Unethical conduct as a multifaceted phenomenon in psychiatric care: Nurse leaders’ perspectives

<b>Background:</b> Mental healthcare can be considered a unique practice due to its ethical characteristics, and an awareness of ethics is crucial when working in a mental health setting. Several ethical challenges exist, and professionals may not always recognize the ethical aspects of psychiatric care. Research on psychiatric care from nurse leaders' perspective is scarce but important, because nurse leaders can impact and cultivate workplace culture. <b>Aim:</b> To explore the phenomenon of unethical conduct in a psychiatric inpatient context from nurse leaders' perspectives. <b>Research design:</b> Qualitative exploratory design. In-depth semi-structured interviews. <b>Participants and research context:</b> Eight nurse leaders from two different healthcare organizations in Finland. Leadership experience ranged between 2 and 30 years. <b>Ethical considerations:</b> Research ethics permission was received from a Research Ethics Board where the researchers are domiciled. Guidelines on good scientific practice as delineated by the Finnish Advisory Board on Research Integrity TENK were followed. <b>Findings:</b> Six main categories were generated: Unethical conduct and violations against patients, Unethical conduct and violations against staff, Unethical conduct and violations by staff against other staff, Unethical conduct and violations against leaders, Reasons underlying unethical conduct, and Consequences of unethical conduct and the positive development of psychiatric care. <b>Conclusions:</b> Unethical conduct was seen to be a multifaceted phenomenon, and patients and staff alike can experience and engage in unethical conduct. Unethical conduct against patients was linked to power imbalance (nature of involuntary care, staff attitudes) and a focus on rules based in historical precedent (paternalistic, routine-focused, not patient-centered). Unethical conduct against staff was linked to the nature of involuntary care and patient ill-health. Unethical conduct by staff against other staff was linked to a lack of understanding for others' work, interpersonal chemistry, (length of) work experience, and staff character. Unethical conduct against leaders was linked to leaders being perceived as the organization.