and Tolerance for Deviance subscales of the Multiphasic Environmental Assessment Program, Staff Demographic Characteristics, Patient Demographic Characteristics, Case Vignettes, and the Nursing Philosophy Statement.

Inpatient units were distinguished by their locked or unlocked security status. These two types of units were also differentiated by patient demographic characteristics and policies for patient decision making. Minimal differences were noted between the two types of units for treatment and enforcement variables.

Frequency results for the ethical principles indicated that beneficence-based items were consistently ranked first choice; however, nurses' decisions were also guided by nonmoral goals of professional responsibility, patient limitations, maintenance of bodily and social safety, and improvement in the patient's quality of life. The lack of a clear mandate for one ethical perspective indicates a situational approach to nursing ethical decision making.
Notes: Source: Dissertation Abstracts International, Volume: 46-08, Section: B, page: 2622.

Thesis (D.N.S.)--UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, 1985.

School code: 0034.