Örebro Studies in Medicine 120 I ÖREBRO 2015
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veikko pelto-piri is a social worker at the Psychiatric Research Centre (PFC) where he works as project coor-dinator and with ethical issues in psychiatry at Region Örebro County. He became a doctoral student in 2008 at PFC, Faculty of Medicine and Health, Örebro University. His thesis deals with the ethical considerations of staff in their daily work and their justifications for decisions made about coercive care. Other research has focused on violence in inpatient care, informal coercion in psychiatric care and treatment and community treatment orders.
This thesis focuses mainly on the ethical considerations of staff, rather than on pre-defined specific ethical problems or dilemmas. It includes staff justification for decisions pertaining to coercive care in child and adolescent psychiatry. It also aims, from a normative ethical perspective; to examine encounters between staff and patients. In a final interpretation, three ideals for staff were identified: to be a good carer, to respect the patient’s autonomy and integrity and to have good relations to patients and relatives. Staff members often felt that the only reasonable way in many situations was to act in a paterna-listic way and take responsibility, but they considered it to be problematic. Four main themes were identified as ethical considerations; the borders of
coercion, the emphasis on order and clarity rather than a more reciprocal
relationship with patients, a strong expectation of loyalty within the team and feelings of powerlessness, mostly in relation to patients. This study has identified four challenges for inpatient psychiatry. First, coercion in inpatient care raises ethical issues and can be emotionally difficult for staff. Second, the professional role and care needs to be developed from providing routinised care to more individualised care. Third, staff members often worry about how patients manage their life after discharge, indicating that patients need better support. Fourth, staff members need support from the management; they often have feelings of being alone with their thoughts about ethical and emotional difficulties at work.
issn 1652-4063 isbn 978-91-7529-069-0
