Ethical Issues Encountered by Forensic Psychiatric Nurses in Japan

BACKGROUND: Criminals in Japan with mental disorders face penal servitude in prison or treatment under the Medical Treatment and Supervision Act, depending on their ability to take responsibility for their criminal acts. Forensic psychiatric nurses caring for this group may face various ethical issues. OBJECTIVE: This study aimed to identify ethical issues forensic psychiatric nurses in Japan encountered. METHOD: We used the Ethical Issues Scale to conduct a survey among forensic healthcare ward nurses and analyzed the data using descriptive statistics. We also conducted semistructured interviews with individual nurses who provided signed consent and responded to the initial survey on ethical issues they encountered. These data were analyzed using Berelson's content analysis. RESULTS: Of 175 nurses, 131 answered our survey. The most frequently encountered ethical issue was “protecting patients' rights and human dignity,” and the most disturbing ethical issue was “providing nursing care with possible health risks.” Seventy-seven percent of the nurses chose to discuss with peers when resolving the ethical issues. Seventeen nurses who were interviewed described these forensic psychiatric nursing-related ethical distresses and conflicts: difficulty in discharge management, prevention of violence and self-harm, compulsory treatment, patient care, and negative emotions toward patient. CONCLUSION: Forensic psychiatric nurses in Japan face difficulties regarding respecting patients' rights. They strive to respect patients' rights by using their expertise as nurses while sharing their difficulties with colleagues. It is important to develop a support system for social reintegration to solve ethical issues.