Therapeutic and ethical practice: a participatory action research project in old age mental health

Despite the contemporary emphasis on evidence‐based practice, there remains a dearth of knowledge about how professional philosophy and expertise influence clinical practice. These issues are magnified when caring for people for whom ‘good’ care is hard to define (for example, older people with mental health needs) owing to the dual demands of physical care (in this study for example, continence care) and psychological care (for example, patient autonomy). The aim of the present study was to analyse ethical tensions of developing and managing continence care in an assessment unit for older people with mental health needs. A participatory action research approach was used, seeking to engage the unit staff in developing their practice. Data were collected by focus group and individual interview, observation and secondary data analysis. The study demonstrated the complexity of decision‐making in this field, not least when there was tension between the duty to provide good clinical care and the duty to respect the autonomy of the patient. Despite the relative stability of the external evidence base in continence care, the clinical decisions fluctuated in time, place and person (situated decision‐making).