Coping with moral distress on acute psychiatric wards: A qualitative study

BACKGROUND: Nurses working within acute psychiatric settings often face multifaceted moral dilemmas and incompatible demands. METHODS: Qualitative individual and focus group interviews were conducted. ETHICAL CONSIDERATIONS: Approval was received from the Norwegian Social Science Data Services. Ethical Research Guidelines were followed. PARTICIPANTS AND RESEARCH CONTEXT: Thirty nurses working within acute psychiatric wards in two mental health hospitals. RESULTS: Various coping strategies were used: mentally sorting through their ethical dilemmas or bringing them to the leadership, not 'bringing problems home' after work or loyally doing as told and trying to make oneself immune. Colleagues and work climate were important for choice of coping strategies. DISCUSSION: Nurses' coping strategies may influence both their clinical practice and their private life. Not facing their moral distress seemed to come at a high price. CONCLUSIONS: It seems essential for nurses working in acute psychiatric settings to come to terms with distressing events and identify and address the moral issues they face. As moral distress to a great extent is an organisational problem experienced at a personal level, it is important that a work climate is developed that is open for ethical discussions and nourishes adaptive coping strategies and moral resilience.