More Thoughts on Ethics, Law, and Morality in Psychiatric Nursing

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Ethics and law, what is it? Ethics and Law in Health Care introduced us to philosophical analysis of the ethics, morals, and values that affect contemporary Canadian mental health practices. All of us came from different backgrounds, different religions, and hold different cultural values. Combined with written laws like the B.C. Mental Health Act and ethical guidelines set out by the College of Registered Psychiatric Nurses of B.C., we set forth to explore the discover the ethical landscape in B.C. mental health care, and how that tied into our acute psychiatry clinical. These topics were not only thought-provoking, but very relevant the experiences we came across at Langley 1 South.

Firstly, we explored the topic of truth telling and moral integrity. I would say that the most of us and the most of you have moral values that want to prevent you from lying to patients. However, we approached the topic of truth telling within the older adult population working with Alzheimer residents. Exploring the term therapeutic privilege, we delved into situations form our residential care semester where it may have been best not to tell the patient the truth. For instance, in a patient with severe Alzheimer’s disease, would they benefit from being told time and time again that their spouse was in fact deceased or would it be better to tell them they were away at the moment knowing that the resident would soon forget? For some, it was a clear cut answer that the resident should be told the truth any time they asked. However, some argued the physiological toll of telling them the grim news every time would have a negative effect on the health of the resident, and transfer to the nurse and staff at an emotional level. Some presented empirical evidence of studies showing that even those with Alzheimer’s sometimes had the capacity to remember such news but the results were not consistent. Not that there is necessarily a right or wrong answer here, but the exploration of our own morals here was quite thought-provoking.

Finally, we explored another topic that we came across several times in acute psychiatry, and that is the use of the seclusion room. B.C. mental health law allows the use of seclusion rooms in order to promote safety for fellow patients and staff, and de-stimulate and re-integrate the secluded patient back into the ward. However, our clinical instructor noted that while she had used it, she did not promote or agree with the values that governed its use. She informed us and encouraged us to do more research on seclusion free mental health care often carried out in the U.K. It was interesting to see that perspective, and to consider that violent and aggressive behaviour is also often encountered on general medical floors without the ability to seclude or essentially jail the patient. Again, ethics played a major role into the consideration for its use, while there is a lot of good that can come of it, we learned that conditioning patients to that sort of punishment due to bad behaviour really did not prepare the patient for the social interactions they would need to become accustomed to outside the acute psychiatric facility.

In the end, this course fostered much thought and exploration into not only the set ethics and laws that govern our work and practice. But we also grew and better understood our own position in the ethical and legal landscape of contemporary Canadian mental health practice.

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