A recent study has shed light on the complex issue of unethical conduct within psychiatric care, offering unique insights from nurse leaders. Conducted in Finland, the research highlights a wide range of ethical challenges faced in inpatient psychiatric settings, where both patients and staff can be affected by or contribute to unethical behaviours. The findings were published in the journal Nursing Ethics.
The study identifies six key categories of unethical conduct, including violations against patients, staff, and leaders, as well as misconduct among staff members. A recurring theme is the role of power dynamics, especially in settings involving involuntary care.
Jessica Hemberg, PhD, a senior lecturer at Åbo Akademi University, explained the study’s focus: “The focus of this study was the phenomenon of unethical conduct in a psychiatric context as explored from a nurse leadership perspective, since the role of leadership in creating ethically sound work environments is seen as crucial for carers’ well-being and safety, which in turn affects patients.”
Patients, often in vulnerable states, are subjected to practices that range from coercive interventions to dismissive attitudes from staff. These actions can erode trust, diminish autonomy, and, in some cases, cause long-term emotional harm. While coercive measures are sometimes necessary, the research revealed that they are not always applied judiciously, raising concerns about patient dignity.
The study also highlights unethical conduct by patients towards staff, such as verbal abuse and physical aggression. These incidents, though often understood as symptoms of psychiatric illnesses, can significantly impact healthcare professionals’ well-being, leading to burnout and reduced job satisfaction.
Hemberg elaborated: “Unethical conduct was seen to be a multifaceted phenomenon, and patients and staff alike can both experience and engage in various forms of unethical conduct. Unethical conduct against patients was linked to power imbalance and paternalistic, routine-focused practices. Unethical conduct by staff against other staff was linked to interpersonal dynamics, work experience, and staff character.”
Conflicts among staff members were noted as a key issue, with some employees using their authority to dominate colleagues, creating tension and an unhealthy workplace culture. Leaders themselves are not immune, often facing undue criticism for organisational decisions beyond their control.
Despite these challenges, the study observes progress in fostering a more patient-centred approach, supported by greater awareness of patients’ rights and proactive measures to reduce coercion. Hemberg added: “This paper provides new insight by explaining unethical conduct as a multifaceted phenomenon, where all parties—patients, staff, and leaders – can become vulnerable to unethical conduct, whether intentional or not. It examines these dynamics in a psychiatric care context and broadens the concept of ethics in mental health.”
Looking ahead, Hemberg recommended further exploration: “We recommend that future research should focus on exploring unethical conduct in a psychiatric context from patients’ and carers’ perspectives.”
The findings underscore the importance of leadership in shaping ethical workplace cultures. By fostering open communication and ethical sensitivity, nurse leaders can improve practices, ensuring patient dignity while supporting the well-being of staff.
