The balancing act: psychiatrists' experience of moral distress.

Experiences of moral distress encountered in psychiatric practice were explored in a hermeneutic phenomenological study. Moral distress is the state experienced when moral choices and actions are thwarted by constraints. Psychiatrists describe struggling 'to do the right thing' for individual patients within a societal system that places unrealistic demands on psychiatric expertise.

To stay or to go, to speak or stay silent, to act or not to act: moral distress as experienced by psychologists.

The moral distress of psychologists working in psychiatric and mental health care settings was explored in an interdisciplinary, hermeneutic phenomenological study situated at the University of Alberta, Canada. Moral distress is the state experienced when moral choices and actions are thwarted by constraints. Psychologists described specific incidents in which they felt their integrity had been compromised by such factors as institutional and interinstitutional demands, team conflicts, and interdisciplinary disputes.

Addressing oppression in psychiatric care: a relational ethics perspective.

In this article we consider oppression in psychiatric care from a relational ethics perspective. We identify the vulnerability of psychiatric patients and the concomitant difficulties that confront medical health practitioners. We suggest that healthcare practitioners can become desensitized to systemic problems in the routine provision of care, that attention to protocols and procedural guidelines is not sufficient to reduce oppression in care, and that the discussion necessary to do so may not be generally supported within clinical environments.

Relational ethics and genetic counseling.

Genetic counseling is viewed as a therapeutic interrelationship between genetic counselors and their clients. In a previous relational ethics research project, various themes were identified as key components of relational ethics practice grounded in everyday health situations. In this article the relational ethics approach is further explored in the context of genetic counseling to enhance our understanding of how the counselor-client relationship is contextually developed and maintained.

Relational pedagogy. Embodiment, improvisation, and interdependence.

In this paper Gadow's philosophical themes are developed considering the pedagogical relation--the relation of teacher and student, nurse and patient, self and world. Relational pedagogy is discussed through exploration of embodiment (being the teaching), improvisation (doing the teaching), and interdependence (locating the teaching in a reciprocal world as home). The pedagogical relation explores the lived space between teacher and learner, nurse and patient, where new knowledge is constructed.

Unable to answer the call of our patients: mental health nurses' experience of moral distress.

When health practitioners' moral choices and actions are thwarted by constraints, they may respond with feelings of moral distress. In a Canadian hermeneutic phenomenological study, physicians, nurses, psychologists and non-professional aides were asked to identify care situations that they found morally distressing, and to elaborate on how moral concerns regarding the care of patients were raised and resolved. In this paper, we describe the experience of moral distress related by nurses working in mental healthcare settings who believed that lack of resources (such as time and staff) leads to dispiritedness, lack of respect, and absence of recognition (for both patients and staff) which severely diminished their ability to provide quality care.

Ethical perspectives for public and environmental health: fostering autonomy and the right to know.

In this paper we develop an ethical perspective for public and environmental health practice in consideration of the "right to know" by contrasting consequential and deontological perspectives with relational ethics grounded in the concept of fostering autonomy. From the consequential perspective, disclosure of public and environmental health risks to the public depends on the expected or possible consequences. We discuss three major concerns with this perspective: respect for persons, justice, and ignorance.

Hermeneutic-phenomenology: providing living knowledge for nursing practice.

The phenomenological approach has gained popularity among nurse researchers as an alternative investigative method to those used in the natural sciences. As more nurse scholars and nurse researchers utilize phenomenology as a research approach, it becomes critical to examine the implications this may have for nursing knowledge development and for the utilization of that knowledge in practice. In this paper, an examination of the results of phenomenological inquiry is presented and compared with the types of knowledge considered important for nursing by Carper and White.

Knowledge for ethical care.

Knowledge needed for ethical care must be constructed in the relationship between professional and patient who strive together to understand what meaning the disease factors have within the experience of the individual patient. Three kinds of knowledge are described. The first two, descriptive knowledge and abstract knowledge, are part of the more comprehensive and complex inherent knowledge.