Improving the ethical climate in psychiatry outpatient clinics

Children, adolescents and adults come to psychiatric outpatient clinics to be assessed, diagnosed and treated. Their symptoms and diagnosis range depression, anxiety disorders, bipolar disorders, eating disorders to obsessive compulsive disorders and post-traumatic stress disorder.

At these clinics they meet a number of professions: physicians, nurses, social workers, psychologists and physiotherapists. Sometimes, difficult decisions have to be made regarding referral to inpatient care or restraint. For the staff, these decisions raise a number of ethical questions. These questions range from how to balance the wish to do good with the respect for the patient’s autonomy to priorities between different kinds of need. Ethical questions to be solved while handling balancing a high workload and demanding patients.

The staff at outpatient psychiatric clinics needs to be prepared to handle these kinds of ethical challenges. Previously, the ethics rounds method has been used in order to try to strengthen healthcare staff’s ability to handle ethically difficult situations. It has been shown to increase mutual understanding and decrease professional hierarchies. This could have consequences for the way in which ethical problems are handled: Besides legal and other regulations and the healthcare ethical principles, the relationships at the specific workplace have an impact on how ethical problems are handled. Business ethics research has used the concept of ethical climate in order to describe how ethical problems are handled, and

This postdoc project (2011-2013) investigated whether ethics rounds can improve the ethical climate in psychiatry outpatient clinics. The project will had a quasi-experimental design, using both control and intervention groups measured before and after the intervention.


Silén, M., Haglund, K., Hansson, M. G. & Ramklint, M. (2015). Ethics rounds do not improve the handling of ethical issues by psychiatric staff. Nordic Journal of Psychiatry, 69(6), 1700-1707.

Silén, M., Ramklint, M., Hansson, M. G. & Haglund, K. (2014). Ethics rounds: An appreciated form of ethics support. Nursing Ethics, 1-11.


Marit Silén joined CRB in December 2011 to work on a project aimed at improving the ethical climate for staff in psychiatric outpatient care. She received her PhD in nursing from Jönköping University in 2011 and is also a registered nurse (2005).


  • Mats G. Hansson, Professor of Biomedical Ethics
  • Kristina Haglund, Senior lecturer, Department of Neuroscience, Uppsala University & Uppsala University Hospital
  • Mia Ramklint, MD PhD, clinical lecturer, Department of Neuroscience, Uppsala University 


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Nursing Ethics & Ethics of Care

Nursing ethics is concerned with the moral dimensions of nursing practice while the ethics of care is a normative ethical theory. For many years CRB has developed these fields from different angles. We have used qualitative studies to describe and explore the kinds of ethical dilemmas nurses encounter in their day-to-day work and how they solve them. Other studies have investigated the role of ethical guidelines in the building of ethical competence in nursing practice and in priority setting. In this report, we provide a summary of our research.

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