{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T05:38:43Z","timestamp":1792647523002,"version":"4.5.0"},"reference-count":45,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nurs Ethics"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emergency departments increasingly serve as access points for patients experiencing psychiatric crises, creating ethical challenges for nurses. These environments remain designed for biomedical acute care, fundamentally incongruent with the needs of individuals experiencing severe mental disorders. This phenomenon has rarely been explored through nurses\u2019 lived experiences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To explore the structurally produced ethical conflicts and the care climate experienced by emergency nurses when caring for patients with severe mental disorders in general hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research design<\/jats:title>\n                    <jats:p>A qualitative study using interpretative phenomenological analysis underpinned by critical theoretical framework. Participants were purposively sampled. Data were collected through semi-structured interviews and analyzed following the six-step IPA procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants and research context<\/jats:title>\n                    <jats:p>\n                      Emergency nurses (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 15) from three tertiary general hospitals in Northeast China with experience treating patients with severe mental disorders. Data were collected through interviews lasting 29\u201354\u00a0min.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethical considerations<\/jats:title>\n                    <jats:p>Ethical principles were observed throughout the research process, including informed consent and participant anonymity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Nurses experienced a pervasive climate of structural violence manifesting through institutional oppression (structural violence reproduction in EDs), technological usurpation (digital ethical collapse in decision-making), and subjective disintegration (traumatic reconstruction of nursing relationships). These conditions were systematically produced through institutional structures, technological mediations, and identity fragmentations rather than individual moral failings. Emergency nurses navigated paradoxical spaces where institutional structures and a violent care climate rendered ethical nursing care structurally impossible rather than merely difficult.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Emergency nurses face fundamental crises in practice that cannot be addressed through conventional ethics consultations or resilience strategies. Findings indicate needs for specialized psychiatric emergency services within general EDs, revised nursing curricula, and policy reforms addressing staffing requirements to create environments where ethical care for patients with severe mental disorders becomes possible rather than exceptional.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09697330261441778","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T20:40:16Z","timestamp":1777408816000},"page":"1646-1664","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Emergency nurses\u2019 ethical challenges with psychiatric patients: A qualitative study"],"prefix":"10.1177","volume":"33","author":[{"given":"Liying","family":"Zhang","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Harbin Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yubin","family":"Chen","sequence":"additional","affiliation":[{"name":"Harbin Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8877-4415","authenticated-orcid":false,"given":"Hong","family":"Su","sequence":"additional","affiliation":[{"name":"Harbin Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"e_1_3_5_2_2","first-page":"1","article-title":"Emergency department visits among adults with mental health disorders: United States, 2017\u20132019","volume":"426","author":"Santo L","year":"2021","unstructured":"Santo L, Peters Z, DeFrances C. Emergency department visits among adults with mental health disorders: United States, 2017\u20132019. NCHS data brief. 2021; 426: 1\u20138.","journal-title":"NCHS data brief"},{"key":"e_1_3_5_3_2","first-page":"293","article-title":"Investigation and analysis of the current situation of mental disorders in the emergency department of A general hospital (in Chinese)","volume":"46","author":"Wu XN","year":"2022","unstructured":"Wu XN, Maimaiti RZ, Zhao GF, et al. Investigation and analysis of the current situation of mental disorders in the emergency department of A general hospital (in Chinese). Int J Psychiatry 2022; 46: 293\u2013296.","journal-title":"Int J Psychiatry"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/inm.12968"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-023-05226-5"},{"key":"e_1_3_5_6_2","volume-title":"The conspiracy of NDN joy: essays on violence, care, and possibility","author":"Belcourt B-R","year":"2020","unstructured":"Belcourt B-R. The conspiracy of NDN joy: essays on violence, care, and possibility. University of Alberta, 2020."},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1159\/000509119"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733019832941"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-023-01186-z"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-025-02958-5"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.2008"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/wps.21230"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-025-02742-5"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/1473095217704234"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/1467-9248.00204"},{"key":"e_1_3_5_16_2","volume-title":"Ethical know-how: action, wisdom, and cognition","author":"Varela FJ","year":"1999","unstructured":"Varela FJ. Ethical know-how: action, wisdom, and cognition. Stanford University Press, 1999."},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1466-769X.2011.00533.x"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1080\/1600910X.2017.1331858"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1080\/17439760.2016.1262622"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/1744987118809528"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/emp2.13040"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(15)00190-4"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11135-024-02022-5"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2022.104343"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2019.03.012"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.3390\/systems10060216"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.281053"},{"key":"e_1_3_5_29_2","volume-title":"Interpretative phenomenological analysis: theory, method and research","author":"Smith JA","year":"2009","unstructured":"Smith JA, Larkin M, Flowers P. Interpretative phenomenological analysis: theory, method and research. Sage Publications, 2009."},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2648.2000.01609.x"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-023-01695-x"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s42844-021-00031-z"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.leaqua.2019.101310"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1037\/tra0001206"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.4087"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.3614"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ienj.2022.101202"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-024-02004-w"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnss.2018.09.013"},{"key":"e_1_3_5_40_2","first-page":"63","article-title":"Psychiatric power and its reversals: can we keep practice humane?","volume":"19","author":"Clapham M","year":"2012","unstructured":"Clapham M. Psychiatric power and its reversals: can we keep practice humane? Philos Psychiatr Psychol 2012; 19: 63\u201365. https:\/\/doi.org\/10.1353\/ppp.2012.0010","journal-title":"Philos Psychiatr Psychol"},{"key":"e_1_3_5_41_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.13159"},{"key":"e_1_3_5_42_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17228540"},{"key":"e_1_3_5_43_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6955-6-5"},{"key":"e_1_3_5_44_2","doi-asserted-by":"publisher","DOI":"10.5465\/amj.2018.0715"},{"key":"e_1_3_5_45_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-021-00579-2"},{"key":"e_1_3_5_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnsa.2024.100271"}],"container-title":["Nursing Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09697330261441778","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09697330261441778","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09697330261441778","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:57:24Z","timestamp":1792645044000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09697330261441778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":45,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1177\/09697330261441778"],"URL":"https:\/\/doi.org\/10.1177\/09697330261441778","relation":{},"ISSN":["0969-7330","1477-0989"],"issn-type":[{"value":"0969-7330","type":"print"},{"value":"1477-0989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]}}}