Relationship between Moral Dilemmas and Mental Stress Faced by Nurses Working in Psychiatric Hospitals

<p>Aim: To investigate the moral dilemmas faced by nurses working in hospitals specializing in psychiatry (psychiatric hospitals), and clarify the relationship between such dilemmas and mental stress.</p><p>Methods: An anonymous self-administered questionnaire survey was conducted in July 2019, involving 486 nurses from 6 psychiatric hospitals (psychiatric nurses), and 418 valid responses were analyzed. To measure moral dilemmas in the psychiatric nurses, an index, adopting a facet design and consisting of three facets: "clinical settings", "moral value of Nurse X", and "people other than with Nurse X", was constructed. The moral dilemma stressor score was calculated by multiplying the mean degree of psychological burden of each item and the case frequency, and the internal consistency and the goodness of fit of the model were confirmed. Each item was examined regarding 2 aspects, the frequency and degree of burden. Then, to clarify the association between moral dilemmas and mental stress in 6 clinical settings according to the facet, multiple regression analysis was performed.</p><p>Results and Discussion: Multiple regression analysis revealed that moral dilemmas related to "relationships other than patient" in clinical settings are closely associated with mental stress. In order to resolve such dilemmas, it may be necessary to collaborate with other medical staff, and clarify patients' needs in their decision-making process. Our findings suggest the necessity of fostering an organizational culture in which people can speak out without barriers to the moral dilemmas.</p>