everyday ethics in mental health

Discussion Prompt: The following scenario depicts a common interaction between patients and interprofessional team members in an in-patient mental health environment. Provide your analysis of the case focusing on trying to understand the subtleties and complexities of the ethics of everyday interactions between patients and staff in an acute mental health unit. In analyzing the situation it’s important to keep in mind that all professionals are fully trained and experienced, and neither the motivation of the staff to help nor the patients to be helped is at issue.

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In your analysis:

  • Consider what the patient’s and staffs’ perspectives are at the level of the interaction. Where do you think they are coming from based on the way they interact with each other?
  • Identify the ethical principle(s) and issue(s) at the core of the situation and explain your response. (An example of an interactional/communication-related ethical principle is patient privacy. Examples of ethical issues are accuracy and truth in communications with patients and professional boundaries.)
  • How can the professionals in this situation interact differently to uphold the ethical principle or address the ethical issue you have identified?

Note 1) your writing should aim to be succinct and precise, and 2) where applicable, remember to support your ideas with literature.

Discussion Participation Due Date: Midnight Sunday, Jan 26, 2020.

Case Study: David is a patient recently admitted from an intensive care unit (ICU) to an inpatient unit for depression with suicidal ideation. After a few weeks in the hospital, David is bored. He feels restless and would love to go to his gym, which is not far from the hospital, for a work-out. He has been for a short walk with the occupational therapist this morning but the group walked very slowly. The physiotherapist is busy giving a relaxation class. David’s doctor walks past. “Hello doctor, can I go out for a walk?” “Talk to your nurse, David. I’m off to a meeting,” answers the doctor.

David has no idea who his nurse is today. In the ICU he always knew who his nurse was because they would introduce themselves each shift. In fact, they were always around, never letting you out of their sight. He walks up to the nursing station. Half a dozen nurses are sitting in the office, laughing and chatting. David knocks on the locked sliding glass window where patients usually talked to nurses. The nurses continue chatting. He knocks again and one of the nurses opens the sliding glass window. “Yes, David, what can we do for you?” “Who is my nurse?” asks David. “I am your nurse today” explains the nurse at the window. “Can I go out for a walk?” “Let me check your privileged status,” she says and turns to read the whiteboard. “Oh, you are only permitted escorted leave. I should have asked the doctor to change that this morning. Never mind, you will probably be able to go out tomorrow. Sorry, I can’t go with you. I have this report to write,” she says, indicating the open file in front of her.

David walks slowly to the patient’s lounge. Maybe there’s something on TV he can watch to distract him from feeling caged. He’ll get a can of Coke too from the vending machine on the unit. As he approaches the vending machine he sees the vending machine operator is busy replacing stock. “Hey guy,” he says cheerfully. “You wanna drink?” “Yeah,” says David, “got nothing else to do.” “Must be boring in this place. Wanna give me a hand? You look like you work out and I’ve got to bring the cartons of drink down from in front of the nurses’ station”. “Sure, I miss my work-outs at the gym.” The two walk off down the corridor together, chatting about their gym routines.

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