Identify the challenges faced by Psychiatric Nurse in maintaining Patient’s autonomy during Emergencies.
The nursing practice standard is organized around the nursing process of assessment, diagnosis, planning specific health outcome, implementing interventions and evaluating the care process. However, psychiatric mental health nurse face various challenges in maintaining the nursing standards while caring for mentally ill patients. According to the standard 9 of the NMBA standards for nursing practice, nurses are required to support individual or groups to informed decision making and respect a patient’s decision for care (Nursing and Midwifery Board of Australia – Registered nurse standards for practice 2017). This implies that nurses have the responsibility to respect patient’s autonomy while delivering care (Rahmani, Ghahramanian & Alahbakhshian, 2010). However, in psychiatric nursing practice, ethical challenges increases for mental health nurses as they cannot engage patients in decision making due to impaired mental and reasoning capacity. This increases the risk of violation of patient’s autonomy and creates a dilemma for nurse. Increase in ethical dilemma apart from the complexity in care of mentally ill patient is the major reason for high turnover rate and poor satisfaction of nurse with psychiatric nursing job (Ma et al., 2016). To overcome these issues and increase the satisfaction of psychiatric nurse in their professional practice, conducting qualitative research to get detailed insight about challenges in maintaining patient autonomy in psychiatric nursing practice is important. This will help to modify models of care and give nurses the flexibility to justify their action of taking clinical decision on behalf of patient in emergencies despite the need to maintain patient’s autonomy during clinical decision making. This research proposal seeks to employ qualitative research method to understand the dilemma faced by psychiatric nurse in decision making during emergency situation.
Research objective:
The main objective of the research proposal is to-
Research question:
The research question is-
Before proceeding with the research work, it is necessary to review previous research done on the topic and find out what questions stills remain unanswered. The review of recent literature on the issue of ethical conflict in psychiatric nursing practice has shown that frequent ethical problem between nurse and mentally ill patient arise due to neglect and careless behavior towards patients, poor knowledge of nursing ethics and poor skills to manage complexities of psychiatric nursing practice (Rahmani, Ghahramanian & Alahbakhshian 2010). Smith & Herber (2015) justified the nurse action of violating patient’s autonomy to serve the best interest of patient and prevent them from any harm. The research explained that people with mental disorders have poor capacity to give informed consent during emergencies and in such situations nurses are required to take best decision on behalf of patient without compromising their life. They do not have the option of consulting family members too because they may not be readily available during emergencies or waiting for them might risk patient’s life. In addition, Puthran et al., (2013) also pointed out that violation of patient’s autonomy incidence depended on level of therapeutic relationship between patient and nurse. This was based on the assumption that a nurse is more likely to respect patient’s autonomy if they have good understanding about the subjective feelings of patients with mental illness. Despite the presence of useful insight regarding ethical implication in psychiatric nursing, the gap in these research work was that no process or system was described by which nurses could report about ethical issues in their practice. In some studies, detailed analysis of challenges was not present which limited the transferability of the findings in real setting. Some studies did not addressed the consequences of the challenges for psychiatric nurse. Secondly, there is lack of appropriate evidence regarding the coping mechanism that nurses can take to manage professional obstacles in nursing practice.
Research paradigm and approach:
As the key focus of the research proposal is to investigate in-depth about the psychiatric nurse’s perspective about violating patient’s autonomy in emergencies, the use of qualitative research approach is considered to be the most appropriate according to the research objective. The qualitative method of inquiry is useful for in-depth understanding of human behavior and this can be effectively used to evaluate the experiences of psychiatric nurse too (Lewis 2015). The nature of this research can also be defined as exploratory as it mainly explores the research question in detail to determine the nature of problem. Data for the research can be collected by semi-structure interview or survey method and the main advantage of exploratory nature of research in the context of the research question is that it will provide better understanding about the ethical challenges faced by nurse and facilitate brining change in the right direction based on the revelations from the new data (Barker and Pistrang, 2015). By this approach, the meaning of the data can be adequately categorized according to different themes. Reliable and clear set of data can be collected by semi-structured interview method. The use of open-ended questionnaire will help to explore relevant topic in depth which might not be possible with close ended questions (Leung 2015). Close ended questionnaire will also be prepared mainly to get demographic detail of research participants such as age, experience and qualification.
Research paradigm is the specific method of inquiry and interpretation to understand a phenomenon in particular context (Mertens 2014). As the purpose of this research proposal is to investigate and evaluate challenges experienced by psychiatric nurse in maintaining patient’s autonomy during emergencies, it is reflective of interpretivist paradigm. Interpretivist research approach aims to understand human experience and as this research proposal particularly investigates about the experience of psychiatric nurse, it is also dependent on participant’s views of the situation (Cohen et al. 2013). It can also be regarded as anti-positivism and phenemonology paradigm because anti-positivism focus on interpreting the individual by the ideological position they posses and phenomenological research approach helps to explore the reasons for specific behavior of an individual based on direct interaction with the phenomena (Burrell and Morgan 2017). Hence, this research will not begin with a theory, however patterns of meaning will be generated by means of appropriate data collection method. The use of semi-structured interview method in this research also shows qualitative phenomenological approach in research which seeks to describe the lived experience of a phenomenon (Smith 2015). In the research, the lived experience of psychiatric nurse will be investigated and the phenomenon is working engaging in decision making with mentally ill patient.
Research design:
Descriptive qualitative research design has been adapted for this research proposal as it seeks to investigate about the research topic by means of qualitative semi-structured interview method. This is in relevance to the interpretivist research paradigm because interpretivist research approach integrates human interest in study and this research also focuses on the interest of psychiatrist nurse (Ormston et al. 2014). The reality of challenges in this study will be explored by interviewing psychiatrist nurse working in emergency care with the use of detailed questionnaire on the research topic. The descriptive research design will help to organize the findings into different theme and analyze them individually. True meaning behind the reason for increase in ethical issues related to patient’s autonomy violation by psychiatric nurse can be understood from this study.
