Ethics and care: an ethnographic study of psychiatric community health nursing practice.

The purpose of this ethnographic study was to explore, describe, and document the practice of a group of psychiatric community health nurses (CHNs), and to provide a forum through which their voices could be heard. Discovery of the nature of issues CHNs experience in an effort to meet the needs of patients with mental illness was the focus. The paper describes the ethical conflict experienced by many of these nurses who wanted to provide beneficial, high-quality care to patients with mental illness but encountered obstacles in practice. Insight into the difficulties nurses experience in applying an ethic of care in the context of administrative constraints, resulting from the strict regulatory mechanisms imposed by third party insurance payers is provided. The negative impact of increasingly stricter payment restrictions on nursing practice and on quality of care is exposed.