Current Ethical Issues and Future Challenges in Psychiatric Nursing : Based on the Pilot Test Outcome

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The purpose of this study was to shed light on present ethical issues in Japanese psychiatric nursing and establish clearly what measures, educational programs, and guidelines are needed in order to improve the care and treatment of patients with mental disorders. Twenty Psychiatric Certified Nurse Specialists (CNSs) were interviewed on ethical issues. This study reports the results of this pilot test. The survey was conducted from October to December of 2012. After approval from the Kumamoto University Research Ethical Committee, objectives, methods, and guarantees of privacy were explained to the subjects and, with their agreement, interviews were conducted. Ethical issues faced by the CNSs fall into 5 categories: 1) As hospitalization lengthens, patient needs are less respected, 2 ) Conflict between patients and family regarding decisions, 3) Struggle in achieving agreement with doctors, 4) Difficulty in developing adequate treatment and care programs, and 5) The insular nature of hospitals. Furthermore, the CNSs resolved these ethical issues as follows: 1) By talking with ward supervisors to resolve ethical issues; 2 ) by proposing and implementing solutions; and 3) by considering ways to strengthen group performance. In Japan the length of stay among psychiatric patients is particularly long and this study shows the characteristics of Japanese psychiatric nursing. In addition this study shows that the family plays an important role in deciding on a patient's discharge. But the CNSs have effective communications with related professionals to solve the problems. Based on these results we will develop an educational plan for psychiatric nurses and we need to clarify the role of psychiatric nurse and CNSs concerning those problems.

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