Research strategy
Data collection:
To address the research question, primary data will be collected by means of interview and survey methods. The interview will be based on set of open-ended and close ended questionnaire related to the research questions. The close ended questionnaire for the study will include the following:
The open-ended questionnaire will inquire about the following
The interview will be conducted with selected sample group in an enclosed room and recorded for data analysis purpose. The main interviewer for the study will be an individual with at least 10 years of experience in psychiatric nursing practice but belonging to different institute. This will eliminate any biasness in analysis of research data. The primary data will help in collection of all information related to research question and topic. This can then be analyzed by researcher to answer the research question.
Sampling method:
The research will be conducted in a reputed mental health care setting in Australia. Non-probability sampling method will be followed to choose specific participants as per requirements of the research. Non-probability sampling is different form probability sampling as it does not employ random methods for selection of participants. This helps in the selection of participants according to specific plan of research (Acharya et al., 2013). The main criteria for selecting sample in this research study is-
Before conducting the research, the ethical approval for the study will be taken from the Research Committee of Australia and the permission for interview will also be taken from the mental health care setting. The participants will be provided all detail about the purpose of research and they will be included in the research study only after they give their consent for research (Marshall and Rossman 2014). For this, consent form will be sent to all psychiatric nurses. The sample size will be determined on the basis of number of positive response by psychiatric nurses.
Data analysis:
After the collection of data from semi-structured interview method, the evaluation of the data can be done by thematic approach. The data obtained from the interview can be categorized into the different themes such as organizational barrier, personal practice barrier and patient related barrier based on the response from participants. The content analysis can be done by summarization and tabulation method. The basic level of analysis will be descriptive account of the data and high level would be interpretive analysis of the participant’s response (Elo et al., 2014). This research design is likely to cover the limitation found in past research as it will provided detailed analysis about challenges and it will also give idea about the limitation in the current system present for nurse to report about ethical challenges in emergency nursing practice.
The proposed research will have five chapters consisting of introduction, literature review, research methodology, findings and discussion and conclusion. The first chapter will clearly explain the purpose and significance of research. The second will present the previous work on the topic of investigation. The third chapter will adequately summarize relevant research design, data collection and sampling methods adopted for conducting the research. The fourth chapter will give an indication about the response of ethical challenges faced by psychiatric nurses while working with mentally ill patient patient. Based on the study finding, the final chapter will recommend appropriate strategies needed to enhance the competency of nurse in maintain patient’s autonomy during care
References
Acharya, A.S., Prakash, A., Saxena, P. and Nigam, A., 2013, ‘Sampling: Why and how of it’, Indian Journal of Medical Specialties, 4(2), pp.330-333.
Barker, C. and Pistrang, N., 2015, ‘Research methods in clinical psychology: An introduction for students and practitioners’, John Wiley & Sons.
Burrell, G. and Morgan, G., 2017, ‘Sociological paradigms and organisational analysis: Elements of the sociology of corporate life’, Routledge.
Cohen, L., Manion, L. and Morrison, K., 2013. Research methods in education. Routledge.
Elo, S., Kääriäinen, M., Kanste, O., Pölkki, T., Utriainen, K. and Kyngäs, H., 2014, ‘Qualitative content analysis: A focus on trustworthiness’, Sage Open, 4(1), p.2158244014522633.
Eren, N., 2014, ‘Nurses’ attitudes toward ethical issues in psychiatric inpatient settings’, Nursing ethics, 21(3), pp.359-373.
Leung, L., 2015’ Validity, reliability, and generalizability in qualitative research’ Journal of family medicine and primary care, 4(3), p.324.
Lewis, S., 2015, ‘Qualitative inquiry and research design: Choosing among five approaches’, Health promotion practice, 16(4), pp.473-475.
Ma, Y.C., Yang, C.Y., Tseng, C.A. and Wu, M.H., 2016’ Predictors of Work Stress among Psychiatric Nursing Staff in Rural and Urban Settings in Taiwan’ International Journal of Studies in Nursing, 1(1), p.70.
Marshall, C. and Rossman, G.B., 2014, ‘ Designing qualitative research’, Sage publications.
Mertens, D.M., 2014, ‘ Research and evaluation in education and psychology: Integrating diversity with quantitative, qualitative, and mixed methods’ Sage publications.
Nursing and Midwifery Board of Australia – Registered nurse standards for practice. 2017, ‘Nursingmidwiferyboard.gov.au.’, Retrieved 31 August 2017, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
Ormston, R., Spencer, L., Barnard, M. and Snape, D., 2014, ‘The foundations of qualitative research’, Qualitative research practice: A guide for social science students and researchers, 2.
Puthran, S., Vaswani, V., Jain, A. & Kakunje, A., 2013, ‘Perception about autonomy of patients having psychiatric disorder/illness by psychiatry nursing Staff’, Age, 21, p.30.
Rahmani, A., Ghahramanian, A., & Alahbakhshian, A. (2010), ‘Respecting to patients’ autonomy in viewpoint of nurses and patients in medical-surgical wards’, Iranian journal of nursing and midwifery research, 15(1), 14.
Smith, J.A. ed., 2015, Qualitative psychology: A practical guide to research methods’, Sage.
Smith, J.P. & Herber, O.R., 2015, ‘Ethical issues experienced by mental health nurses in the administration of antipsychotic depot and long?acting intramuscular injections: A qualitative study’, International journal of mental health nursing, 24(3), pp.222-230.
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