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Volume 3, Issue 2 (4-2024)
JRHMS 2024, 3(2): 16-36 |
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Khalili Senobari S. Beyond individual resilience: The need for transforming the ethical environment in mental health settings: A scoping review. JRHMS 2024; 3 (2) :16-36
URL: http://jrhms.thums.ac.ir/article-1-114-en.html
URL: http://jrhms.thums.ac.ir/article-1-114-en.html
Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran , khalilis1@thums.ac.ir
Abstract: (3 Views)
Nurses working in psychiatric and mental health settings face a complex set of ethical challenges that often lead to moral distress, impaired clinical decision-making, and adverse individual and organizational consequences. The ethical environment of clinical units is a key determinant of the severity and experience of these challenges; however, existing evidence is fragmented, and a comprehensive understanding of this phenomenon remains lacking.
This Scoping review was conducted to elucidate the ethical challenges faced by nurses in mental health settings and examine the role of the ethical environment in the process of clinical decision-making.
A comprehensive search was conducted in PubMed, Scopus, Web of Science, CINAHL, SID, and IranMedex databases. Relevant articles were identified without time limitations and screened using a stepwise screening approach. Eligible studies were analyzed based on conceptual themes, and findings were synthesized in a critical narrative manner.
Evidence demonstrated that the most significant ethical challenges include the use of coercive measures, shortage of human and organizational resources, conflict between professional principles and safety requirements, role ambiguity, and insufficient managerial support. The ethical environment, particularly the quality of interprofessional communication, organizational ethical support, the presence of ethical reflection mechanisms, and leadership style, plays a fundamental role in how nurses perceive and manage these challenges, and can increase or decrease the severity of moral distress and the effectiveness of clinical decision-making.
The results indicate that ethical challenges in psychiatric nursing have multidimensional and structural characteristics, and individual-focused interventions alone cannot address this complexity. Strengthening the ethical environment, establishing formal structures for ethical support, and developing combined individual and organizational approaches to promote ethical resilience and improve clinical decision-making are essential. Presenting structured models of ethical support and case-based reflection can help reduce moral distress and improve the quality of care in mental health settings.
This Scoping review was conducted to elucidate the ethical challenges faced by nurses in mental health settings and examine the role of the ethical environment in the process of clinical decision-making.
A comprehensive search was conducted in PubMed, Scopus, Web of Science, CINAHL, SID, and IranMedex databases. Relevant articles were identified without time limitations and screened using a stepwise screening approach. Eligible studies were analyzed based on conceptual themes, and findings were synthesized in a critical narrative manner.
Evidence demonstrated that the most significant ethical challenges include the use of coercive measures, shortage of human and organizational resources, conflict between professional principles and safety requirements, role ambiguity, and insufficient managerial support. The ethical environment, particularly the quality of interprofessional communication, organizational ethical support, the presence of ethical reflection mechanisms, and leadership style, plays a fundamental role in how nurses perceive and manage these challenges, and can increase or decrease the severity of moral distress and the effectiveness of clinical decision-making.
The results indicate that ethical challenges in psychiatric nursing have multidimensional and structural characteristics, and individual-focused interventions alone cannot address this complexity. Strengthening the ethical environment, establishing formal structures for ethical support, and developing combined individual and organizational approaches to promote ethical resilience and improve clinical decision-making are essential. Presenting structured models of ethical support and case-based reflection can help reduce moral distress and improve the quality of care in mental health settings.
Type of Study: Narrative Review |
Subject:
Special
Received: 2026/01/8 | Accepted: 2026/01/22 | Published: 2026/02/28
Received: 2026/01/8 | Accepted: 2026/01/22 | Published: 2026/02/28
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